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.�. .� <br /> APPLICATION FOR CONSTRUCTIVN PERMIT � <br /> TO BE COMPLETED IN BLACK INK—PLEASE PRINT <br /> r�f� HEATING SYSTEM: GAS ❑ELECTRIC ❑ <br /> ��� BUILDING DEPARTMENT <br /> 259-6810 <br /> Y � . � DEMOLITION I I COMBINATION BUILDING �I I MECHANICAL I I PIUMBING I I SIGN <br /> ty 01Y1lEl1 MAiL40CNE55 CITY ZIP PNONE <br /> � H �u�z�r Fkv.a,�✓G Aui�avP�,-y /9e� Pv.�a�. ST �,�r�i �'8wi a58' �'uz <br /> (] IEN�NI MAILADDPE55 CIIY ZIP PIqNE <br /> ��� �Of.IIpf.GlOfiDE51GLC0 MNLMDIIf55 CIiY 71P PIIONE <br /> ��� ��',tEI1�/ A�Ji�ecn /r�z �u.ir ^'_ �YS�i� I.vA 1�pzo ��'3r6/ <br /> rrNFnnicomm�aon unnnooncss env zm riwr�e SiqEIIGENSEI <br /> o� ./� /e. f'.%os� ti.- <br /> Q�� IAffIUNiCRC1JR�f.IOq M411�0�I1f:55 CITY ZIP PIIUNE 51�TELIGENSE/ <br /> Y <br /> HH PIUMpMOCONTMCTOR MAIIADDI1E55 CIIY 21P PIIONf: S1�tEtICENSE� <br /> ZH <br /> a�ss oF woaK / <br /> ��H I I NEW I I ADDITION I I ALTERATION �/ REPAIR I I DEMOLITION I I WOODSTOVE/FRPL INSERT I I BUILDING RELOCATION <br /> � COIlTACTPEflSONR PIIONENO. <br /> � � a ovn oov 'T �ss�tf a�'�'• 3/�/ <br /> CONTR�GT PFILE OF WORN <br /> F� DESCHIBE WORK�ND 5 W ApE FOOi�GE INVOIVED <br /> O Vl I �l�S/.✓(p Un�'�' — F9VJ <br /> FROPOSEDUSEOFBUILDIN6 / / I HEFiEBY CERTI�Y THAT I HAVE READ AND EXAMINED THIS <br /> LOGI /A�LOrttEr /rtlUS/Nli APPLICATION ANO I�NOW 7HE SAME TO BE TRUE AND CORRECT.ALL <br /> LEG�LDESCRIPTIONOFPROFERTY�SHOWNBEL01YOtlAiT4CNi0URCOPIES� PROVISIONSOFLAWSANDORDINANCESGOVERNINGTHISTYPEOF <br /> � WORK WILL BE COMPLETED WITH WHE'HER SPECIFIEO HEREIN ON <br /> iot BIOCH or NOT. THE GRANTING OF A PERMIT D�ES NOT PRESUME TO GIVE <br /> AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br /> OTHER STATE OH LOCAL LAW REGUTATING CONSTRUCTION OP THE <br /> PERFORM�NCE OF CONSTRUCTION.THAT 1 AM AUTHOR12ED BY THE <br /> OWNER OF TIiIS PROPERTY TO PLRFORM THE WOPK FOH WHICH <br /> APPL�ION IS MADE AND I COMPLV WITH THE STATE <br /> CON A ORS LAW 27 RCW AND 296200 WAC. <br /> �._ �.� e, . . ,.�vs x Ltnw �c��.2� /- 3 •Fz <br /> PROJECT MDPE55 sicN�tun[ W�E <br /> '�1 � O —O —D —O' /I/ C S1' c�rnmm�cvir.�rrsc�m <br /> PLUMB:NG MECHANICAL <br /> ' ' N0. TYPE OF FIXTUHE OR ITEM FEE NO. TYPE OF E�UIPMENT FEE <br /> WATER CLOSET(TOILET) A/C—A/HNDLG UNITS—H.P. i <br /> '�' � BATHTUB ' � FORGED AIR SYSTEMS—B.T.U. M E.A. 1 <br /> ' ' LAVATORV(WASH BASIN) _ � UNIi HEATERS—B.T.U. M � <br /> � , SHOWER CLOTHE�DRYERS T <br /> KITCHEN SINK 6 DISP � VENiILATION FAN � <br /> ' DISHWASHER � RANGE HOOD � <br /> ' LAUNDflYiRAV ; WATERHEATER 1 <br /> CLOTHES WASHER _ � WOOD STOVE i <br /> URINAL ' METAL FIREPLACE 8 CHIMNEY � <br /> �1 � <br /> DHINKING FOUNTAIN � FIREPLACEINSERT ; <br /> '� FLOOR ORAIN � HEAT PUMP � <br /> � BACKFLOW PREVENTERS ; GAS PIPING � <br /> �t � flOOF DRAINS—RAINLEADERS � E%HAUST FAN <br /> SINK(SEHVICE—BAR,ETC.) ; <br /> �' � <br /> i i <br /> � <br /> i <br /> 1 1 <br /> --� <br /> i i <br /> � SUBTOTAL E _ ; SUBTOTAL E <br /> PERMIT $ i PERMIT $ i <br /> `----- TOTAL FEE $ ' TOTAL FEE S ' <br /> FOR OFFICE USE ONLY: ��a 3 0 <br /> FRONTSEIB�CK PE�RSEIB4GK SI�ESEID4GN PlA11f.NECNNOM�E� FEE RELEIPTNO. <br /> ��— 1� 1 � I�i t�l <br /> useza�e iornnen vncnr+rsnc FEES VALUATION FEE <br /> BUILOING � h G� i�/�) <br /> nIeYP[OICONIS.AIIOWABIE lYMOiLON510.C1URl OcHtNu�xr wauwIlPNGUYiR � <br /> !VD /�ID___�'�� ^pnm PLUMBING � <br /> —i— <br /> SREOfBl06. NOAFS10PiES BASEA1ENi MECHANIC�L <br /> , � N� <br /> OCCOPANGYLO�D FiRESPfINNLEnSflE00 11EIGI1TU61IIpiloll �D�ITIONALPLANCHECN ' <br /> NU ND SPRINKLEH � <br /> i <br /> RGSON f011 SPpiNRLERS ' <br /> STATE BUILDING SURCIIARGE / ��) <br /> iNu�eer P�nr+snvrnweoev CITYOFEVERETT PUBLICWORNS � <br /> � LOCALSALES � <br /> �. �j 9y J�(/� TAX CODE IS 3105 �*�� ; J <br />