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APPLIC�'�10� FOR CONSTRUCT��-�afV PERMIT � <br /> T7 BE COMPLETED IN BLACK INK—PLEASE PRINT <br /> BUILDING DEPARTMENT HEA7ING SYSTEM: �i.qS y'ELECTRIC :J � <br /> 259-8810 �J <br /> DEMOLITION COMEINATION �BUILDING MECHANIC/!�L PLUMBING SIGN <br /> owr�er� r,:aanooaess arv ,i.—�---- ... . _ <br /> . nhn _Ro�:'ne� IS�31 ���(,�i�i,� vP.,,�.;�' `�fiTul 7SZ- Z�nr� <br /> iENANt ldAILAD�R'c55 � CITY 21P PMONE <br /> Aq(;MITECTOqOESIGNER 1.IAllADDPE55 PHCNE <br /> � �Gic1 me .��(,��� �b� (=ve �r.L_y$��( 5�- �7D� VYII�LLAHI'm7j�=P . <br /> GEnEFALCOt1TRACTOfi IdNLApDRESS � Clri ZIP PMONE <br /> $TNTE IICEII$F.a <br /> IdEC11ANICALCONiRACTOR ldqRADDRE55 CIIY ZIP PPDNE <br /> STqTE lll'.NS@ a <br /> F'LUIdBINGCONiqqCTOR MqIIApDflESS GiY 21P PHONE -- <br /> STA'E LIG[NSE♦ <br /> (10NTRqCT PFIf,E OF tVORK ' � + <br /> ' D �L[SCRIBE W�RK ANO SOl1AR[POOiAGE INVOLVED CONTAC'PERbUN AN�PHONE h0. <br /> -- _. i�a�,cl (�,b,�.,. }� 7 5� - Rvav � <br /> _43�, Ic! , / � ___ -- � <br /> — i <br /> I HEREBV CERTIFV THAT I HAVE READ AND EXAMINEG THIS � <br /> enot�oseo use oF ewtoiN� APPLICATION AND KNOV✓THE SAME TO BE TRU[AND CONHECT.ALL <br /> - Re'�f"'� PROVISIONS OF LAWS AND ORDINANCES GOVEP.NING THIS TYPE OF <br /> i=r.,+i orscmm�ouorrnor�arv�sr�owr�ee�owonpnrracr�twocoNiesi WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br /> ����- o�ocrc Z oF !J.Er.L1�.lI.'r.L.,,/� NOT. THE GRANTWG OF P, PERMIT DOES NOT PRESUME TO GNE <br /> �} 1 p AUTHO��T� TO VIULATE OR CANCEL THE PROVISIONS OF ANY <br /> �C�C�� t/ I //9��z��rJ�i1jT'",9Q 3 Sneho [o,,,,,/ Ol"HEF STA7E OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br /> p J -�- PERFORAIANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br /> 5=/�I� -GOZ '� -Q �n y OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br /> anace�raaio.r�un+aea APPLICATION IS MADE AND I COMPLI' WITH THE STATE <br /> CONTRACTORS LAW 1827 RCW AND 296.2001NAC. <br /> CONSiql1CTIONLOAN�EHUER.A0�RE5S iE�EP110NENUMBER <br /> .�7 <br /> PFOJECT ADDRESS � , l � � �I_L-�- <br /> 1,///1 ...• U0.11. <br /> �'� �/ ��G�� . . <br /> uu . .SV..V;v. • <br /> PLUMBING . MECHANICAL <br /> NO. TYPE OF FIXT�I;�,';OR ITEM fEE NO. TYPE OF EOUIPMENT FEE <br /> WATER CLOSET(TOILE i� A'C-A-HNDLG UNITS-H.P. <br /> Bl�THTUB FORCEDAIRSYSTEMS-B.T.U. M E.A. <br /> � LAVATORY(WASH BASIN) UNIT HEATERS-B.T.U. M � <br /> _ SHOWER CLOTHES DRYERS <br /> KITCHEN�INK 8 DISP VENTILATION FAN <br /> I DISHWF.SHER RANGE HOOD <br /> LAUNDRY TRAY WATER HEATER <br /> CLOTHES WASHER WOODSTOVE <br /> _ URINAL METAL FIREPLACE(WOOD BURNING) <br /> __ DRINKING FOUNTAIN i FIREPLACE INSEHT <br /> _ FLOOR DRAIN HEAT PUMP <br /> BACKFLOW PREV�NTERS GAS PIPING <br /> ROOFDRAWS-RAINLEADEFS EXHAUSTFAN - <br /> SINK fSERVICE-BAR,ETC.) <br /> / � z � � - <br /> - � - <br /> --�-- <br /> _ SUB TOTAL 5 SUB TOTAL 5 ;UC� <br /> ___ PERMIT S PERMIT S <br /> TOTAL FEE $ l � � TGTAL FEE 5 �— <br /> FOA OFFICE USE ONLY: <br /> n•,:n�seroncK nEnRseronck sioeseroncn r�nvo�E vtromoen Fee / neeFmrr;o <br /> , � I � �7� GL���.� �� � <br /> J� [') <br /> ��'�r .�f��` �ornnr.n ��( vncarvr;rte FEES VALUATION FEE <br /> _11'� ' Opp f— YES �O BUILDING 4.�„� , � /� � /� T� <br /> iv�.Crf.0�5i NOOF'TOqi[S r�..:rv.;. ��oa�m5�r.�4ci,��c �__. �ZjQ— �'V� .� C� <br /> � � � �3 PLUh1�ING �i� <br /> i <br /> _ _ �_ ° 9 ; _ <br /> siz�or�n�oc �ciae sraiNrc�e�s aEoo nasE�nErir <br /> � � YES - N� h1ECHANICAL —��� � �� � <br /> �1 L Sf _,____ <br /> oCCUNnr�Cv�pnD FiREnLnaMR[o�o H[i[aiici�.nnnoq ADCITIONALPLANCHECK � <br /> —� 4 --�_- '�/' OTH[R ' <br /> iiCnson — ���<''�- � � C�;�. <br /> _ STATF 9UILDING SURCHARGE � ' <br /> �..�."; ,:..,-- -- � - r,nNsnavaoveoav --�� CITYOFEVERETT - - -- �1 , <br /> LOCALSALES �'ueucwoaHs �,� � , <br /> �:,r�' <br /> c.,,i I TAX CO�E IS 3105 Tora� �_ j� <br /> � � �� <br />