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APPLICA'�IO.J FOR CONSTRUC'1`; ,N PERMIT LVefP�t <br /> v,•c-�-e�g�cc� TO BE COMPIETED IN INK—PLEASE PRINT � <br /> CITY OF <br /> eve rett HEATING SYSTEM ❑GAS ❑ELECTRIC ❑ <br /> BUILDING DEPARTMENT <br /> 259-8810 <br /> DEMOLITION COMBINATION BUILDING �i1ECHANICAL PLUMBING SIGN <br /> 0�:t,.FA M1IA �DRE55 q I.���j CIiY 'IP PHONE � <br /> ,\� \) ' I � \c� , � ��,�� �-� g J t �g 2v/ �, � �- R 2 �o <br /> �` '��� � cm Z r PHONE <br /> 1������7 MAILADDFES <br /> nRCurt[CTOR�ESIGNER AIAILAOORE55 GITY Z�P PHONE <br /> ��� CITY ZIP PNONE UCENSEb <br /> GHlERALCONTRAGTOii MAILADOflE55 <br /> ay <br /> �.�JH RIECHANICALCONifiALTOR M�ILADORE55 CI�Y ZIP PHONE LICENSEI <br /> ayv� l��G- ll � SC F �F �l� r.l� 9uf `�18209 3sS� 3331 ��45HrA)Gcr�zo� <br /> H �� PIUf.�pINGGONTRACTOR M41�AODPE55 GITY 21P PHONE LICENSEI <br /> y �—+ <br /> H�7 <br /> f,LA550F WORN <br /> � y H . NEW . �. ADDITION ALTERATION -. REPAIR - DEMOLITION WOO�STOVBFRPL INSERT . BUILDING RELOCATION <br /> CONTACi PEHSON AN�PNONE 1!0 <br /> y r U <br /> � O� CORTRAGT PRICE OF WORN <br /> y� �ESCRiBE WORK AND SOUAPE FCOTAGE INVOLVEO <br /> Irs-�QI� �oal l; �Q �I- Ccn�arson b�s�Qr <br /> � �g Nr+oaoseouseoFem�oir+c I FEREBV CERTIFY THAT I HAVE READ AND EXAMINED THIS <br /> ,n� n � F'� APPLIGATION AND KNOW THE SAME TO BE TRUE AND CORRECT.ALL <br /> H PROVISIONS OF LAWS AND OR�INANCES GOVEPNING THIS TYPE OF <br /> 9 y� �ecn�oescaiano�+oFraoreNn�sNowr�ee�owor+nr*ncnFouacoPiesi yypRK WILL BE COMPLETED WITH WHE7HER SPEGFIED HEREIN OR <br /> r H y ��r B�ocK oF NOT. THE GRANTING OF A PEFMIT DOES NOT PRESUME TO GIVE <br /> AUTHORITY TO VIOLATE OR CANCEL THE PFOVISIONS OF ANY <br /> g � OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OF THE <br /> H <br /> n ty N PERFORMANCE OF CONSTRUCTION.THAT I AA1 AUTHORIZED BY THE <br /> � �,�'� — OWNER OF THIS PROPERTY TO PEFiFORM THE WORK FOR WHICH <br /> APPLICATION IS MADE AND I COMPLV WITH THE STATE <br /> z y^p� COYTRACTORS LAW 18.27 RCW AND 29E200 WAC. <br /> H O� 5•,'oUUREOFLONTRAGTO�ORAUTHOPREDAGENT DATE <br /> X___`=-=� �Q�1U: �— �2'i' / <br /> �ea=c*nnor+css — J <br /> -� ��� � � rn� AVVucANiSCIiVOusiNE55LIc=NSEun n::uBus�'+ESSNn1AE <br /> G� <br /> PLUMBING MECHANICAL <br /> � � NO. TYPE OF FIXTURE OR ITEM FEE NO. TYPE OF E�i11PMENT FEE <br /> ' ' WATER CLOSET(TOILET) !vC—NHNDLG UNITS—H.P. <br /> BATHTUB FORCED AIR S`.'STEMS—B.T.U. M E.A. <br /> LAVATORY(WASH BASIN) UNIT HEATEFS—B.T.U. M <br /> CLOTHES DRYERS <br /> '�'s SHOWER -- <br /> '� KITCNEN SINK 8 DISP _ VENTILATION FAN <br /> DISHWASHER flANGE HOOD <br /> LAUNDRY TRAY _ �'�'��TER HEATER <br /> �° � WOOD STOVE <br /> CLOTH[S WASHER <br /> �g -- METAL FIREPLACE&CHIMNEV <br /> URINAL <br /> DRINKING FOUNTAIN FIREPLACE INSERT __� <br /> �o FLOOR DRAIN HEAT PUMP _ <br /> !� � DACKFLOW PREVENTERS " GAS PIPING <br /> ROOF ORAINS—RAINLEADEFS EXHAUST FAN <br /> SINK(SERVICE—BAR,ETC.) <br /> 0 = o <br /> � <br /> -�.•�.. — <br /> ��! SUBTOTAL 5 SUBTOTAL S _ ' <br /> PERMIT 5 PERMIT 5 ' <br /> TOTAL FEE 5 TOTAL FEE 5 � ' � <br /> ' FOR OFFICE USE ONLY: <br /> FROIliSEt�RCK FEAiiSETBACN SIDESETOAGN PLANCM[CNNt1M0[R FEE NEGEIPTNO. <br /> usezor+e �oraaen VACANTSIiE FEES VAIUATION FEE <br /> BUILDING <br /> ivPFOiGONfSAIlOWPBIE iVPEOlCONSIRCIUPL OLcurnr:Cr xaorpwnuhGu•eis � <br /> p°WP PLUMBING � <br /> SIZEOFOLOG. NOAFSTORIES �ASEMEtlT MECHANICAL ��G � <br /> i <br /> OCCUPANCYIOFD FIRESPRNKLERSREO�� H[IGHTLIMITFTION AODITIONALPLANCHECK <br /> OTHER <br /> --T <br /> {i[A501!FOR SPRMHlE115 � <br /> STATE BUILDING SURCHAflGE <br /> wrneeov aue+snrrnoveoor CITYOFEVERETT PUBUCWORHS �' <br /> LOCALSALES � <br /> TAX COUE IS 3105 TOTAL �C% ;— <br />