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APPLICATIO� FOR CONSTRUCT► JN PERMIT � <br /> TO BE COMPLETED IN BLACK INK—PLEASE PRINT <br /> BUILDING DEPARTtv1ENT HEATING SYSTEM: I�GAS ❑ELECTRIC ❑ <br /> 259-8H10 <br /> I I DEMOLITION I I COMBINATION � BUILDING I I MECHANICAL I I PLUMBING I I SIGN <br /> owr+em m�anunness arv zm r��one <br /> IEN�NI M�IL�OUf1E55 CIfY ZIP PIIONE <br /> MCIIIIGC�OfiDG51CNIFR M�I�ADDRE55 cIIY ZIP pNONE <br /> GEIJ:MLCOY.Ift�CiUfl MnIL�UURESS Cllv ZIP pHONE STATELICENSER <br /> L�L�6�PS /�Ly// F_��pf PE�ic/ [UB��J�Ece�TT l(1�+.��20f� 29/I-/b'/� LL6U//�1F 9//'�� <br /> lAEC114NIC�LCO�IIp�C70R M�IL��Df1E55 CIIY Z'P PHDNE STATEIICENSE! <br /> PLUM�MCCONiMC70(i M�ILADDRE55 CIIV IIP PIIONE STATELICE�:SE� <br /> CLASS Of WOBH ' <br /> I NEW � I ADDITION I I ALTERATION I I RFI'AIR ' I DEMOLITION ! I WOOUSTOVE/FRPL INSERT I] BUILDINO RELOCATION <br /> eor+mcr rensor+n'N/u riwr�e ruo. <br /> comm�crrniceorwoi�n _ ����Q1� /�D/l/� <br /> oescniee nronn nr+o sounne roornce ir+votveo <br /> SP#2z-92 _zq0 -/�/ � <br /> rnoroseouseoromiort+c i HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br /> S�NI�L��M/L f� /�j1 M —cJ APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT.ALl <br /> LEGAL�ESCf11PilONOFPROPEf11Y�5HOWN0ELOWORATTACHFOUHGOPIES� PROVISIONSOFLAWFANDORDINANCESOOVERNINGTHISTYPEOF <br /> WORK WILL BE COMr.cTEO WITH WHETHER SPECIFIED HEflEIN OR <br /> �or�_ e�ocK'� or — NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br /> AUTHOP.ITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br /> A � OTHER STATE OR LOCAL LAW REGULATINO CONSTRUCTION OfliTHE , <br /> PERFORMANCE OF CONSTRUCTION.THAT I AM AUTHORIZED BY THE <br /> S C GO^Id {�L 7 Z�_ �j(o S �i�'� OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br /> APPLIC�TION IS MADE AND 1 COMPLY WITH THE STATE <br /> CONTRACT S LAW 18. RCW AND 296200 WAC. <br /> I O i Al. SQ FT, I � So x — <br /> anaeetnooravss \} sk: mm�e s / onre <br /> 7� b � Z N�r ulC V ri G ♦ ��Cr( / C�trflU$INESSIICf11CFNL � <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM FEE NO. TYPE OF E�UIPMENT FEE <br /> WATER CLOSET(TOILET) � /VC—A/HNDLG UNITS—H.P. � <br /> Z, BATHTUB ; FORCED AIR SYSTEMS—B.T.U. M E.A. � <br /> � LAVATORY(WASH BASIN) � _ UNIT HEATERS—B.T.U. M � <br /> SHOWER CLOTHESDRYERS � <br /> / KITCHEN SINK 8 D�SP �_ VENTILATION FAN ; <br /> DISHWASHER � � RANGE HOOD � <br /> �' LAUNORY TRAY � W�TER HEATER � ' <br /> CLOTHES WASHER �__ $ WOOD STOVE � i <br /> �— <br /> URINAL METALFIREPLACE G � E Gr <br /> $ DRINKING FOUNTAIN FIREPLACE INSERT i <br /> �- fLOOR DRAIN $- HEAT PUMP <br /> BACI<FLOW PREVENiERS ; GAS PIPING ; <br /> ROOF�RAINS—RAINLEADERS �_-- E%HAUST FAN � <br /> —�— <br /> SINK(SERVICE—BAR,ETC.) _ ' <br /> --— � <br /> � <br /> — r- <br /> —— � <br /> — - � — � <br /> — <br /> � <br /> SUBTOTAI S _���___ _ SUBTOTAL $ — <br /> PERMIT $ � PERMIT S � <br /> TOTALFEE $ TOTALFEE E ' <br /> FOR OFFICE USE ONLY: /IS Z�//n <br /> FIiONT5E19�CK fiEARSETBACH � SI�ESEI�qCR �'L�Nf.HECHNUMOER FEE RECEIPJ 10. <br /> � ' �/S'-Ss' ��� �Z � � <br /> usezor+e iotnnen VAC�NTSIIE FEES VALUATION FEE <br /> ��Z S�7L Y _ pUILDING �% � � _ <br /> fYFEOfCONIS.�IlOWAOIF IYPEOfCONSI.AGIVAL o[curnrKr xo(+mrtlU�;emurs i <br /> .�\{/ lI ar , p�UhI81NG 77� <br /> SREOFOLD� NO.OFS70NIE5 B45EMENf MECHqNICAI ((/(/'! <br /> I55� 3F G a Z /�l V ' <br /> OCGUP�NCYIO�U iIf1E5PRNKLERSREOD IICIGIIiLIAlI1nTI�N ���ITIONALPLANCHECK �— <br /> nen^nr+r nsrniuniens <br /> -- �- RA�IU � � � <br /> STAIE BUIL�ING SURCHnRGE L/ � <br /> i <br /> INI�HEOV vi�us\elrrR(�VEDDY� CITYOFEVERETT PUBUCWORKS 2CJ ; ' <br /> N LOCAL SALES � <br /> 3/��q�/ TAX COOE IS 31L5 mrni � <br /> =-� <br />