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,��� <br /> � <br /> APPLICATIOhI FOR !:ONSTRUCT�N PERMIT °`'''«'" <br /> , TO BE COMPLFTED IN INK—PLEASE PRINT � <br /> cn or <br /> eve rett HEATING SYSTE�A: ❑GAS ykj ELECTRIC U_ — � <br /> BUILDING DEPARTMENT <br /> 259-8810 <br /> H o � DEMOLITION )C COMBINATION '� BUILDING MECHANICAL PLUMBING SIGN I <br /> oc:r�en <br /> n�.m�aooness cnv zir PNONE (n `/%"' 6 z(�( <br /> A �'zp'� �o�fr �4 To��.uS�nJ //9z0 �,� 6�a�c��1 r�0. C-�^nN.'�Q tz.a�ls, c.�B Q��2— I <br /> � y � TENANT AIAIIADDRESS CITY ZIP PNONE <br /> y�r � nRC�u1L'C10RDE51[N[11 AIAllA0�PE55 GITY ZiP PMON[ ��� <br /> K n <br /> y � CRY 21P PHONE LIC[NSE• <br /> � H � Gl�ti['lt/�LGe O�N;RA��� �INL4DDFE55 <br /> V� H � a_ <br /> � x� vi:C��ANICALC06iRACTOP M4itADDRESS CILY ZIP �MONE LICENSE — <br /> O�d i'�UnIpINGCONT(1ACTOR MAILaDDRE55 CITY 21P PHO�i[ LiLENSE� . <br /> ��8 <br /> y7� p anssoFwonK <br /> ,.�"'�l y� VEW ADDITION ALTERATION ?S REPAIR DEMOLITION WOODSTOVE�FRPL INSERT BUILDING RELOCATIGI: <br /> — CONTALT PERSON PND PNO4E NO <br /> � z � /� '�// _ • , / <br /> �H CONI�AGT P�ILE OF�YORN G M ��'` � 'O` V S WV �Z9..[ �� � �� <br /> gH oEscaie�wor+K n�r+o sounn�oo`r,npe ir+vavEc�y/t•po7',5 .o�t �a�C� <br /> C d� �oafA UU l4-7,Oa .A�7't .O v� J w)�� <br /> 3 [�i �+ raovoseo seo 911R inc �� � .� I HEREBY CERTIFV THAT I HAVE READ AND E%AMINED THIS <br /> z y y �� �A APPLICATION AND KNOW iHE SAME TO BE TRUE AND CORRECT.ALL <br /> H O p� iecni oesGaianorv oF rnorer�tv isi�owNae�awoannacN�ouacovies� PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br /> WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OF <br /> ipr_3�_ e�ocK �JC� oF ��U — NOT. THE GRANTWG OF A PERMIT DOES N0T PRESUME TO GIVE I <br /> LI /� ,( AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANV <br /> �(J�o-r� L�-�/ Cn :_(?�y ��^h0( `•�'�'�� OTHER STATE OF LOCAL LAW REGULATING CONSTRUGTION OR THE � <br /> v � PERFORh1ANCE OF CONSTRUCTION.THAT I AM AUTHORIZED BY THE <br /> OWNER OF THIS PROPERTY TO PEFFORM THE WORK FOR WHICH <br /> �PPLICATION IS MA�E AND I COMPLV WITH TIiE STATE <br /> �— CONTRACTORS LAW 1827 RCW AND 296.200 WAC. <br /> �3y D � / OS _ K�/ �O�O 516tlATUREOFCONTfiACTORORAUT110RIZG�AGENT DAT[ <br /> !p� V <br /> � i C/ I <br /> , , N e. �—� <br /> _,—� <br /> �'RJJEGi/DGViE55 <br /> po 1TSCITYOUSINE55� SENO AN�OUSINFSSNA6iE <br /> PLUMBING MECHANiCAL <br /> / �` NO. TYPE OF FIXTURE OR ITEM FEE NO. TYPE OF EOUIPMENT FEE <br /> I C��� WATEF CLOSET(TOILET) NC—NHNOLG UNITS—H.P. <br /> ��i BATHTUB FORCEDAIFSYSTEMS—B.T.U. M E.A. <br /> LAVATORV(WASH BASIN) � UNIT HEAT[RS—B.T.U. M T_ <br /> SHOWER CLOTHES DRYERS <br /> ���, VENTILATION FAN <br /> KITCHEN SINK 8 DISP <br /> . �� DISHWASHER _� RANGEHOOD <br /> � LAUNDRY TRAY WATER HEATER <br /> �� CLOTHES WASHER WOODSTOVE <br /> � '�w METAL FIREPLACE 8 CHIMNEY <br /> ' URINAL <br /> �� DRINKING FOUNTAIN FIREPLACE INSERT <br /> FLOOR DRAIN HEAT PUMP <br /> BACKFLOW PREVENTERS GAS PIPING <br /> � ' 1 i _ ROOF ORAINS--RAINLEADERS EXHAUST FAN <br /> SINK(SERVICE—BAR ETC.) <br /> '�� ' ' SUBTOTAL 5 SUBTOTAL > <br /> I PERMIT 5 PERMIT S <br /> I�='i TOTAL FEE S - - TOTAL FEE 5 <br /> FOR OFFICE USE ONLY: <br /> vhorasctnncn i�raase�uacn sioeseronc� rinr+a�c.cnrur.�rrn �rc nccemr��o <br /> usEzoNe LOTARER WG4Ni;rte FEES VALUATION FEE <br /> DUIL�ING '< � <br /> IVPEO�CON15AllOWABIE iYCE0FC0YStAGi11Al ocforxN[� nutvOnuv+:uy�:s — - -- <br /> �P"p° PLUM6�NG <br /> 9ZEOFBIDG. NO.OFSTORIES BRSEMENT MECHANICAL � <br /> UCCUPANCYl0�0 FlRES�RNKLERSFEO�U NEIGHTLIMiT�t10N ADDITIONALPLANLHECK <br /> OTII[R <br /> - _—___'_r '_. <br /> ��L nS�N FOR SPPINNLENS . <br /> STATEBU�LDINGSURCMARGE � • <br /> ��nner:av rinr+;nv�'noveoor ' CITYOFEVERETT PuouCwoRKs <br /> LOCAL SALES <br /> TAX COOEIS 3105 T�T�� <br />