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APPLICATIG.�1 F4R CONSTRUC7.JM PERMIT �� <br /> � i� '�� TO BE COMPLETED IN BLACK INK-PLEASE PRINT � _�� <br /> , <br /> I HEATING SYSTEM: ��GAS J ELECTRIC J __. _ __ __ � 1 <br /> BUILDING DEPARTMENT <br /> 259-8810 <br /> DEMOLITION CONBINATION BUILDING �xMECHANICAL PLUMBING SIGN <br /> O\YNER A�NLA�DRE35 CItV Z�P PNON[ <br /> � - �. _.�`\ \?�C� S�`-�\C� �C.-.��-.-a� R��� � �—�� <br /> � �i �y IENANi AUILAD�RESS ` QiY 21P PMONE <br /> y � � AqCHRECTOR0E51GNER MAILAOOR[55 GTV ZIP PHONE <br /> [' H N <br /> H � S �ITY ZiP PMONE STATE IICENSE� <br /> y y M G[NERALCONTRAGTOR MNU�DPESS <br /> O CL O CiTY ZIP �J�J� STATE 4CENSE� � <br /> rp N H Id[CHANICALCONTRACTOR IAAILPD�RE55 ("� <br /> �y � y �c � �f-cl Q�� � � ��Y �� Zc?�.C_.�:y�. �Q 1� �l��C'� A�� li <br /> F�i+ PWMBiNGC04LMCiOB �dAiLA�ORESS GITY 21P � PHONE SiAiEUCENS[� I <br /> o � <br /> Ei <br /> p�j � p f.U550FWORN <br /> a M � NEW . ADDITION x�LTERATION EPAIR DEMOLITION WOODSTOVE�FRPL INSERT BUILDING RELOCATION <br /> y CONtACT PERSON AND PHONE NO <br /> � � y CONTflACTPRICEOFWORK T 1 ��'� -- <br /> N <br /> N �ESCRiBEWORKr1NDSOUAPEFOOiAGEINYOt1'ED � <br /> O N <br /> � � r ��� �C� �'�Q� . — I <br /> y y vno�oseousaoFaw�oinc i HEREBY CERTIFY 7H.�T I HAVE READ AND EXAtdINED THIS <br /> APPLICATION AND KNOVJ THE SAME TO BE THUE AND CORRECT.ALL <br /> o y icc,�o�Ni�TIONOFPROP(.OttISM01YNBElO\YORATTALHFOURCOPiE51 P�OVISIONSOFLAWSANDORDiNANCESGOVERNINGTHISTYPEOF <br /> WORK WILL BE COM1IPLETED WITH WHETHER SPEGFIED HEREIN OR <br /> ioT��a�G�_ e�ocrc E��_ oF �lC - O�.I�\� NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br /> AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br /> OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br /> PERFORMANCE OF CONSTRUCI ION.THAT I AM AUTHORIZED BY THE <br /> OWNER OF THIS PFOPEPTV TO PERFORAI THE WORK FOR WHICH <br /> APPLICATION IS MADE AND I CO'.�.PLY WITH THE STATE <br /> CONTRACTOR$lAW 1827 RCW AND'29620�WAC. <br /> �-�,�����c-c���',�S.•�F=-c-- +��2sa x �.1 s.�—�,L'::�?_Cs;Ccu C�'�i�c��- <br /> .��_ � <br /> PROJECTADOR[55 _�X. \ c�_.—' __ "__ _ "___ <br /> .r-.., __ <br /> ��� PLUMBING MECHANICAL <br /> �I NO. TYPE OF FIXTURE OR ITEM FEE NO. TYPE OF EQUIPMENT FEE <br /> WATER CLOSFT�TOILETI _ �C-A HNDLG UNITS-NP ___ _ _ <br /> � BATHTUB �_ FORCED AIR SYSiEMS-B.T.U:-�+§4: � <br /> � ,�� IAVATORV IWASH BASIN) UNIT HEATERS-8 T.U. M <br /> ��� SHOWER _ CLOTHESDRYERS _ <br /> KIrCHEN SINK 8 DISP VENTILATION FAN _, _ <br /> DISHWASHER RANGE HOOD <br /> LAUNDRVTRAY WATER HEATER <br /> CLOTHES WASHER WOOD STOVE <br /> I�� URINAL � 61ETAL FIREPLACE 8 CHIMNEY � � <br /> DRINKING FOUNTAW FIR6PLACE INSERT I <br /> FLOOR DRAIN HEAT PUMP � <br /> I10� BACKFLOW PREVENTERS GAS PIPING <br /> ROOF DRAINS-RAINLEADERS EXHAUST FAN <br /> SINK(SERVICE-BAR,ETC.) _ <br /> i <br /> !..� I _ I <br /> I� SUB TOTAL 5 SUB TOTAL S _ '-_ <br /> I � PERMIT 5 PERMIT S _� <br /> � �1�� TOTAL FEE 5 TOT�L FEE 5 <br /> � i� <br /> FOR OFFICE USE ONLY: i <br /> iRONTSET�ACK �EMSEi�ACK $IDESLICACK P�ANCI1[CNNUMpEN PEE i:(QI'iN0 i <br /> �j� L 7 <br /> usezove �ornnen �4GFNTSILE FEE VALUATION FEE <br /> ouaoiNc <br /> ivP[OfCONiSAIlOWA6lF lYPEO�tONStACiOPL oca�u:cr Foorc.:i�.�-.�•..i':is ---' <br /> �"D1° � PLUMOING <br /> T <br /> 9z[oF�LOG. NOOFSTOPiEs DASEMENT MECHANICAL <br /> � OCCUP�NCYLORD FIRESPRNKLERSREO'0 HEIGIIiLIMIiRtION AODITIONALPLANCNECK _ <br /> SPRINKLER t <br /> H[ASUNFORSPRINNIERS �— 1 <br /> STATE�UILOING SURCHARGE I <br /> ir�inK�ov r�nr�snvvnovcoov CITYOFEVERETT I'l1BUCWORN$ i <br /> LOCALSALES <br /> TAX CODEIS 3105 TOTAL <br />