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APPLICATIO . FOR CONSTRUC�� iN PERMIT � <br /> TO BE COMPLETED iN BLACK INK—PLEASE PRINT <br /> BUILDING DEPARTMENT HEATING SYSTEI.1: U GAS ❑ELECTRIC U _ _� <br /> 259-8810 <br /> DEMOLITION ' ' COMBINATION �UILDING i I MECHANICAL I 1 PLUMBING ' SIGN <br /> �p/���.'jq M�ILADDR@55 CiT': LIP PNOYE <br /> J�JJ ,T I�r�n�� l� ��xl�-�s 3 �P�}� ��ao� 3�� /�G� <br /> T.r� �qry�/ !AAR40DRE55 � CIT/ ]IP PNUNE <br /> /�/�/ P _ <br /> pIiCHIIECTOROF5IGN[R IAAILADDRESS CITV ZIP PMONE <br /> ��NERALGONiRACTOii MAILqDORE55 QTY ZIP PHCAE STATEUCENSE� <br /> �\ ���'P�� � _ <br /> h+i.CNANICALCONTRPCIOR MAIIAD�RESS CITY 21P PHONF 5TIITELICENSEa <br /> P1U41l31NGCONiRAGTOR MAI�.AJDBESS CITV _ PNONE STATELIGENSE� <br /> CO!QRAGT PRiCE OF WORK <br /> DE;CFIEE WOPK AN�SOUARE FOOTAGE INVOLVEO COYT4CT PERSON RHD PHONE N a u� <br /> °�ihP -�i 5 rs' <br /> _(� COo A G p /�PL f3v/4 L — <br /> rA7.PI�d X �//� X �S I HEREBY CERT'�Y THAT I HAVE fiEAD AND EXAMINED THIS <br /> nr��o ;Eo use��r ouao�r�C APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT.ALL <br /> ` __���� PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br /> IfONLDESCRIPTIONOFPROPfRTY15 IUELOWOR�TTAGHTWOCOPIES) WORK WILL �E COMPLETED WITH WHE7HER SF'ECIFIED HEREIN OR <br /> NOT. TNE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br /> r�,r etocK oF AUTHORITY TO VIOLATE OR CANCEL THE PAO'1I510NS OF ANY <br /> OTHER STATE OR LQCAL LAW REGULATING CONSTRUCTION OR THE <br /> � PERFORMANCE OF CONSTRUCTION.THAT I AM AUTHOR�ZED BY THE <br /> OWNER OF THIS PROPERTY TO PERFORM TNE V`'ORK FOR WHICH <br /> APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> r�ni�ce�Tnr i o.ruun�aea CONTRAG70RS LAW 18.27 RCW AND 296.200 WAC. <br /> CO!4SiRUCiIONLOANLENDER.ADDRE55.TElEP E NUM9ER /' <br /> �aao ,z l ��� xlif � � � � 3- fs-� <br /> PROJECTADDRES,�' _�+�*u�+e � ouc —__ _ <br /> � � r,irnusn+rsi�c�nsrr�a <br /> PLUMBING lIECHApICAL <br /> NO. TYPE OF FIXTURE OR ITEM FEE N0. TVPE OF EOUIPMENT FEE <br /> WATER CLOSET(TOILET) � NC—A.�HNDLG UNITS—H.P. _ <br /> BATHTUB FORCED AIR SYSTEMS—B.T.U. Id E.A. <br /> LAVATORY(WASH BASIN) UNIT HEATER:i—B.T.U. M _ <br /> SHOWEN � CLOiHESDFYERS <br /> Y,ITCHEN SINK&DISP VENTILATION FAN <br /> CISHWASHEfi RA�lGE HOOD <br /> LAUNDRY TRAY ' WATFR HEATER <br /> � CLOTHES WASHER �— VrOOD STOVE <br /> URINAL � METAL FIREPLACE(WOOD BUFNING) ' <br /> DRINKING FOUNTAIN I FIREPLACE INSERT � <br /> FLOOR DRAIN HEAT PUMP <br /> BACKFLOW PREVFNTEFS GAS PIPING _ <br /> ROOF DRAINS—RAINLEADFRS � EXHAUST FAN _ <br /> SINK(SERVICE—BAR.ETC.) ; — <br /> _ � <br /> -- — -- � <br /> SUB TOTAL 5 SUB TOTAL 5 <br /> PERMIT 5 PERMIT S <br /> TOTAL FEE 5 TOTAL FEE 5 <br /> FOR OFFICE USE ONLY: <br /> IRONTSEIDACK �6AR5[TBnCK 3UF.SETOACK PIANCH6 ��� ER FEB RECEIPTNU <br /> '��!�7`J <br /> usezor+e LOTAREA VACANTSrtE FEES VALUATION FEE <br /> O YES � �. PIO pw�oiwG __��J ; � <br /> iYYC OF CON57. NO.OF STORIES OctuvexGv no M M:liu�,r�urv.6 � <br /> snauo pWMBING � <br /> SiZfOPOLDQ FlFESPRINKIERSRE00 BASEM[NT AIECHANICAL <br /> C' YC-S ': � NO .. <br /> ��CNPANGY LOAD FIRE�IARM FEOD MGGHT LIMITniION ADDITIONAL PLAN CHECK <br /> OTHER i <br /> REASON i 7 ) <br /> $TA1 B BUILDING SURCHARGE G`� <br /> ��,-,�kco� P�nNsnaano��oo� CITYOFEVERETT PUGLIC\NORKS <br /> LOCAL SALES —� <br /> onte TAX CODE IS 3105 rorn� <br />