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�9 � Cl'PfPlf � ' <br /> �' ' -- APPLICATI�N �OR CONSTRUCT �JN PERMIT � r: <br /> ' TO BE COMPLETED IN INK—PLEASE PRINT <br /> the Ere�green <br /> CITY OF <br /> evnrett HEATING SYSTEM: ❑GAS ❑ELECTRIC lJ — � <br /> BUILDING DEPARTMENT <br /> 259-8810 <br /> DEMOLITION COMBINATION BUILDING MECHANICAL �PLUMBING SIGN <br /> OWNER , LvdLADORE55 r �) CITY , ZiP/ PHONE/\1{� �/� ��11 <br /> ' /�C I TU/✓ l �C�GC Iv I� � / L' I����l'�, �,��`� P�ONE /A � F'Or ��C�l <br /> iENANT MAII A RE55 CITV <br /> ARCHITECTOROESIGNER MPILADORE55 GIiY ZIP PNOKC <br /> ��� GENERRt�CO/NTf1ACTO/R' /AIAIL A�ORE CITY / 21P PNONE LICENSE e . <br /> ��/1/L.. c C-C-� .L� � /'7�%��.G, <br /> ��� �1[GHANiC�LLONTPAGTOR MRhR��RE55 GRY ➢P PHONE LIGENSC• <br /> G H <br /> a�y FW�d�iNGCONTRRCTOR AIAILADDRE55 � Cltt 21P GHONE UCENSE� <br /> rr-� 3 �i%'l C� �C=/�r/�C F' ��7l7 �S��//(jC'crn1•.c't �E�F 1`'S"L/7/ i J y-2 5�b�D �7i'Jf�sS�'iG S �/_S <br /> C1A55 OG 1VOAN <br /> � y� y: NEW ADDITION ALTERATION REPAIR DEMOLITION WOODSTOVE/FRPL INSERT BUILDING RELOCATION <br /> � �,x,.�� GONTPCT PERSON ANp PNONE NO <br /> (p H <br /> x CO4TRACT PRiC[OF YlORN <br /> �y ^S OG . ipE WORrc pND SOURRE POOT�GE IHYOtVEO <br /> �']d i <br /> �y eeoPose u eoFemimr+e I HEREBV CER71Fv THAT I HAVE READ AND EXAMINED THIS <br /> � [�q Q (/�(N.1 . / APPLICATION AND KNONJ THE SAME TO BE TRUE AND CORRECT.ALL <br /> ZM iecnLoescairnor+oFrnorcarvisNow��ee�owoannncH�ouatoPies� PROVISIONSOFLAWSANDORDINANCESGOVERNINGTHISTVPEOF <br /> WORK WILL BE COMPLETED WITH WHETHER SPECIfIED HEREIN OR <br /> 9 H �or etacK _ oF NOT. THE GRANTING OF A PERMIT DOES NOT PRESUldE TO GIVE <br /> t� M y �UTHORITV TO VIOLATE OR CANCEL THE PROVISIONS OF AIJY <br /> y OTHER STATE OR IOCAL LAW PEGULATING CONSTFUCTION OR THE <br /> H ,! r�y_ PERFOFtdANCE OF CONSTRUCTION.THAT I AM AUTHORIZED BV THE <br /> � �y Jv � / Z3 -� �� OWNER OF THIS PFOPERTY TO PEPFORM THE WORK FOR WHICH <br /> APPLICATION IS IdADE AND I COMPLY WITH THE STATE <br /> � �Crc1 "�c—� CONTFACTORS LAW 1827 RCW AND 296200 WAC. <br /> ZH� � SIGtIAiu�[O�CONTRFCTOROPAUiHORIZEDAGENT Dn1E <br /> H O C/� <br /> 0 <br /> � ' i <br /> _ — ��?`�= � .�-. :�:�.< < %%l.J�e�s;=�_s��J <br /> PRQILCT R�ORE55 y �. ppp���pq}g�11Y BtI5ME55lICENSE NO AHD BlISME$5 NARI[ <br /> �77 l. //K��'�...' t�1-c-' /n <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM FEE NO. TYPE OF EOUIPMENT FEE <br /> �� 3 WATER CLOSET I701LET) � AC—A HNDLG UNITS—H.P. <br /> fv�� BATHTUB FORCED AIR S`.'STEh1S—B.T.U. M E.A. <br /> � LAVATORV IH'ASH BASIN� � UNIT HEATERS—B.T.U. M <br /> / SHOWER CLOTHES DRYERS _ <br /> ''^� VENTILATION FAN � <br /> KITCHEN SINK 8 DISP _—� <br /> �'' DISHWASHER RANGE HOOD <br /> LAUNDHYTRAV WAT[R NEATER <br /> CLOTHES WASHER WOOD STOVE <br /> �� URINAL MEiAL FIREPLACE 8 CHIMNEY <br /> DRINHING FOUNTAIN FIREPLACE INSEFT � <br /> --� <br /> FLOOH DR�IN HEAT PUMP <br /> � ��' _ BACKFIOW PREVENTERS _ GAS PIPINC. <br /> ROOF DRAINS—RAINLEADERS EXHAUST FAN <br /> / SINK(SEAVICE—BAR,ETC.) _ <br /> '^��..' _ -- . ^ = ---� <br /> --9—., <br /> � ff�.'6 c r �1L-)J!7� i'�G_ c�,O" Ca � --� <br /> i <br /> '�� r� SUB TOTAL J' <br /> SUBTOTAL 5 �J �� <br /> ;' ' J PERMIT S � PERMIi 5 <br /> TOTAL FEE 5 � TOTAL FEE 5 --� <br /> � FOR OFFICE USE ONLY: <br /> fRti:ItSEiLUCK R[ARSEipACK SID[SETBACK PIANGQ_CNNUA�BI�.R FCE RECEIPTNO <br /> us�:raue iotnREA vncnNrsrtE FEES VALUATION FEE <br /> —r— <br /> �UILDING <br /> Id�tafcONISRLLOW�BtE 1YeE0fLOq9AClul�t ocuvrvn xoqowP.i+�e�xns — <br /> cAou� p�UMBIN6 <br /> i <br /> . �i of�LDG. NO.OFSTOAIES BRSEMENT MECHANICAL <br /> Or:;;ut'pNCYIOA� FIRESPRIIXLE(iSRE00 H[iGHiLIFVTATION �DDITIONALPLANCHECN <br /> OTHER <br /> f t n';i�l FOR SPRINNIERS <br /> STATE Bl11LDING SURCHARG[ <br /> irv�nflf[Y PUNSAPPBOViDtiv CITYOFEVERETT PUBUCWOflNS <br /> LOCALSRLES <br /> TAX CODE IS 3105 TOTAL <br />