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,—. ,-. , <br /> APPLICATI4.� FOR CONSTRUCT�JN PERMIT � <br /> TO BE COMPLETED IN BLACK INK—PLEASE PRINT <br /> BUII DING DEPARTMENT HEATING SYSTEM: I,�(f GAS U ELECTRIC ❑ _ <br /> ?.59-8810 <br /> I I DEMOLITION I I COMBINATION � BUIL�ING I I MECHANICAL f I PLUMBING I I SIGN <br /> owuen Nnr woness cnv zir r��ot+e <br /> TEN�N� MAILADDf1E55 CIfY 21P P/IONE <br /> :ACIIIIECiORDE51GNE0 MAILAODf1ES5 CIIY 21P PHONE <br /> L�GEN nnicor�mncion A1nIL�U0f1E55 GIIv 21P PNONE SiATELICENSE� <br /> L l3dicDr�c //l y// F_✓ED/P�Fit(_L!/Bi�.�lIE2_�'7T �,_Q�zot� 29o-i�i� c.c6vii.� 9/�� <br /> MEC�IANiC�LCONI0�CT0f1 MnILADORE55 GItY 2m PHONE SUTELICENSE� <br /> PLUMOWGCONIMCIOiI MML400f1E55 Giv 2iP PHONE STATELICENSE• <br /> anss or wonn <br /> I�NEW I I ADDITION I I ALTERATION I I REPAIR � I UBMOIJTION I I WOODSTOVE/FRPL INSERT ❑ BUILDING RELOCATION <br /> cor+rncr rcnsor+nNu ruo�r+7F rvo. A <br /> comm�crrniceorwonrc _��f-,e�V !'�/�/() <br /> UESCf11BE WOOK AND SOUnfiE 1'OOT�GE INVOLVEO <br /> S" 2Z-Y?_ .ZcJO -��/�' <br /> raoroseuuseoreuaoiNc / i HEREBY CEFITIFY THAT I HAVE READ AND EXAMINED THIS <br /> S/N(�LC ��y�/�,`1c5 ,L_ ��'PLICATION AND KNOW THE SAME TO BE TflUE AND CORRECL ALL <br /> LEGALDESCRIPtIONOFPqOPE0IV�51101YN�ELOWOfiATir1CNFOlIHLOPIES) 1 PROVISIONSOFLAWSANDORDINANCESGOVERNINGTHISTYPEOF <br /> WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEiiEIN OR <br /> iot_� e�ocK' or NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br /> AUTHORITY TO VIOLATE OR CANCEL TFiE PROVISIONS OF ANY <br /> Z A t OTHER STATE OR LOC`,L LAW REGULATING CONSTRUCTION OR�THE � <br /> * PERFORMANCE OF CONSTflUCTION.THAT I AM AUTHORIZED BY THE <br /> S C GO^IU I�L 7 Z� 5 OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br /> APPLICATION IS A1ADE AND I COMPLY WITH THE STATE <br /> CONTRACTORS LAW 18.27 RCW AND 296200 WAC. <br /> O 1`A (.. S F T ( x � - � <br /> PRQIEGTADDRE55 N� Siar+mm�E � �/� DaE <br /> 7�{D � Z I�P SE E1�E= C c��rnus,�[ss�,ct�sErro <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIl(TURE OR ITEM FEE NO. TYPE OF EQUIPMENT FEE <br /> WATER CLOSET(TOILET) � $ !vC—A/HNDLG UNITS—H.P. <br /> t BATHTUB FORCED AIR SYSTEMS—B.T.U. M E.A. ' <br /> 3 LAVATORY(WASH BASIN) � _�- UNIT HEATERS—B.T.U. M � <br /> SHOWER CLOTHES DRYERS � <br /> KITCHEN SINK 8 DISP �_ VENTILATION FAN ; <br /> DISHWASHER RANGE HGOD � <br /> �' LAUNDRVTRAY ; WATER HEATER � ' <br /> CLOTHES WASHER WOOD STOVE � Y_ <br /> URWAL L_ METAL FIREPLACE [> ' E, � ' <br /> � ORINKING FOUNTAIN FIREPLACE INSERT �- i <br /> �— <br /> fLOOR DRAIN _�_ � HEAT PUMP � <br /> BACKFLOW PREVENTERS ; GAS PIPING ; <br /> ROOF DRAINS—RAINLEADERS �— EXHAUST FAN —�— <br /> SINK(SERVICE—BAR,ETQ) � <br /> _ _ _— <br /> i <br /> _ � <br /> i <br /> i <br /> SUB TOTAL $ SUB TOTAL S <br /> PERMIT $ PERMIT E <br /> TOTAL FEE $ TOTAL FEE 5 ' <br /> FOR OFFICE USE ONLY: Z <br /> FRONTSETBACK PEARSEIBACK / SIDESEiOALK PLnNCNEGKNUMBER FE RECEIPT . <br /> Z�' y��s s ' .5.5— 3.�'/�32 <br /> use zorue ior nnen vncnNt srt� FEES VALUATION FEE <br /> ��Z 633 y cui�oiNc g � -" <br /> IYCEOiCONfS.ALLOWAOLE IYPkOlCONSI.ACIUAI acUrmlR NOMrn+fIU'+6Unn5 i <br /> �'/J _� nour � PW1.I�ING �� i <br /> SIZE OF OIDG NO.OF STO�IES 9ASEMENT MECHANIC�L [/�D� <br /> i 55� S G 4C �L ��/D <br /> � <br /> OCCUPANCYlOAO FlItESPRNNIERSPEO'D NEIGHiLIMIiAT10N �UDITIONALPLANCHECK � <br /> N zg ' _�A��U �o ; . <br /> �- <br /> aensorrFonsrnwKiens �� <br /> STAiE BUILDING SURCHAIiGE � • <br /> MT�NEBY rinNsnrrHoveuov CITYOFEVERETT pueucwonKs � �D' <br /> J�- LOCAL SALES � <br /> 3 � TAX CO�E IS 31U5 T�T�� _ /Z� � <br /> � <br />