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rw �, <br /> APPLICAr'ION FOR CONST��►.:TION <br /> PERMIT <br /> •ho F orgroon <br /> CITV OF <br /> rvrrrl� <br /> �verett e <br /> BUILDING DEPARTMENT <br /> 259-8810 TO BE COMPLETED IN INK— PLEASE PRINT <br /> OWN[II MAILApDR[55 �ILY 21P p110NE <br /> ��L�r_4�►o �av g��r s� ��ccaT RBac�� 337-ylos�/ <br /> i[NANt A141LAp�fIC55 GIIY ="- PMON[ � <br /> eFCMILECTONUESiGNER A�qiLApCeE55 CrtY v - PppNE � <br /> T,�,��fE5SI�N �6N �,�c�r,s�,cJ l�IL,eeFJ� 9�Q3_353=3� <br /> GEHERµCONTflACiOH MAILADDRE55 �IIY :iV PI�ON[ tICCNtiL• <br /> �.1�6r2�lLG��s?. 1����0�58��sis�.��,�F��b�o�,�s7 ves�,eslcz�s�Yos <br /> M[�H4NICAL CONTRALTOA <br /> VWMBINGCONiR�CTOR MAilA00AE55 GIIY ,. %IONE UCCNSL• � <br /> CL�SS OF WOPIt — - <br /> NEW ❑ ADDIiION ❑ ALTERATION ❑ REPAIR ❑ DEMOLIiION ❑ WOODSTOVFJFRPL IN°ERT ❑ BI:I�OING RELOCATION <br /> 1E:�NIIMPROVEMENiORI\'iER10R REMODELONLY � CONiACivEN50N�NU'NONENO � <br /> CONTPaCi PqiGE Gf WORK <br /> �5ovo°= G/���(/� _� 3� - �S - <br /> DESGPIBE1VOPrcAND50U�RElOpiA EINVGLYED -- --- <br /> �1�-1.c) p�.c P�.E k <br /> va vsm osEoe eunoiNe -- -- � <br /> I N ER[BY CERTIFV TMAT i HAVE REA0.4ND EXAM W ED THIS APPLICA71ON AND <br /> -=S � �Z KNGWTHESAh1ETOBETRUEANDCOFRECTALLPROVISIONSOFLAWSAND <br /> LEW oesc IPTIONOFPROPEHiY�SMOWNBELUVORATIALHiOUPCOV�ES OR�INANCESGOVERNINGTHISTVPEOFWORKWILLBECOMPLETEDWITH <br /> /, q WHETMERSPECIFIEDHEREINORNOT.THEGRANTINGOFqPERMITDOESNOT <br /> �oT / BLOGK� oF I 1 I�LS �i U .tX` PAESUME TO GIVE AUTHORITV TO VIOLATE Ofi CANCEL THE PROVISIONS OF <br /> ANYOTliER STATE OR LOCAL LAW REGULFIING CONSTRUCTION OR TME PER� <br /> FORIdANCE OF CONSTRUCTION.THAT I AM AUTHORIZEO BY THE OWNER OF <br /> THIS PROPERTV TO PERFORI�1 THL WORK rOR WHICH APPLICaTION IS MADE <br /> FND I COMPLY W1T4 THE STATE CONTRACTORS LA\V 1827 RCW AND <br /> 296 200 WAC. �j / �/ <br /> $:ulI�IU�C�lf�O'11BA[,i(`9pFdUI1�ORIj�p�GCBi D�IC �/ �( � 6 � <br /> VROJELIADGRE55 ����� — _V____. _ ___._ __. _ . <br /> I �1L / y . ' �� / I �rr�t�CuU1LIT0uS4f� li L�.._ ..��� er�D0U5�4C55r:<q� <br /> PLUMBING MEC4ANICAL <br /> N0. T'PE OF FUCTUqE OR ITEM FEE NO. TYPE OF EOUIPMENT FEE <br /> WATERCLOSET(TOIlET) ' NC–A/HN�LGUNITS–MP. <br /> BATHTUB � FORCEDAIRSYSTEMS–BTU. McA <br /> LAVATORVpNASMBASIW r' � UNITHEATERS–B.TU. h1 <br /> j� SHOWER —'� CLOTHESORYERS <br /> — — � ! <br /> �` KITCHEN S�NK d DISP. — VENTILATION FAN — <br /> '� DISHWASHER _� _ � RANGE HOOD .._. <br /> LAUNDRYTRAV _z WATERHEATER — <br /> oZ CLOTMES WASHER –� WOOD STOVE <br /> URINAL METAL FIREPLACEdCMIMNEY � <br /> DRINKINCaFOUNTAIN FIREPLACEINSERT <br /> FLOOR DRAIN HEAT PUMP <br /> BACKFLOW PREVENTERS GAS PIPIN6 <br /> RUOF DRAINS–RAINLEADERS E%HAUST FAN <br /> SI NK�SERVICE–BAi�ETC� <br /> SUBTOTAL S � SUBTO7AL 5 � <br /> PERMIT 5 PERMIT 5 <br /> TOTAL FEE S TO7AL FEE S <br /> [RONiSf�tl��' PEARS'iQ' S�DESEi9nG' ^_ pIAN�ECNNUMBEB-s�.�'j(� iEE�— RE (��/ � <br /> (� L ' // <br /> ( / U <br /> u5E2oHe �ot,wu ¢•• ❑r FEES VALUATION FEE <br /> �-7 �,�5 ::„� <br /> C� <br /> rvvEorto�+5t Cuvul caouv ��co�owuiir�cuN�+s BUILDING ojs �� /„�/ r,� <br /> LLrx <br /> HIowABtc�� ��.. � OK Pr'rt PLUTABING <br /> � �i�..�Z _ _ ��f�� — <br /> 54E 0�OLDO tl0 O�SiOFi[5 USMi OCL LOAD <br /> �I�pCJ Z 'p� MECNANICAL /1�(j; -- <br /> r�[�GrrtuviunOr� -- � OTHER I !rb',(t• <br /> �:p <br /> fIREBPRINRLERSREW111ED crE9 AO+o STATEB ILDINGSURCNARGE _ ��j <br /> STATE ENERGY SURCNARGE 1J ��`! <br /> evcuunor��ccer ni.vs�F��aor — " <br /> PUBLIC WORH$ _I ; � � <br /> � �� ��� TOTAL <br /> � , �( 1- a <br />