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i <br /> � <br /> s.+, r�•, <br /> APPLICATION FOR CONSTRUCTION PERMIT � <br /> TO BE COMPLETED IN BLACK INK—PLEASE PRINT <br /> � � HEATING SYSTEM: GAS ❑ELECTRIC l] <br /> BUILDING DEPARTMENT <br /> q � 259-8810 , <br /> sr � ' i DEMOLITION I I COMBINATION i ' BUILDING �I I MECHANICAL I.I PLUMBING I l SIGN a <br /> M�� ovrtien Mnanooness citr zm ruorve 1 ; � `"� <br /> i <br /> � c, �✓�z�r �k�.s,�✓4 Au�ue�ry /�. Pv.�a2 ST ��ai�i �'81vi �'S8' f2zz . � }'i <br /> ��� IEN�NT M�IL�DOIlE55 CIIY ?IP PIIONB �� -f"' 'V <br /> ���j � :i i 'F Y <br /> � nnc�u�ectoivo�scnen raniunoness ein zm rnoNe ,� ; <br /> { � <br /> R�p J�,%rE/1.��J A,�c•l�r�cr.; i4v2 fi�urT �+�� �Y6�i r Lv.d >'f zo/ �f 3ib/ - t. ��•- ., <br /> rJd GENEMIGONiRAGiOp 4UilR��fiE55 CItY ZIP PIIONC SI�IEUCENSEt <br /> p�� �n �iP_ ('w�OSr n� <br /> y MEGIINlIC��GON7fULTOf1 MAIIADDRESS CITY 21� �IIONE STpiEUCEN5E1 <br /> �y� PIUMUMGCON111AC100 M�ILAUOIIf.55 --- CI1Y III' --.. . ..1'IN)Nf S1�IElIG[NSL� <br /> ��y y cinssoFwoaK / � <br /> py~ I 1 NEW I I ADDITION I I ALTERATION (/ REPAIR I 1 DEMOLITION I I WOODSiOVE/FRPL INSERT I I BUILDING flELOCATION <br /> �A <br /> �a� coNrncrrensoNn riio�ie�ro. (� <br /> � CONIflACT PRICE OF VOPN � � UL�� OOU T f`��'� �l ' �I�I <br /> y DESCRiOE WOtiN AN0�OUME F007AGE INVOIVED <br /> � �01.6!✓!� �/� � !'�4.0 <br /> vnoaoseouseovouaoiwe I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br /> �w ���p �� �Ff APPLICATION AND KNOW THE SAME TO BE TRUE AND CORPECT.AlL . <br /> IEG�L0E5GRIPIqNOFPROPERTY�S110WNBELOWOf1�T1�CHFOUIIGOPIES� PROVISIONSOFLAWSANUORDINANCESGOVERNINGTHISTYPEOF � , <br /> WORK WILL BE COMPLETED WITH WHETHEfl SPECIFIED HEREIN OR <br />` iot siocK or NOL THE GRANTING OF A PEFMIT DOES NUT PRESUME TO GIVE <br /> AUTHORITY TO VIOLATE OR CANCEL THE PFOVISIONS OF ANY <br /> OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE � <br /> PERFORMANCE OF CONSTRUCTION.THAT I AM AUTHORRED BY THE ��, <br /> OWNER OF THIS PROPEPTV TO PERFORM THE WORK FOH WHICH '� <br /> APPLI ATION IS MADE AND I COMPLY WITH THE STATE ' <br />, CON A ORS LAW/�.)Q27 RCW AND 296200 WAC. <br />� .� C.��- /�� w / //�J A�y.,�p1'{%lS x � VLVVLVHC/ /- 3 •Fy <br /> � - . prfv7L—)'GnA��rr�— (�f-• � ' <br /> � '�, PR0.1EGi�DDilE55 SCH�mn[ MiE � <br /> I � F'�� E mLOCk S� CIIYPUSMFSSICf�RFW <br /> , ' PLUMBING MECHANICAL <br /> � NO. TYPE OF FIXTURE OR�TEM FEE NO. TYPE OF EOUIPMENT FEE <br /> ��1 WATERCLOSET�TOILET) � A/C—A/HNDLGUNITS—H.P. i <br /> BATHTUA � ' FORCED AIR SYSTEMS—B.T.U. M E.A. � <br />' 1 ' LAVATORY(WASH BASIN) i UNIT HEATERS—B.t.U. M i <br /> SHOWER ' CLOTHESDPYERS � <br />� 1 �. KITCHEN SINK 6 DISP _ � VENTILATION FAN � <br /> � DISHWASHER � RANGEHOOD r <br /> LAUNDRYTRAY � WATERHEATER ' <br /> CLOTHESWASHER � WOODSTOVE � <br /> � URINAL ' METAL FIREPLACE 8 CHIMNEY � <br />� t�' DRINKINCa FOUNTAIN � FIREPLACE INSERT � <br /> � FLOOR DRAIN � HEAT PUMP � <br /> BACKFLOW PREVENTERS i GAS PIPING � <br /> � � E%HAUSTFAN � <br /> RC10F ORAINS—RAINLEAUERS <br /> '� SINK(SERVICE—BAR,ETC.) ; ' <br /> �1 i <br /> � i <br /> '� i <br /> i i <br /> � � <br /> '�' SUB TOTAL S i SUB TOTAI S ' <br /> — PERMIT $ � PERMIT S i <br /> TOTALFEE S ' TOTALFEE S � <br /> FOR OFFICE USE ONLY: ' S– 3 <br /> FRONTSEIBRCN [� `1 PEMS[1pACK SIDESE19Af.N PUNCIIECRNIIMDEO PE[ IiEGEIPiNO. <br />' "�L' , � .L 7� � ��i.l ��� <br /> �F ' ' .. _ <br /> useza+€11� iornnen vnenHrsue FEES VALUAiION FEE <br /> Lei:?. <br /> T BUILOING � <br /> -'�. }, - . IYPEOfCONISALtO �BIE i1TE0ftOp5l�tIU0. ocNre�Cr walm2WetuIDS � <br /> _ Au. G 7/�/�'b_ I�6 i�., �l:n'r �!f PLUMBING � <br /> ,!p_�' /17U j;7cIJKL! /V h <br /> - SIZEOFBlO�i. NO.OFStORIES OASEAIENt MECHANIC�L � <br /> A� G . ti�a , <br /> OCGUPnNCvlOno FlR[SPRNNtEn5REo0 ��EIf111U1.111AlION AODITIONALPLANCHECK � <br /> i <br /> � � NU SPRINHLEq ' <br /> i <br /> nensor+ron srnrtuniens �— <br /> STATE BUILDING SURCIInRGE i <br /> iern�cnr rur+snranoveuor CITYOFEVERETT PU9LICWORKS ; <br />_ ✓ LOCAL SIILES / <br /> ?�ZQ, Z �/M TAl(COOE IS 7105 TOTAL � �� <br />