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��PL�C�1'�'�f'� F()F� COIVS'Pf�flCT ,PI P�'t�G�il� �� <br /> TO BE COMP�ETED IN BLACK INK—PLEASE PRIIJT `Tr <br /> �EATING SYSTEM: �J GAS ❑ELECTRIC �J �LL1_ _ � <br /> 3UILUING DEPARTMENT � <br /> 259-8810 <br /> DEMOL!TION COMBINATION �y BUILUING ' -MECHANI:,AL I PLUMBING SIGN <br /> owr:e� i+nv,o��es, crtv nv aHoue <br /> C ii7� uG EUEz£�i 3zua C'csa2 Sr. �vEp��7 l�roi a 59-�xoo <br /> �C�iRt1f MtILADCRE55 CIiV ZiV PIIONE <br /> ,.i:CNf1ECTORUE5iG�1ER A�4iLAt)ORESS C�iY ZiP PHONE <br /> U1hb� KIN�A�fl � r•ry aF fufjl.Ft1 f�un eF <br /> OC':PRqLP.ONTNACiOR Idq.LAD�nE55 CITV ZIP PNCNE STATELICENSEt <br /> !-'`i'�j ar- EaE2fTi urit.�irs [�fpr. <br /> �'!'.CMANILAIGONiPAGTOR lAA1�,1pDPESS GITY ZIP FHONE STATELICENSE� <br /> C �rlia� £v£v��i _ _ <br /> �'.UlABINGCONTRACTOR lANLAD�iiESS GIY ZIP <br /> FHONE STATELICENSEe <br /> C011TRACt PiJCE OF WORK <br /> CESCBIGF�WORN�NOSOUABEi00TAGERJVOLVF.� CONTACTVE 50 ANg P�MONENO. I, <br /> _.r��u�o z ��en�,�t rHrf onr uvtn� _�Z�f''_=� 2��C.�/ <br /> _A/L�?S o.4J EActi s�_�v� is.-i,t�i', raan <br /> B LDG • �%7G�� _ _ I HEREBY CERTIFY THAT I HAVE REhD AND EXAMINCD TFIIS <br /> ���oPoseouseoFeuaoi��c APPLICATION AND KNJW THE SAME 10 BE�iRUE ANC �:ORREC7.ALL <br /> t�rn/sAG�f O/% Fqu i.��j_ PROVISIONS OP LAWS AND ORDINANCES GOVERNIIJ6 THIS TYPE OF <br /> �iccn_�escqiatior+oFaaoa[alv�sr�orrvse�ewoan*rrcHrv+ocoa�es� WORK WILL Be COh1PLETED N11TH WHETHER SPECIFIEU HEREIP! OR <br /> �OT. THE GHANTING OF A FF_RMIT DOES NGT FRESUA4F TO GI`,'E <br /> i_.�� SiocK —�— oF --- qUTH�RITV TO V!OLATE OR CANGEL ThE PRGJISIONS OF ANv <br /> L.(>CA rlCe.�) ��L��j��I[��ni.r7f LL'A7Z��L OTHE9 STATE Oft LOCAL LAW P,EGULATING CON�I AUCTION OR THE <br /> PERFORPdANCE OF CONSTRUCTION.THAT I AM AUTHORIZED�Y THE <br /> OWNER OF THIS FROPERTY TO PERFORFd THE WORK FOR WHICH <br /> �!t'�n��U� D�p.ALY-- --- APPLICATION IS MADE A�D I COMPLY WITH THE STATE <br /> v'n�.ce�1nz i.n Nurneea CON fRACTOR�LAW 1827 RCW AND 296.200 WAC. <br /> '.—. '._ / / <br /> (.O;JSTFUCLONLOfNLENpEF.AODRESS.TE.EPHOaENUMBER �/ / //C� q <br /> a' ��/I;:AC �! �;�:��/��.�.('] — `-/�/�/ •'% �— <br /> PROAIEC��/ �!�� � Y —� . –n.r� -- <br /> �1� _ c .� �.cu:.�, �. <br /> PLUMBING MECHANICAL <br /> NO. TVPE OF FIXTURE OR 17EM FEE N0. TYPE OF EOUIPMENT FEE <br /> WATER CLOSET(TOILET� � A'C—A�HNDLG UNITS—H.P � _ <br /> BATHTUE FORCED AIR SYSTEIdS-81.U. t." E A. <br /> LAVATORY(WASH BASIN) UNIT HEATEFS—B.T.U. M <br /> SH06VER CLOTHES DRVERS _ <br /> � KITCHEN SINK 8 DISP VENTILATION FAN � _ <br /> DISH'NASHER RANGE HOOD ___ <br /> LAUNDRY TRAY WATER HENTER _ <br /> CLOTHES WASHER WOODSTOVE _ <br /> URINAL 17ETAL FIREPLACE(WO BURNING) <br /> DRINKING FOUNTAIN FIFEPLACE INSFRT ; � <br /> FLOOR DRAIN HENT PUMP / <br /> --r— <br /> BACKFLOW PRFVE ERS i GAS PIPIPlG _ <br /> ROOF DRAMS—Rp NLEADERc EXHAUST FA _ <br /> SINK(SERVICE� AR,E7Q� —_ _ <br /> j i � _—_ <br /> / <br /> �__. <br /> �' i <br /> i� SUB TOTAL S � SUB TOTAL S ____ <br /> PERMiT 5 PERMIT F <br /> TOTALFEE S TOTALFEE S ' <br /> FOR OFFICE USE ONLY: <br /> .-RONTSETBACK RC4RScTPFCK SIOES[T�ACH PLANCHECKNli61uER FCG REC[iPiNO <br /> usezor�e LOi�qER vncnNisire FEES VALUATION FEE <br /> Cr'. � <br /> ❑ YES Cl NO BUiLoiNG Z�j�` 2�i��[_ <br /> iVPEOFGONSi. NO.OFSTORIES OCcu�eNCr NOOvuMwxr,9rvii5 — I <br /> � � caeuP � pLUM1781�G � _ <br /> / � <br /> GREOFBLUG FlflESPFRIKLER5RE0'0 CFSEMENi MECHANICAL � ; <br /> I��?� P�xIt01� ND C5 VES ?<NO ' -- � _ —_ <br /> �ODITIONAIPLANf,HECK ,� 7 i f�'-_ <br /> OCCUPANCYLOAD FlREALARMF[Q'D HEIGMTLIIAITATION / <br /> 7 �U OTHER ' <br /> rIEASON <br /> STATE BUILDING SURCHARGE �- <br /> �' _ <br /> ,��i�,-�,,�;i��� r�nNsnPPaoveonr CITYOFEVERETT �uouCWORKs ; <br /> �M LOCAL SALES ,���''� <br /> Da� ����I�� � TAX CODE IS 31OS TOTAL CC�.`I��-�=i '�`� <br />