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i <br /> APPLICATIl,:+1 FOR CONSTRUCti .ON PERMIT �'�<<�" <br /> m�,e�-��m�r��� TO BE COMPLETED IN INK—PLEASE PRINT � <br /> cirv oF <br /> �j�j � ��verett HEATING SYSTEM: � GAS ❑ELECTRIC U <br /> p � � BUILDING DEPARTMENT <br /> Qy H 2E9-8810 <br /> t' H C/� <br /> H � � _DEMOLITION COMBINATION BUILDING MECHANICAL PLUMBING SIGN <br /> y H C'W1M1,cq /1 MnPILA�O�REf$ 3ay L.�/l��tY��ul.l:. _ZiP� \/�, �� �I��� <br /> �H � l.V 1 I I I(�-4'��� V�� <br /> Q�N Q� tEry / RiLA00RE55 CITY 21P PHONE <br /> fA HM � �}`�� <br /> y r�^ Sr AFCNITEGTOR�ER MAiLr1D�RE55 GTV 21P PHONE <br /> O H d ✓� �//� <br /> GE :RALG IRACTOR M I� pDR � .�/LO�S ����N�- IP /� _ /PNpNE� � LIC NSE� n� <br /> Y'f�l / c. Cf I�'1 <br /> �i �g : � �, a i i� c_ rr � <br /> �i1� O 61ECNANILALCONi TOR MAILCD�PE55 CIiY ZIP PHONE IICENS � <br /> �1�1�IU�' �53 �-f3 9r <br /> �y�, PWMpiNf.CONiFACTOR lANLAODBE55 CITV 21P PMONE IICENSE� <br /> HH <br /> ti <br /> GUSS OF WORK <br /> n�y - � NEW � ADOITION ALTERATION REPAIR . � DEMOLITION . . WOODSTOVE/FRPL INSERT _�: BUILDING RELOCATION <br /> ^ CONTACT PERSON AND PIION�NO <br /> � H � CONTRRGT FPICE OF WOFK '��U ' v� — <br /> y �y pESCPIBE W RN�Np OU E FOOTAGE INVOLVED / <br /> 1c.c� �h� e <br /> PROPOSEDl15E0iDU1L0 G I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br /> ��.i I APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT.ALL <br /> IEGAL�ESCFIPTIONOFPROPERTY15110WN0ELOWORATTr1CHFOURGOPIE51 PROVISIONSOFLAWSANDORDINANCESGOVERNINGTHISTYPEOF <br /> WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br /> ior etocK oF 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 LOCAI LAW REGULATING CONSTRUCTION OR THE <br /> PERFORMANCE OF CONSTRUCTION.THAT I AM Al1THORIZED BY THE <br /> OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHIGH <br /> APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> CONTRACTORS LAW tE27 RCbV AND 296200 WAC. <br /> SiGNATUR[OF CONTRACiOR OR AUTHOF2ED A ENT DNTE <br /> X �� ` � r�nd���d �/����� <br /> '�, rnaec*nooaEss r�h�� � �n/' ` <br /> � � �� pP LICANi5C1TV8U51N SIICEN$ENO NpBU51NF.5$NAl,IE <br /> ' ' PLUMBING MECHANICAL <br /> � NO. TVPE OF FIXTUFiE OR ITEM FEE NO. TYPE OF E�UIPMENT FEE <br /> '�' WATER CLOSET(TOILET) A/C—NHNOLG UNITS—H.P. — <br /> BATHTUB FORCED AIR S`.'STEh1S—B.T. . E.A. <br /> LAVATORY(WASH BASIM1� UNIT HEATERS—B.T.U. M _� <br /> '�' SHOWER CLOTHES DRYERS ' <br /> VENTILATION FAN � <br /> f�' KITCHEN SINK 8 DISP --T— <br /> DISHWASHER RANGE HOOD <br /> 1 ' LAUNDRY TRAY WATER HEATER <br /> CLOTHES WASHER WOOD STOVE <br /> � LIRINAL MET�L FIREPLACE 8 CHIMNEY <br /> �i DRINKING FOUNTAIN FIREPLACE INSERT <br /> FLOOR DRAIN HEAT PUMP <br /> � BACKFLOW PREVENTERS GAS PIPING <br /> 'w' ROOF DRAINS—RAINLEADERS i EXHAUST FAN <br /> ' SINK�SERVICE—BAR.ETC.) <br /> i <br /> � ' <br /> '�I SUBTOTAL 5 SUBTOTAL S O ' _ <br /> -_ PERMIT 5 PERMIT 5 /5 � <br /> TOTALFEE 5 70TALFEE 5 f' ' <br /> FOR OFFICE USE ONLY: <br /> FRO�rtS[T6ACN PERRSETOACrc Si�E5ET8ACK PlANQ1ECNtlUh10ER FEE RECEIPTNO <br /> usezoNE iotnaen vnenrv*sire FEES VALUATION FEE <br /> BUIL�ING <br /> 1VPEOit0�R5ALLOWABtE iYPEOfCONSL.ACiVAL rccur�xr boNV.V:oh:;uti�-is <br /> coou> PLuh+91NG <br /> SIZ[OFBIIX'i. NOAFSTORIES BRSEMENT MECHANICAL �� <br /> OCCUPANCYIO�D FIRESPRNNLERSREO'0 HEIGMTIIMrt�T10N AUOITIONALPLANCHEL'K <br /> OTHER <br /> PEASON�OR SPPINNLERS <br /> --=� <br /> STATE BUIL�ING SURCFARGE <br /> IIITANEDY PlfNS�PPRGVEDOY CITYOFEVERETT PIIBLICWORN$ <br /> LOCAL SALES 5� �� <br /> TAX CODEIS 3105 TOTA� <br /> , <br />