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APPLICATIC"`I FOR CONSTRiJCT �W PERMI'� '��� <br /> TO BE COMPLETED IN BLACK INK—PLEASE PRINT <br /> HEATING SYSTEM: GAS U�LECTRIC J_ —�� <br /> BUILDiNG DEPAR i MENT <br /> 259-R�10 <br /> DEMOLITION COMBINATION ��BUILDING 1(,MECHANICAL �LUMBING SIGN <br /> �5�'IER -- MA.'_ADDRESS Q � CI�TV ,� ZIP�y PNONE <br /> AIrvU �e.��Q�51�_��J�'T_�—C!�'iHc_,�_7��5�/�.��-� — <br /> T[NRNT <br /> IARP_Af1�RE55 ��TY ��P <br /> �� <br /> ARCNRECT OR DE9GNER MAR A�DiiE55 CrtY Z�P PMONE <br /> �`517�i '�l 'i L ` ci,� zio-- zr�wHe / 33Gbaf(��l�� <br /> G@ERRLCONTRAGiOR IAAIL DDR[SS �r � � �4� <br /> l��jlvr��1�1—�.-��—��'�'�..��-�—�7il��L-1���=-L`� - <br /> 1-3 � M[:HANiCALCONiRALTOl1 MAtLADON 55 CI1Y TiP FN046 SiAiELILEH$Eo <br /> � � T � '�A/f�/r'Al -- -- — <br /> � � _! � UiY ZIP 1'H?VE SiAiEIICCNiER <br /> D x PIiJVB�y CONLRACTCOA_ MA�I��ORES.. --- - <br /> > y w ��� �-S�L7l�'-`�J�� �"� <br /> . <br /> ty x,f ClRS50F WORK <br /> y Z M xNEW ADDITION ALTERATION PEPAIR DEMOLITION WOODSTOVEFRPL INSERT BWLDING RELO <br /> i.ON'PCTaERSO dNDP��ONEH <br /> "H z .?ll,c���Ir'O�l� 'S3�� <br /> � N � CONTRAGT PRiCE OF WOAK - <br /> y � DESCRiBE WONK AND SOIJARE FOpTPGE INVOLVED <br /> � Pnoros[oUSFo`BUi��� I HEREBY CER7IFY THAT I HAVE REPD AND ExAMINED THIS <br /> O Qy � � APPLICATION AND KNOW THE SAM[TO AE TRUE AND CORRGCT ALL <br /> PROVIS�ONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br /> M �t7 �ew�ofle.c�a1ivTior+oFraoPeArv�sNowneeiowonenecNrouacovie�� yyORK WILL BE COMPLETED WITH WHETHER SPECIPIED HEREIN OR <br /> �� n �aT� g�p�K or ��%P�f NGT THE GRANIING OF A PER1d1T DOES NUT PFiES�lA1E TO GIVL <br /> 1-1 � AUTHORITY TO VIOLATE OR CANCEL THE PROVISICNS OF ANV <br /> Z y � _ 3 - a9 OTHER STATE OR LOCAL LAW REGULATING CONSTPUCTION OR THE <br /> � PER�ORIdANCF Of CONSTRUCTION.THAT I AM AUTNORIZED B�THE <br /> M H OWNER OF THIS PROPERTV TO PERI'ORM THE WORK FOH WIiICH <br /> g y �„� APPLICATION IS MADE AND I COMPLY WITN THE S7ATE <br /> n Cy y CONTRACTO S L 182 �3CW AND 296200 WAG. <br /> � d / <br /> �� ` � 9-� <br /> � _��.3 0 ��'.:�-/��d� X , - - -_ �-�-,..�1 � <br /> raaeci ao ess ---- .,. ---_ ---- ---— <br /> � PIUMBING MECHANICAL � . <br /> NO. TYPE OF FI%TURE OR�TEM FEE NO. <br /> TYPE OF EDUIPMENT FEE <br /> � WATER CLOSET ITOILET) _ A'C—A HNDLG UNITS—HP. _ _ <br /> I �� B�THTUB FORCEO AIR SVSTEMS—B.T.U. M E.A. I <br /> LAVATOFVIWASHBASIN) UNITHEATEFS—BT.U. M � <br /> . CIOTHESDRYERS _ <br /> SHOWER <br /> KITCHEN SINK 8 DISP /; VEWTILATION PAN _ <br /> � D�SHWASHER �S� RANGEHOOD _ <br /> I � LAUIJDRV TFAV _ :. WATER HEATER = i <br /> � t� , WOOD STOVE <br /> CLOTHES WASHER � ��_.� <br /> , URINAL METAL FIPEPLACE 8 CHIMNEV <br /> GPINKINu FOUNTAW RREPLACE WSERT <br /> FLOOR ORAIN HEAT PUMP — <br /> i �� — GASPIPING <br /> ' 6ACM.FLOW PREVENTERS <br /> ROOF ORAINS—RAINLEA�ERS EXNAUSTFAN <br /> i <br /> �t_ SINK�SERVICE—BAR,ETC.) '—' � �, <br /> ' — -�2 v-s-�� <br /> I_ SUB TUTAL $ SUB TOiAL $ O; CIT�� <br /> �� PERMIT $ PERMIT 5 —*'� <br /> � TOTAL FEE $ TOTAL FEE $ —�'—�� <br /> FOR QFFICE USE ONLY: R«civT Ho <br /> fE[ <br /> FRONTSETB�Cv REANS[IDALK SIDESETBACN PInNC��ECKN�M�E ��� `� �//// <br /> � 2� l J 37s lo , <br /> USE20NE y ��TA�EA _ <br /> vncnNtsiTe FEES VALUATION FEE <br /> �� I 7 BUILDING _ �l'��� J 'i.J <br /> !i � ♦ <br /> 1YPF01GONi5.AllOWRBLE 1YPOiCONS'FLIUPL Oc4qoccr xoacwnre:amrs PWMOING '�V <br /> SiZ[o� No O�5'ORiES BASEuI[NT � 1AECHANICAL 9D � �� <br /> I �T9 55 A � <br /> ADDIiIONAL PLAN CHECN ' <br /> nCCUPANCV LOF� FiRE SPRNY.LERS REdD MEIGHi LiMilp110N � <br /> �AyI/ $PHRJKLEH �� / <br /> R[ASONlOPSPRINNLERS Y iJn <br /> STATE BUILDING SURLNARGE _ <br /> INTAaEOV t'lANSPFPHOVEDBY CITYOFEVERETT FUBLI�WOPKS J"v � �, <br /> �� LOCAL SALES ��� <br /> o TAX COOEIS 3105 toT^� <br /> r��l� 92 <br />