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APPLICATit,.� FOR CONSTRUC7 .ON PERMIT �� <br /> TO BE COMPLETED IN BLACK INK—PLEASE PRINT <br /> BUILDING DEPARTMENT ( HEATMG SYSTEM: V GAS ,� e�ecTRic J � <br /> 259-8810 <br /> DEMOLITION COMBINATION X'BUILDING MECHANICAL PLUMBING SIGN �i <br /> OWNEP IAAIL�ODRE55 Ciiv ZiP PNONE �� <br /> Ma2��� 3' ,L1 oc�o�rc 2 soG oarcc� Fv�an cJ� �rgLot zs,r a� r9 <br /> TENANT MAiLApDRE55 Cltt Z�P PMONE <br /> ARC�uT[C*ORDESiGNEB MAiLA�DRE55 CRV ZIP PHONE <br /> 1-3C'1� GLHERALCONTRRCTOR MAILA�ORE55 CITY ZIP PNONE SIATELICENSE• � <br /> t� <br /> �� �� ����� <br /> ��� L!ECHANiCALCONTRACiOR M�ILADORE55 GITY ZIP PHONE STATELICENSE• <br /> ay5yy PLUI.IBINGCONTRRGiOR MRiLP0�PE55 GTY 21P PNONE STATEUCENSE+ <br /> y zH <br /> K' O CLASSOF\YORN <br /> O S O NEW JLADDITION ALTERATION REPAIR DEMOLITION WOODSTOVEiFRPL INSEflT BUILDING RELOCATION <br /> � y H ;'/ co�+tncr rEnsori nr�o ciror+E no <br /> y cor�rr+nctrniceoFvroRK ujQ 1 Y :��- �� 'D ,J��j�c_t.� �,$'� /�G T�i <br /> � D�if �ESCRipE\YORKANDSOUAR[iOOTAGEIYVpLVED <br /> o H d �cl�l_Ft1v rt� o r !iv_o�� s — <br /> x1 OC7 FnoaoseouseoFouaoir+c C i HEREBV CERTIFY THAT I HAVE READ AND EXAMINED THIS <br /> �_�A�. �,S�_�� .f� APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT.ALL <br /> z H C� � ` v� PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br /> LCGAlDESCRIP iONOFPPOP[RiY�5MOl4NBE�0IYORATTRCHFWFGOPiES� <br /> � y z VJORK WILL BE COM1IPLETcD WITH WHETHER SPECIFIED HEREIN OH <br /> i�r e�ocK oc NOT. THE GRANTING OF A PERMIT DO[S NOT PRESUME TO GiVE <br /> y H AUTHORITV TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br /> g �„� OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OF TH[ <br /> n d(� PERFORMANCE OF CONSTRUCTION.THAT I AM AUTHOFIZED 8Y THE <br /> � �r OWNER OF THIS PROPERTY 70 PERFORRI THE WORK FOR WIiICH <br /> � .1PPLICATION IS h1ADE AND I C01.1P1Y WITH THE STATE <br /> 7. H V! CONTRACTORS LAW 7827 RCW AND 296.200 WAC. <br /> H O p� <br /> x_�'G.G..1C'� I - �3'`�7 �— <br /> _._------ - <br /> �>no�ecr aooeess � c•'� <br /> O Q O /A (t PS CcJ �LO <br /> PLUMBING MECHANICAL � <br /> NO. TVPE OF FIXTURE OR ITEM FEE NO. TVPE OF EOUIPMENT FEE <br /> f'���, WATER CLOSET ITOILET� _ _ ____ A C_A HNDLG UNITS—H P. _ <br /> �.� BATHTUB FGqCED AIR SYSTEMS—�T.U. 1,1 EA. <br /> LAVATORV(WASH BASIN) UNIT HEATERS—B.T.U. h1 <br /> � SHOWER CLOTHESDRVERS <br /> I �' KITCHEN SINK 8 DISP VENTILATION FAN ' <br /> �— � DISHWASHFR —r RANGE HOOD —T— <br /> LAUNDRV TFiAV WATER HEATER <br /> CLOTHES WASHER �— WOOD STOVE <br /> ��. URINAL h1ETAL FIREPLACE 8 CHIMNEY <br /> ORINKING FOUNTAIN FIREPLliCE INSERT i <br /> FLOOR DRAIN HEAT PUMP <br /> ��' � BACKPLOW PREVENTEFlS _ GAS PIPING <br /> � ROOF DRAINS—RAINLEADERS EXHAUST FAN <br /> SINK�SEFVICE—BAR,EiC.) <br /> �� � <br /> I�, e SUBTOTAL 5 ; SUBTOTAL 5 <br /> �` PERMIT 5 —�__— PERMIT 5 <br /> TOT�LFEE 5 TOTALFEE 5 <br /> - FOR OFFICE USE ONLY: <br /> FBONi5nEt0^ACe R[ARSEIDACK SiOESEcT�RCN f�l4NC��[CnNUA10EP f/CF� .� HE/CEIPiNO `/ <br /> C�/ � .7 ' �--�"� � / /L�. �U C�������J <br /> use zor�e ioT/anea �.j VRCRM SRE FEES VALUATION FEE <br /> 2 Z �pCCA Ll' ND �UIIOING ��jZ37 �(/L� 'C-iJ <br /> ivPiOln::tSALIOWABIf iYPE01G0�i51RCiWt acu�+vo honm�w�a��ris — <br /> � - cr,yr p�UMOWG _ <br /> � <br /> 9ZE OF B�OG. NO.OF STOPiES O�SEMENT h1ECHANICAL <br /> �t33 5f A 1 � — <br /> occuanr.�cv�ono Fin[srnHrci[n5nE0o r�eic�nurartqnnor� ADUI710NALPLANCHECK <br /> N A �✓� zv , SPRINKLER <br /> NfA50N ORSPRRIXLERS — �T— <br /> STATE�UILDING SURCHARGE `�C� <br /> enna�.nv P:ANSAPPROVEDOY CITYOFEVERETT PUOLICWORK$ <br /> LCCAL SALES <br /> J�� L(�/it TARCOOEIS3105 TOTAL � <br />