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APPLICATIO. . FOR COPDSTRUCT: 1N PERMIT `'`°'°" , � <br /> tnnEvergmen TO BE COMPLETED IN INK—PLEASE PRINT � 4 <br /> CITY OF <br /> everet� HEATING SYSTEM GAS O ELECTRIC J , <br /> BUiLDING DEPARTMENT , i <br /> 259-8810 . <br /> � ' <br /> DEMOLITION COMBINATION BUILDING �MECHANICAL PLUMBING SIGN <br /> ON'NER dAI�qODRE55 Giv PP oNOhE • <br /> �lc�r r � (;'�c.r �-o�, 1Z"'0 �eJl- ���' J+. 25� -d�r��� <br /> iENANT � I ,�MA��A�ORE55 CITY ZIP PMONc ' <br /> /fiG�iTECTOFDESiGNER MAILADDRE55 Crtv Iiv �NCnE � ' <br /> ��� GENEAALCONTRACTOR— I ^MRiLA�ORE55 qTV 2iu PHONE L'.CEuSE• � <br /> n <br /> I I �� <br /> ��� M[LHAKICAL CONTRRC MAIL ADD 55 diY 21P PHONE I�GENSE• <br /> I'1 i,� IJ�Cr4-P( I�tc� tel �1\O �, �\ �1���,J� �5�'i -533% <br /> C,ay yN PLUb�BINGCONTPALTOR MNLRDDRE55 CIiV ZIP >MONE LIGENSE/ . <br /> � �C{mP � m�CI�U��<<c, l Vl�,����=%h7��32 �- ``, <br /> H �-�+ <br /> CLASSOFWORN � p'. <br /> K y%� NEW � ADDITION �/ALTERATION � REPAIR DEMOLITION WOODSTOVEiFRPL INSERT BUILDING RELOCATION � ; <br /> 1 <br /> / /� }'y� CONIACiP� ANDPNONENO L <br /> � \ �J � �ln!� L 1 . .t: <br /> 1�-3+ NC'� CONTRACTPRICEOFWORK ` `n n � <br /> p O� OESCRiBEWORKGNO50WREFOOTAGEMVOLVED � <br /> L+, ya c1(:i\\. �l . C�15 l�.G�e� �\fc;��� ��jc/- 33� <br /> �y aPOPOSEDUSEOFBURDMG I HEAEBV CERTIFY THA7 1 HAVE REFD AND EXAMINED THIS <br /> H [�+7 O APPUCATION AND KNOW THE SAME TO 8E TRUE AND CORFECT.ALL <br /> �" n — PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TVPE OF � <br /> z H� �ecnioEscaivTioHOFPAOPea���SHowr�ee�owca�+rTFCHrouacoP�es� vypRK WILL BE COMPLETED WITH WHETHER SPEGFIED HEREIN OR � <br /> 9 -3 �o� BLOCK or NOT. THE GRANTING OF A PEflMIT DOES NOT PRESUME TO GIVE <br /> t" H y p ^� AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANV <br /> t7 V�H �C.�J� � G 1`) � / -G -�_6� pEiiFORMANCOOFOONSTRUCT10N.THATG AM AUTHORIZOED BV THE <br /> n h� OWNEii OF THIS PROPEFTY TO PEHPORM THE WORK FOR WHICH <br /> C,3,, APPLICATION IS MAOE AND i COMPLV WITH THE STATE <br /> C+7 �j L�7 CONTRACTORS LAW 1827(iCW AND 296.200 WAC. <br /> ZHV1 SiGSAIDREOfGONiRnCTORORaU%NOHi2E�AGEM1i DATE <br /> H O f/� _ <br /> i <br /> X � �ttti_?��iQ,?��l C/�� <br /> PROJECTADDRESS <br /> ` ��`I � . �, APPLI ANTSQiY8051NE55LICEN A��DB�Ii;N�Y5NA1 <br /> �J V U � � <br /> PLUMBING MECHANICAL . <br /> N0. TYPE OF FIXTUHE OR ITEM FEE N0. TVPE OF EOUIPIAEN7 FEE _ <br /> " s WA7EFi CLOSET!TOILF_T) � ArC-0.�HNDLG UNITS-F1.P. � <br /> ;o' BATHTUB FORCED AiR SYSTEMS-B.T.U. M E.A, � <br /> LAb'4TORY(WASH BASIN) UNIT HEATEAS-B.T.U. M <br /> SHONER CLOTHES DHVERS <br /> I6`�� �� KITCHEN SINK 8 DISP VENTIIATION FAN <br /> � - � DISHWASNER RANGE HOOD �.. <br /> LAUNDRV TRAY _ _ _ ______ � WATER HEA7ER I <br /> CLOTHES WASHER � WOOD STOVE � ,' <br /> +�.� URINAL METAL FlFiEPLACE&CHIMNEV � �r <br /> DRINKING FOU��TAIN FIREPLAGE INSERT <br /> FlOOR DRAIN HEAT PUMP <br /> I y� � BACKFLOW PREVENTERS GAS PIPING <br /> ROOFURAtNS-RAINLEADERS � EXHAUSiFAN <br /> SINK(SERVICE-BAR,ETC.) ' <br /> p . �I <br /> �� — <br /> - — — — I <br /> SUBTOTAL $ SUB TOTAL 5 � ' - <br /> !�! PERIdIT 5 PER�dIT S - <br /> TO7ALFEE 5 ' TO7ALFEE 5 —_ <br /> �_ : FOR OFFICE USE ONLY: <br /> FFONLSETBACK AEARSETBACK SIOES[TBACN PIANCnEGKNl1MBER FEE AECEiPTNO <br /> �� � <br /> usezone tJTRPEA MCANiSRE FEES VALUATION FEE <br /> OuiLDiNG <br /> '•�"I��LONi5All0'NRBIf ��vfO�CON9nL1L=� v.t:'•x:� 4Umrvm,i��.��'+ -- <br /> c�o�� PW1.1(31NU' <br /> Si2E0F6LDG NDOFSTORiES OASEMENi h7EC��ANICAL � <br /> OCCUPANCYIOAD fiPESPNNNlER5RE0D M[iGHTIiMITAT10N A�DITIONALPLANCHEGN I <br /> OTMER <br /> HEASON FOR SPRiNKtENS <br /> STATE BUILDING SURCti/RGE , <br /> �mrn.eo+ cim+snrar+oveux�� CITYOFEVERETT i�uuucwoak5 <br /> LOCAL SALES <br /> TAX CODE IS 3105 TOTAL <br />