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v '�- APPLI�ATIC.r�! FtTR CONST�iUC1.O�fl PF4iNl�3` �"'�'«'" <br /> �n�•e,�e,�,���,� <br /> TO BE COMPLETED IN INK—PLEASE PRINT � � <br /> i;17Y OF <br /> eve rett f HEATING SYSTEM: i:1 GAS ,�ELECTRIC lJ — _� <br /> BUILDING DEPARTMENT ' <br /> 259-8810 <br /> DEMOLITION COfdBINATION BUILDING xMECHANICAL ' PLUMBING SIGN <br /> �� pµ�ryEq iAnRFG�RE55 CiTY ZiP PHONE <br /> � T�„ ��.•u _ /�-� 7 t n�A��ZIUGl�1t�DJ �. �Ya��ft '7'/3- SF�,� �/ �� <br /> IENAI.T AIRIL4DDRE55 CIiY ZIP PMONE <br /> nHCNiTECTOR�E5IGN[P 1dAtLROD1iE55 GTY 21P PHONE TO/fAIC- / /,3 / <br /> J�nc o Z71G. j/a 3 C'c-�,�.� .6 �.�—_,.r �'iFz90 SS£, S� 6v G 9 <br /> GCNERALCONtRAGTOfl MAllA0DRE5S CI7Y 2tP PHONE LICEhSE� � <br /> � <br /> p�� inCCNANICALWNiRACiOR M�ILA��RESS CITV ZIP PHONE IICENSE� <br /> q H X VCIIC O �qC S�i $- b'7Gl� <br /> ayy ��.UM�iNGCONTRACLOP n'AilA0DRE55 QTY ZIP �HONE UCEN.iE� <br /> � CLA55OF WORN <br /> � y� �' NEW � ADDITION � ALTERATION '. � REPAIR DEMOLITION WOODSTOVEiFRPL INSERT . �. BUILDING RELOCATION <br /> � H� ' CONtAGT FEii50N ANp PHONE NO <br /> � <br /> �'~ S'GU —' <br /> F] C'� CONIiiA;,TPPIC[OFIVORK <br /> � �� OdSCFiBEWORNANOSOU/REFOOiAGEINVOLV"e0 <br /> c�-4'�c� <br /> �,y vROPOSEDUiEOFBUiL��NG I HEREBV CERTIFY THAT I HAVE REAO AND EXAI�IINED THIS <br /> N C�47 O APPLICA�i ION AND KNOW THF.SAME TO BE TRUE AND CORRE::�. ALL <br /> Z H� L[GALDESCRIPTiONOF PROPERTYISHOWN BELOW ORArtACNiOUR.,JPiES� PROVISIOtJS OP LAWS AND ORDINANCES GOVERNING THIS TVPE UF <br /> WORK WILL BE C061PLETF.D YlITH WHETHER SPECIFIED HEREIN OR <br /> � H Z �or etocK ov ___ NOT. 7HE GRANTING OF A PERMIT DOES NOT PRESUME TO��IVE <br /> H� AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANV <br /> �y OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR'�HE <br /> N <br /> O H PERFORI.�A�CE OF CONSTFi:JGTION.THAT I AM AUTHORIZED BY THE <br /> nC", dy OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHI�H <br /> ,3� APPLICATION IS MADF AND I CO�iPLY WITH THE SThTE <br /> Cs1 �L'7 CONTRACTORS LAW 1827 RCW AND 296200 WAC. <br /> `r. H V� SiuIATUREOFCONtRACiORORRL'iNOla .ORGENT DAiE <br /> H O p� — / <br /> _ X ��') <br /> J7� z �111,_ � i�� �J:_'t�_✓ 1�r,�� _„�.;7 " yP,(/!/�/�!f '- <br /> ��OJECiADDHE55 f��/t-�"_— }u� /''�_-7 — �� — <br /> .ICAN*SCILVIlUS'4ESSL�sE NO �NDBOSMESSNA6'�[ <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FI7(TURE OR ITEM FEE NO. TYPE OF E�UIPMENT FEE <br /> �� WpTER CLOSET(TOILEi� A C—A HNDLG UNITS—H.P. _ <br /> !� BATHTUB FORCCD AIR S`.'STEMS—B.T.U. M E.A. _ <br /> IAVATORY I�YASH BASIN� UNIT HEATERS—D.T.LL Id <br /> SHOWER CLOTHES DRYERS <br /> '`' — — <br /> KITCHEN SINK 8 DISP VENTILATION FAN� <br /> �! DISHWASHER RANGE HOOD <br /> �_AUNDRV TRAV ' WATER H[ATER _ <br /> CLOTHES WASHER T— WOOD STOVE <br /> .��, URINAL METAL FIFiEPLACE 8 CHIMNEY <br /> DRINHING FOUNTAIN FIR[PLACE INSERT <br /> FLOOR DFAIN REAT PUMJ <br /> � '�� __BACKFLOW PREVENT[RS GAS PIPING _ <br /> FOOP DRAWS—RAINLEADERS E%HAUST FAN <br /> SINK(SERVICE—BAF ETC.� <br /> '�1' __ _ � <br /> �Y� _��— <br /> ��� SUO TOTAL S SUB TOTAL $ � <br /> "� PERMIT � PERMIT S / <br /> TOT^.L FE= 5 TOTAL FEE S .30 ' <br /> FOR OFFICE USE ONLY: <br /> iNONTS[TpAGN RFiM5El0ACK ':�OLSETBACK VtANCNCCKNUAI[iER �EE �ECEiPiNO <br /> usezoHe imnnen VAC�NTSITE FEES _ VALUATION FEE <br /> OUILOING <br /> h'PEOfC0�if5AllOWAflIE iVPEOfCON9.At1Wl IXNruKr xoaPvlui�co•,:5 — — <br /> °"0pP PLUMBING <br /> SiZEO�OIOG NOAFSTOPIES ORSEMENT MECHANICAL 3Q <br /> UCCIIPqNGYLO/.0 FIPESPliNKIENSREOD HEIGIITLIMiiATION pODITIONALPLANCHECK <br /> OTHER <br /> REASON FOR SPRI4NlEP5 --i—� <br /> STATE�UIl01NG SURCNARGE <br /> w?ancur - r�nr�snvrnoveoor CITYOFEVERETT ououCwoRKs ; <br /> LOCALSALES , <br /> TAX CODE IS 3105 TOT/�.— �� i.— <br />