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APPLICATIQ� FOR CONSTRUCTY'�N PERMIT � <br />TO BE COMPLETED IN BLACK INK—PLEASE PRINT <br />HEATING SYSTEM: f� GAS ❑ ELECTRIC ❑ <br />BUILDING DEPARTMENT <br />259-8810 <br />C! DEMOUTION f 1 COMBINATION p( BUILDING X M�CHANICAL �C PLUMBING ❑ SIGN <br />DESIGNER <br />c <br />f PRICE OF <br />WORK Ary0 <br />MAIL AOOFhS:; <br />MAII �OORESS <br />MAIL ADDRESS <br />�� <br />MAIL ADDRE55 <br />FdJ�AGE <br />�ROPOSEU USE OF BUILDING <br />5. � /E Es�nEti c.r= <br />LEGALDE IPiIONOFPROPEFNISHOWN�ELOWORNRACNTWOCOP1E57 <br />LOT '—�-- BIOCN OF <br />�,1.�. 0�.,_ � ��. _�� <br />PARGELTA%I.D.NUMBEF <br />CONSTRUCTIONLOANLEI <br />TYPE OF FU(TURE OR I7 <br />`NATEF CLOSET (TOILET) � <br />BATHTUB ' <br />LAVATORY (WASH BASIN) <br />SHOWER <br />KITCHEN SINK 8 DISP � <br />DISHWASHER � <br />LAUNDRYTRAY <br />CLOTHES WASHER � <br />URINAL <br />DRINKING FOUNTAIN <br />FLOOR DRAIN <br />BACKFLOW PREVENTERS <br />ROOF DRAINS-RAINLEADERS <br />SINK jSERVICE-BAR, ETC.) <br />FOR OFFICE USE ONLY: <br />FRONTSETBACK FEAR: <br />_ � / <br />AnEn <br />iYPE <br />SIZEOFBLDG FINt <br />i436 sF t <br />4�v0 IF CzAa <br />OCCUPANLV LO�D FIRE <br />pTv <br />CITY <br />cirv <br />J <br />CITV <br />CITV <br />ZIP PHO�E <br />?S'�0 _ � `%'- j�''�`,1 <br />ZIP PHONE <br />ZIP PHONE <br />ZIP PHONF STATE IICENSE � <br />`I.P�Zo�/ ��--;939 �c�✓M[.! <br />Z�p PNONE STATE LICENSE • <br />ZIP PHONE STATE LICENSE d <br />CONTPCT PEFSON AND PHONE N0. <br />li�N' r� � � � <br />��i�s;�-,� � �-z�'� <br />i HEqEBY CERTIFY THAT I HAVE flEAD AND EXAMINED THIS <br />APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br />WORK WILL BE COAIPLETED WITH WHETHER SPECIFIED HEREIN OR <br />NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br />AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br />OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br />PEFFORMANCE OF CONSTRUCTION. THAT I AM AU i HORIZED BY THE <br />OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br />APPLICATION IS MADE AND I COMPLY WITH THE STATF. <br />CONTRACTORS LAW 18.27 RCW AND 296.200 WAC. <br />-- c' �/1r� i�_nn..-l- 2- 7� li�� <br />liG[NSG <br />FEE N0. TYPE OF EOUIPMENT FGE <br />� !VC-NHNDLG UNITS-H.P. � <br />� FORCED AIR SYSTEMS-B.T.U. tit E.A. ' <br />� <br />, UNIT HEATE-RS-B.T.U. M <br />~— CLC�THES DRYERS � -� <br />�- VENTILATION FAN � <br />--T <br />� RANGEHOOD � <br />� WATER HEATER ' � ' <br />, WOOD STOVE <br />� METAL FIREPIACE (WOOD BURNING) Q� ' <br />� ; FIREPLACE INSERT <br />HEAT PUMP ' <br />; GAS PIPING <br />� � EXHAUST FAN /// ' <br />0 <br />SUB TOTAL 3 <br />PERMIT 5 � . _ <br />TOTAL FEE 5 <br />�CK / SIDESETBALK / PWNGHECI NUA18 R <br />' L �i <br />VACANi SIT� FEES <br />�_ i-; ves ❑ No ew�niNc <br />ilEs aNvexr uo n1 oxt:ur.Guerts — <br />"Dtl0 PLUMBING <br />� 3 I <br />�EaSeEO'D BnSEMEN7 / MEC1!ANICAL <br />/U �! ves �9�No — <br />FEO'D HEIGHTLIMITnTlO� ADDITIONAL PLAN CHECN <br />J � OTHER <br />STATE BUILOING SURCHARGE <br />gy pLpNSAPP��EDOY � CITYOFEVERETT PUBIICWORKS <br />`j LOCAL SALES <br />OATE'J�7�/�jlf.� I TAXCODEIS3105 rorn� <br />SUB TOTAL 5 <br />PERMIT 5 <br />TOTA�. FEE 5 , <br />FEE `� ^� , ^ I REGEIPT N ; <br />�l (✓ C �J1 <br />� <br />� <br />• <br />