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APPLICATIC ] FOR CONSTRU�T'-1N PERMIT � <br /> TO BE COMPLETED IN BLACK INK—PLEASE PRINT <br /> BUILDING DEPARTMENT HEATING GYSTEM: GAS J ELECTRIC J__ <br /> 259-8810 <br /> DEMOLITION ' ' COh'81NATION �BUILDING ti�MECHANICAL �LUMBING ! I SIGN <br /> OC:t1GR ldNL AD�PESJ CiIY li� PIION[ <br /> �B�N�/y /qGeq-.7.?/{uEk? L�,vN��o�J.a. 9�036 �.�ya� <br /> �����,1�,[Y� S � �.�����/a 3o�3�T ff� �� ��,���NT A P ��o�E <br /> �' �/ .ss-.�9sy <br /> A(1CNITECTOqDE51GN[R hNIL4DpRESS CILY ➢P PMONE <br /> G[NLRAI Ct'.Ni11AC10R l.1NL pUDPESS CIIY ZiP P10NE STqTE L�CENS[v <br /> �tr-�. �� ,Tr�mQ�i86 r�orHE���9�y_��9i.� bTAcozr/SoNf/ <br /> A1ECw\NICL'..001lTRACTOR 6bll�ADORE55 C Y ZIP PHONE SiAT[LILENSE• <br /> f��1.�arY�L�aTie�6 �6o%iaisi.-s� GoN�wa,o. ��l �ys-�9.�b Hm,P/ZNTy/.39-DC/ <br /> PWA19iNGSON'PALTOR M1IAILAU�RESS CIIY T ZIP PtiO4[ SiATEUGENSE� <br /> ,Q�AR P���a,�v� iii9 �'EivT,s��� �r o3t ���•yoao 6E�RP��Io� <br /> �TfinCi op!�E oF WoqN <br /> � <br /> �ESLqIB LVOFKANOSOUA9EfOOTAGEMVOLVE� CONIACTPERSONpNDPHONGNO <br /> �t_ p ,� �� s�.fT FRA o �� .��',�se�v - �oG -ys'/-�/�s"o <br /> ' �� % ' �« I HEREBr CERTIFY THAT I HAVE READ AND EXAMINED THIS <br /> ��/L�G��E oiNcFAM/L S� �G.�`j—r CE PAOV SION�S OF L�AWS AND ORDINANCOES GOVERN NG TH SRTYPE OF <br /> �ew�oescmanoNOFaaoPearrisNow eiowoanTrnairwocoaieps WORK WILI BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br /> SP # �I•/ ? NOT. THE GRANTING OF A PERMIT DOES NOT PRESUt�1E TO GIVE <br /> �or� eiocrc uF AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br /> ���_Q�_S�_� of .�� �y Tas 'JTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br /> 7—' PERFORA1AIvCE OF CONSTRUCTION.THAT I Ald AUTHORIZED BY THE <br /> �_ R / E„ �// - qOPpLICATIONISISRMADETANDPERCOMPLY WITOHKTHERSIATE <br /> rna�i rnx i c ruun�oe�— CONTRACTORS LAW 1827 RCW AND 296.200 WAC. <br /> � y� 8t y- y-oo / - �Jo9 <br /> WNSiHUC110NLOANLENLER.ADDRE55.TELEPNONENUMOER �/���Gi�'�✓1/"��� � ��— <br /> /,/ <br /> PROJECT A DRESS �� sica.ninr n.�c <br /> � � LIiYHJ".f$$l'ClNS[�:O <br /> � ._Jl_. <br /> PLUMBING MECHANICAL <br /> NO. TVPE OF FI%TURE GR ITEM FEE NO. TYPE OF EOUIPMENT FEE <br /> WATER CLOSET(TOILET) NC—A]INDLG UNITS—H.P. <br /> BATHTUB FORCED AIR SYSTEMS-6.T.U. M E.�. <br /> LAVATORY(WASH BASIN) UNIT HEATERS—B.T.U. M <br /> SHOWBR ' CLOTHESDRYERS <br /> KITCHEN SINK& DISP VENTILAIION FAN <br /> DISHWASHER RANGE NOOD _ <br /> LAUNDRYTRAV WATEF HEATER _ <br /> CLOTHES WASHER � WOOD STOVE _ <br /> UHINAL METAL FIRF.PLACE(WOOD BU9NING) _ <br /> DRINKING FOUNTAIN FIREPLACE INSERT �-��, � <br /> ___ _�� <br /> FLOOR DRAIN HEAT PUMP __ __ _ <br /> BACKFLOW PREVENTERS .T GAS PIPING _ <br /> ROOF DRAINS—RAINLEADERS ,� EXHAUST FAN __ <br /> SINK(SERVICE—BAR,ETC.) � — <br /> i —. <br /> SUBTOTAL S SU9TOTAL S <br /> PERMIT S PERMIT S <br /> TOTALFEE 5 TOTALFEE 5 —T <br /> FOR OFFICE USE ONLY: <br /> f'BOHTSETOACH R[4RSETHACK SIOESETBACK PLA'JCHELKNUA113ER F[E R[CEiPTNO <br /> —Za , Zo , �� �z5 N� �.. � � '�ld�� I 0 y� <br /> usemNe winnen vncnriTstte FEES VALUATION FEE <br /> I�-I g767 Yves No eu���wc �,�O,�-L ;S 'r�c) <br /> rm�arcausr. No.aFsroaiEs uc�:>,,r, ,.�,,o�o�,����a�.v�,s <br /> �-�� � -`2 � PLUMBING '��J � ��t� <br /> J — <br /> SiZEOF�I�G R4iE5PRINKLE(i5RE0'0 BFSEMENi MECHANICAL �(J(J � n�, <br /> Ivod sF r U ves ✓� — <br /> ��-�-� � ADDITIONALPLANCHECK --`- <br /> OCCUP�hCY l AD FIRE ALMM R[OD HEIGHT Uh11iATION <br /> � �J �� OTHER /� O�� <br /> REASON <br /> SLVEBWI.OINGSURCHARGE �� ��. � <br /> inrn.cn� a�nHsnav�o�oav CITYOFEVERETT pueucwor�Ks �J ; '7�' <br /> `f LOCAL SALES <br /> p�i� 5 6 y,� TAX COUE IS 3105 TOTAL �G�S ; 5�-! <br />