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APPLICATI.1�! FOR COWSTRlJC o 10�1 �ERIIAIT '�� <br /> TO BE COMPLETED IN BLACK INK—PLEArE PRIIJT <br /> CEATING SYSTEM�. Kl GAS ❑ELECTr�IC CI — � � <br /> 6UILDING DEPNRTMEP'i <br /> H C � 259-8810 — <br /> DEM�LITION ' I COMBINATION � I BUILDING X' MECHANICAL ! PLUMBING SIGN <br /> � � MAILAD�qE55 CIIY ZIP PMONE <br /> C 9 H (�YrNf R — <br /> `� L•'V[sRE7T i1Q1SiNG AU1410RIT1l 14th 6 POPIIIR �S7ERI%PP. WA. 98201 75R-9722 <br /> � H � u:n4Ni MARMOR[55 CITY 21P PNOM1'c <br /> H � � _" <br /> � � ,+lICHrtEGT Ofi DESiGN@R MA�I A�ORESS ��T�' Z�P PHONE <br /> �� .�' � - CITY Z�P PHONE STRLE LICENSE I <br /> �+j H � .RIEPALC�NTBAC10fl MFILAODRE55 <br /> V1 H <br /> y HF�. ROCLSQ�IINAL i(1N(DDP 7969 HF�NNL7'•AN RIl LVNnN3J wn 9H7(,4 "is�y5fi1 srnreucEHSE. <br /> x z a iA[O+ANiGiCONiP�GTOH MALLA�ONE55 QIY ZIP PHON6 <br /> L�) O C=G] <br /> OORBY. INC 1471 127th P�RRt.TF�V[!L',—�'" """�` 64fi "id71 rnRFiY==7��rtc <br /> P�WeOiNGCOIRpRCiOP MALLA�DR[SS CrtY ZIP PHONE SiRiEUCENS[a <br /> �� g _ <br /> �V n <br /> �--� L1A550F WORK <br /> �y� , NEW I .' A�DITION X� ALTERATION i I REPAIR I I DEMOLITION I I WOODSTOVE/FRPL INSERT I I BUILDING RELOCATION <br /> rz LONiAGT PEii50N AND PNONE rv0. <br /> �JNy GONiIiAGTPliICEOFWORN SZSZ.00 ��'��� ��n <br /> � �� DESCRIOEWORNANDSOUAfiEf00tAGEiNVO�VED ��[��' <br /> � L"t" � I HEREBY CEflTIFY THAT I HAVE READ ANO EXAMINED THIS <br /> PFOPOSED US[OF BUR�ING <br /> z �'� mm nnmrrv APPLICATIOM AMD HMON!THE SAME TC1 EE TRIIE ANU CORRECT.ALL <br /> H Q � PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF , <br /> i.LGAL0E5CRIPTIONOFVPOPEfliY�SHOWN�ELOWOBRTTACHFOUFCOPiES� W�RK WILL 8E COMPLETED WITH WHETHEF SPEGFIED HEREIN OR <br /> ��r etocrc oF NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE � <br /> AUTHORITV TO VIOLATE OR CANCEL THE PFOVISIONS OF ANY <br /> OTHER STATE OR LOCAL LAW REGULO.TING CONSTRUCTION OH THE <br /> PERFORMANCE OF CONSTRUCTION.THAT I AM AUTHORIZED B1'THE <br /> OWNER OF TH�S Pf10PEqTt�TO PGRFOFM THE WORH FOR WHICH <br /> APPLICATION IS MADE AND I COMPLY W�TH THE STA:F <br /> CONT RS LAW 18.27 RCW AFD 25:.200 WAG. <br /> � /7� <br /> ����aecrnooaess <br /> x�„.��AE :,.,E <br /> 1204—OS-10-12 IAFtCiI =������s."�ss��_������ <br /> - � PLUMBING MECHANICAL <br /> � ��� �p, TYPE OF FI%TURE OR ITEM FEE NO. TYPE OF E�UIPMENT FEE <br /> I NC—NHNDLG LiN1TS—H.P. <br /> ��'� WATER CLOSET(TOILET) - <br /> � OATIITUO .�_ FURCEUAIHSYSIEMS—tl.I.U.(�M E.A. <br /> �I LA�/ATORY(WASH BASIN) UNIT HEATERS—B.T.U. M �_ <br /> CLOTHES DRYERS ' <br /> , ��vI - K TOHEN SIIJK 8 DISP VENTILATION FAN �_ <br /> � . DISHWASHER RANGE HOOD . <br /> � LAUNDRY TRAV WATER HEATER <br /> ��r CLOTHES WASHER �NOOD STO'iE �_ <br /> I �` URINAL tAETAL FIREPLAf,E&CHIMNEY � <br /> DRINKING FOUNTAIN FIREPLACE INSERT <br /> T <br /> FLOOR DRAIN HEAT PUMI' <br /> B BACKFLOW PREVENTERS GAS PIPING <br /> , �O_' FOOF DRAINS—RAINLEADERS EXHAUST FAN <br /> SINK(SERVICE—BAR,ETC.) <br /> '�'�+ — — <br /> i <br /> �� , . SU8T01AL $ SUBTOTAL $ <br /> PERMIT $ PERMIT $ <br /> '� TOTAL FEE $ <br /> ��~� —TOTAL FEE $ — — <br /> r <br /> FOR OFFICE USE ONLY: <br /> inUNI5C1tlACN NEANSEIf1ALY SIDEiETORCN PLANGHECHNtIMO[R FEE N6CGIPINO <br /> ��:'(� �_ } <br /> �.rezoNe IOTABER vncu+rsirE FEES VAWATION FEE - <br /> 9WLDING <br /> i�PIU11:UIlISAIWWPOLE IVYtOfGONSI.PGIWI a[mawn xuoroF[tuxGUY�l9 <br /> �A'"'v ' PLUM�ING <br /> nt[OFBLDG. NO.OFSIORIES BASEMENT MECHANICAL <br /> �iCCI1PANCYLOAD FIRESPPNNLEHSf1EOD NEIGHTLIIAIIAiION AODITIONALPLANCHECN _ <br /> SPRINKLER <br /> — r—_ <br /> i�.f�ASON FOfl SPflINNlENS <br /> STATE BUILDING SURCHAflGE <br /> :�IPHE�Y PI.ANSRPPFOV[DOY CITYOFEVERETT PUF3LICWORK$ <br /> LOCALSALES <br /> TAX CO�EIS 3105 �oTA� _ _ , <br />