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ION FOR CONSTRUCTION PERMIT � <br />TO BE C�PLETED IN BLACK INK—�LEASE PRII � <br />BUILDINQ DEPARTMENT HEATINO SYS7FM: CiAs �] ELEC7RIC D <br />259-8810 � <br />❑ DEMOLITION ❑ COMBINATION O BUILDING �I �IECHANICAL ❑ PLUMBINQ ❑ SION <br />����,-e ��P✓ �a5 ��r��,d. �u� ���'�-� ��o� .339-5j8� <br />T[wr'.^ �, n rna wonaa cm a► vHOH! .. <br />L:i.�3i�] <br />c <br />��� <br />ILMI DE�CMIION Of �ROPERTV (&10'M/lELOY OR ATAICN 7W0 <br />loT aopt � <br />r� �a <br />j'.,.�1I:1 <br />6 <br />1 <br />� Fon o�ce use oN�v: <br />�� �� <br />W[n011! IOTMfA <br />w� <br />�r.:�:� �� <br />CIN ZIP <br />GTY 21P <br />cin nr <br />CITY Z�p <br />f�.:!.'C� <br />li�::.� <br />CONTACT ►ERBp� /JIO PIqNE NO. <br />r <br />i HEREBV CERTIFY THAT I HAVE READ AND EXAMINEO THIS <br />APPLICATION AND K!!OW THE SAME TO BE TfiUE AND CORRECT. ALl <br />PROVISIONS OF LAWS AND ORDINANCES GOYERNINCi THIg TVpE OF <br />WORK WILL BE COMPLETED WItH WHETHER SPECIFIED HEREIN OR <br />NOT. THE aRANTINO OF A PERMiT DOES NOT PRESUME TO Ci1VE <br />AUTHORITY TO VIOLATE OR CANCEL THE PROV1810N3 OF ANY <br />OTHER STATE OR LOCAL LAW REC�UTATINCi CANSTRUCTION OR THE <br />PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHOqRED BV THE <br />OWNER OF THIS PROPERTY TO F'ERFORM THE WORK FOR WHICH <br />APPLICATION IS MAGS AND 1 COMPLY WITH THE 8TATE <br />CONTMCTOHS LAW 18.27 RCW AND 2Y6.200 WAC. <br />� ��s e� � � 93 <br />SpN�t E p�f( <br />UNIT HEATERS—B.T.U. M <br />CLOTHES DRYERS <br />VENTILATION FAN <br />RANOEH000 <br />WATER HEATEF <br />WOOD STOVE <br />METAL FIREPLACE (W000 <br />FIREPLACE INSERT <br />HEAT PUMP <br />GAS PIPING <br />EXHAUSTFAN <br />RAN CNECN <br />r! VES :�� NO BUtl01NG <br />oon�c. woaowtuwcuw�s <br />� PIUMBtNG <br />�� ��M MECNANICAL <br />❑ YES ❑ NO <br />� NEqNf LMrtA7pN ADDITIONAL PLAN CMECK <br />OTHER <br />STATE BUIIDING SURCHARGE <br />�er CITYOFEVERETT rusucwonKs <br />LOCALSALES <br />TAX COUEIS 3105 roT�� <br />TOTAL FEE S I <br />- ��..�. <br />� <br />i <br />i <br />