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APPLICATIO.. FOR CONSTRUCT�.►N PERMIT �'�<<P'� � <br /> , m�,E��.�.�,�� TO BE COMPLETED IN INK—PLEASE PRINT � ' <br /> cirr u� <br /> evere�t HEATINGSVSTEM: ❑GAS UELECTRIC 'J � , <br /> BUILDING DEPARTMENT <br /> 259-8810 � ' <br /> DEMOLITION COMBINATION BUILDING MECHANICAL PLUMBING SIGN I <br /> O'::M1EB 1AAILq00�1E55 CITY 21P PMO'lE ! <br /> /+Pti'�� ��' r�++:ia�, izzo ircrr ��i� E�i�:Err 93z�r 2s� -c9�q. <br /> ifNANT MAILAppRE55 CRY T�P PIIONE <br /> piiGMILEGTOR�E51G4FB MAILADDRE55 CIiV ZIP PNONE <br /> yn~ GE:EFALLONTflAGTOR IAAILRODFE55 CITY ZIP PHONE LICENSE[ � <br /> ��� � � ( <br /> ��S M[CHANICPLCONTflPCTOR h1AiLAD�PE55 GITY ZIP FNONE IiCENSEt � <br /> aHc~i� Il'NC- Cu, IIS ��t"�✓rAtTi' INN/L tvRY �b�-�FTi_ y31U$ 3SS 3�1 �,�RSN/NC-735G8 <br /> H "'3 PLUI.IpINGWNTR4CiOF IMILpGC:4E55 CITY ZIP PHONE LICENSE� ,I <br /> y �r-+ — — <br /> K y� CLASSOF WORK <br /> O x O NEW X ADDITION ALTERATION REPAIfI DEMCLITION � VJOODSTOVE/FRPL INSERT BUILDING RELOCATION <br /> � �H �� CONLACTPERSONAN�GNONENO <br /> � z� CONiRACTPFICEOFWORN � � � _ � <br /> t] <br /> n o�•� DLSCFIBE WONKANDS�IIARE FOOiAGE INVOLVED <br /> o H� 150�LER. eoNVaCs�onl v�c Gk5 — <br /> H ��7 vnovosEouseoFeuaoir�c I HEREBV CERTIFY THAT I HAVE READ AND EXAMINED THIS <br /> � F � � <br /> APPUCATION AND KNOW THE SAME TO BE TRUE AND CORRECT.ALL <br /> H V � 5 � PROVISIONS Of LAWS AND OFDINANCES GOVERNING THIS TVPE OF . <br /> L[GAL OESGRiPTION OF PROPERrv ISHOVIN UF.LOW OR PTTACM FOUR COPiE51 <br /> H <br /> WORK NSLL 6C COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br /> t9., y z ior e�ocK _ oF NOT. THE GRANTING OF A PERtAIT DOES NOT PRESUME TO GIVE <br /> H�7 AUTHORITY TO VIOLATE OR CANCEL THE PFOVISIONS OF ANY <br /> � �N -Tf)K NCCH��- 4099 - 227 - G<'�� - 000$ OTHER STATE OR LOCAL LAW fiEGULATIN�CONSTRUCTION OR THE <br /> n Cy(p PERFOflMANCE OF CONSTRUCTION.THAT I AM AUTHORIZED BY THE <br /> C Q r — OWNER OF THIS PROPERTV TO PERFO9M THE WORK FOR WHICH <br /> �� t��� APPLICATION IS MADE AND I COIdPLV WITH TH[ SiA7L <br /> z y q� CONTFACTORS LAW 18.27 RCW AN�296.200 WAC. <br /> F3OC/� SIGNFTU9FOFCCHTRAGfOROR�OTHORIZEOAGENT OAiE <br /> aaaEc�noonEss / X /"�(.�ct�[. l./41/L. '7�/3 � i�� _ <br /> �aao /, �A'�� APPLICANTSCIiY051NE5SUGFNSENORN�8U5ME55NAlAE <br /> Yo� ' <br /> PLUMBING MECHANICAL <br /> � � <br /> NO. TYPE OF FIXTURE OR ITEM FEE NO. TYPE OF EQUIPMENT FEE _ <br /> � ' WATER CLOSET(TOILET� fvC—A'HNDLG UNITS—H.P. <br /> �`� �ATHTUB FORCED AIR SYSTEMS—B.T.U. M E.A. _ <br /> LAVATORY�WASH BASIN) UNIT HEATERS—B.T.U. M _ <br /> _. SHOWER CLOTHESDRVERS _ _ <br /> E� . .�;� KITCHEN SINK 8 DISP VENTILATION FAN <br /> DISHWASHEP (iANGE HOOfI <br /> LAUNDRY TRAY WATER HEATER <br /> CLOTHES WASHER WOOD STOVE <br /> `r "� �q�Nq� METAL FIREPLACE 8 CHIMNEV <br /> DRINKING FOUNTAIN FIREPLACE INSERT <br /> � E�.' FLOOR DFAIN HEAT PUMF <br /> �._P BACKFLOW PREVENTERS I GAS PIPING <br /> ROOF DRAINS—RAINLEADERS EXHAUST FAN _ <br /> SINK(SERVICE—BAR,ETG) _ <br /> b j <br /> �w��� SUB TOTAL 5 SUB TOTAI S <br /> PERMIT 5 PEFMIT S <br /> TOiAL FEE 5 TOTAL FEE 5 <br /> �--' FOR OFFICE USE ONLY: <br /> (NO'IISEipACK RGpfI5E1BAL�. SI�ESETpACN PLA1lLHECNNWA5ER F[[ f1ELNPiNO <br /> 3 7 3s �, <br /> u��,ezone �oTnaea vncnNtsrte PEES VALUATION FEE <br /> BUILDING <br /> *��'iOfCONiSAIIOWABIF fYPEOiGONSI.dLNAL Occucu¢v NOmPenureuon5 <br /> ceouv PLUlABWG <br /> Sili:OFOLOG. NO.OFSTOPIES OASEMENt MECHANICAL <br /> 9CCt1PANCYtaAD FIRESPRNKIERSREO'n NEiGMiUMITr1TION AODITIONALPLANCHECK <br /> __ OTHER <br /> N!ASONFOBSPqINNLCRS ---T <br /> SiATE BUI�DING SURCNAHGE <br /> '.4iAH[pY PUNSAPI�RO�[OI;T CITYOFEVERETT PUBLICN'ORHS <br /> LOCAL SALES <br /> TAX CODEIS 3105 70TAL <br /> � �� _ / <br />