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APPLICATIQ- 1 FOR CONSTRUCT' lN PERMIT �"� <br /> TO BE COMPLETED IN BLACK INK-PLEASE PRINT <br /> BUILDING DEPARTMENT � HEATING SYSTEM: �GAS J ELECTRIC J -__ I <br /> 259-8810 <br /> DEMOUTION COMBINATION BUILDING xMECHANICAL PLUMBING SIGN <br /> �c;�r a r.mi�nooaess c�rvI zia/� eNor�e <br /> �mes ����,CCIUt�YY,�N� l 1AJ ��` l0� �/.�'� <br /> �[NNJT 61NLAD�RE55 GITY ZIP PHCNE <br /> 3Z�'--��� _ <br /> ARCNITECTORDESIGNER Id.DLA0DRE55 CIiY 21P PHONE <br /> G°NLR�LCONiRACtOR lANLApOPF.SS QiY Z�P PHOHE STATELICENSEx <br /> �q�ly }{�m e S <br /> L1�CHANIC�LCO ' CTGF IdPRApDHE55 LttY ZIP PHON[ ST LIGENSEa <br /> �oGs -�.rv+�.P �� R�x �J���� ��c- 9�so�� 7y7-�63� �i�s�c.2�s� <br /> PW61�iNGCOtJ�RhCiOR IdAILA�DRE55 QTY ZIP PHONE STAT[IIC[NSEa <br /> GONiRACT PRICE OF\YORK <br /> .�^�s�/K� c��,��eXe l�iiT S;rS%e'ti _ <br /> DESGi1'�BE WORN AN�SOUARE FOOT�GE INVOLVEU CONiACi�RSON�ND Pl.J E 0.—S �� � <br /> 7- G3 � <br /> I HEREBY CERTIFY THAT 1 HAVE READ AND EXAMINED THIS <br /> PROPOSEDUSEOFBWLpING APPLICATION AND KNOW THE SAME TO BE TRUE AND CORHECT.�LL <br /> PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br /> �ecn�oesca�rnor�oFaaoaearv�sHovrtuse�owoaarncNnv coaies WORK WILL BE COMPLETED WITH WHETHER SPEGFIED HEREIN OR <br /> �_I___ Se�U�__ NOT. THE GRANTING OF A PEFMIT DOES NOT PRESUME TO GIVE <br /> �or e�aK �F AUTHORITV TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br /> OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br /> PERfORA1ANCE OF CONSTRUGTION.THAT I AY1 AUTHORIZED BY THE <br /> OWNER OF THIS PROPERTY l0 PEflFORM THE WORK FOR WHICH <br /> APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> aaace�tnz i.o.r+uraeea CONTRACTOR'LAW 18.27 RCW AND 29620G WAC. <br /> CONSTRUCTIONLOANIENDER.ADORESS.TELEPHONE NU1dBEB <br /> � ����q) <br /> PROJECTADDRESS '�'O1 °'� ����� <br /> �So� ' kr��t,c/1 fkl�. ���,P�S�..Fss����„���,.� <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF PIXTURE OR ITEM FEE N0. TYPE OF E�UIPMENT FEE <br /> WATER CLOSET(TOILET) A�C—A�HNDLG L'NITS—H.P. <br /> BATHTUB FORCED AIR SYSTEMS—B.T.U. M E.A. <br /> LAVATORY(WASH BASIN) UNIT HEATERS—B.T.U. M <br /> SHOWER CLOTHESDRYERS ' <br /> KITCHEN SINK 8 DISP VENTILATION FAN � <br /> DISHWASHER / RANGE HOOD <br /> LAUNDRY TRAY WATER HEATER <br /> CLOTHES WASHCR WOODSTOVE <br /> URINAI METAL FIREPLACE(WOOD BURNING) _ <br /> DRINKING FOUNTAIN FIREPLACE INSERT __� <br /> FLOOR DR�IN HEAT PUMP ' <br /> BACKFLOW PREVENTERS i Z GAS PIPING _ <br /> ROOF DRAINS—RAINLEADERS EXHAUST FAN <br /> SINK(SERVICE—BAR,ETC.) <br /> SUB TOTF.L 5 SUB TOTAL S _ <br /> � PERMIT S —T PERMIT S <br /> TOTALFEE 5 TOTALFEE S f ' <br /> FOR OFFICE USE ONLY: �'� <br /> FR01lt SETB�GN BEAN SETpACK SI�E SETBACN FLAN CHECN Nl1M11B[R �EE IiECEIPT NC. <br /> u=_emr�e iorna-.� vncnNtsire FEES VALUATION FEE _ <br /> � VES � NO PUILDING <br /> i�rCC'COIlSi NOAF3TORIES � occJruia rmG�ocn�r+:i.:,is � <br /> taouv PLUMBING <br /> SRCOFBL�G FIRESPFINKLERSREO'0 BASEIAENT MECHANICAL <br /> YES NO <br /> CLCIIDANCv�OFD FiRE ALnRM REOD HEtGMT LRdITnT10N ADDITIONAL PLAN CHECK i <br /> � <br /> OTHER <br /> r:L�SON <br /> S iATE BUILDING SURCHARGE <br /> ,,,.rAy PI�NSFPPFOVED�� CITYOFEVERETT PUBLICWORKS i <br /> LOCAL SALES - �- <br /> " �ATt TAX C"'�E IS 3105 TOTAL <br />