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APPLICATIO�. FOR CONSTRUCT�JN PERMIT <br /> TO BE COMPLETED IN BLACK INK—PLEASE PRINT � <br /> BUILDING DEPARTMENT HEATING SYSTEM: I�GAS ❑ELECTRIC ❑ <br /> 259-8810 <br /> I I DEMOLITION I I COMBINATION � BUILDING I i MECHANICAL I I PLUMBING I I SIGN <br /> ownen �ananooness cirv zm rHor+e <br /> TENANi M41l�ODRE55 CIIY 21P PHONE <br /> �I1C111iECTORUE51GNEf1 M�ILAUDOESS CIII' ZiP PIIONE <br /> L�GEN O�LCONIRAC70R MMLAUOOE55 CIfV ZIP PIIONE SiATEIICENSE.• <br /> jdi - �27�� F✓FP�_-PF�i�� c,i,�� E✓,�,errr' /,dA. 9�20f� 290 /8��cau/,�•tE �/�b' <br /> MECIUNIGLCONIDACIOR MNL�DDPE55 CIIY ZIP PHONE $UTEIICENSEt <br /> PLUMBIN(iCONIMC70R MAILAO�RESS CIIY 21P PNONE STATELICENSEt <br /> CLASS OF WORK - <br /> NEW I I ADDITION I I AITERATION I I REPAIR i I DEMOLITION I I WOODSiOVEIFRPL INSERT ❑ BUILDING RELOCATION <br /> COtJi�CT PEfi50N ANU PIIONE N0. <br /> CONiIiACTPf110EOfY/OfIN ����v �Q/v� <br /> DF.SCIileE WORN ANu SOU�f1E i00TA0E INVOLVEU <br /> �1c0 -/�/ � <br /> PIlOPOSEDUSEOFBUILOIN/G n�J i HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br /> S/NI�LC [�q�A.�/GY �D.NCS .0 P� G� APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT.ALL <br /> LEGnLOESCBIPIIONOF PROPEO7V�SHOWN BELOY/ORATT�CHFOUR W E i PROVISIONS OF LAWS AND ORD�NANCES OOVERNING THIS TYPE OP <br /> WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br /> tor BIOCK� _ O NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br /> � / AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br /> 7b S A, C OTHER STATE OR LOCAL LAW REGUTATING CONSTRUCTION OR�THE <br /> PERFORMANCE OF CONSTHUCTION.THAT I AM AUTHORIZED BY THE <br /> S C CA^I� }'L 7(�O " '� �C� I �nrr OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br /> --'�-'-t` APPLICATION IS MADE ANC 1 COMPLY WITH THE STATE <br /> CONTRACT AW 1B2 i:W AND 296.200 WAC. <br /> IOT�AI. S FTI �(a5 x 37 <br /> PPQIECT AD011ESS S�aHnWnE E <br /> 2 ciirousm[ssikErrscMa <br /> PLUMBING MECHANICAL <br /> . NO. TYPE OF FI%TURE OR�TEM FEE NO. TYPE OF EOUIPMENT FEE <br /> . WATER CLOSF.T(TOILET) /( � � NC-A/HNDLG UNITS-H.P. <br /> BATHTUP I � FORCEDAIRSYSTEMS-•B.T.U. M E.A. � <br /> LAVATORY(WASH bA51N) / / � __� UNIT HEATERS-B.T.U. M ; <br /> , SHOWER � CLOTHES DflYERS T <br /> ' KITCHEN SINK 8 DISP - VENTIUITION FAN ; <br /> � OISHWASHER - RANGEHOOD --� <br /> �' LAUNDRV TRAY ' WATER HEATER - � <br /> � CLO7HE5 WASHER � � WOOD STOVE <br /> URINAL IdETAL FIREPLACE G � E � ' <br /> �, $. 7RINKING FOUNTAIN I FIREPLACE INSERT - ; <br /> � fLOOR DRAIN �. HEAT PUMP � <br /> RACKFLOW 1'FiEVENTERS ; GAS PIPING ; <br /> ROC1F ORA1N5-RAINLEADERS E%HAUST FAN J � <br /> . -i-- <br /> ' SINK(SERVICE-BAR,ETC.) ' <br /> — � <br /> . ; —�— <br /> � <br /> � i <br /> — � <br /> , � � <br /> � <br /> _ SUBTOTAI $ _�T__ SUBTOTAL $ . Q' <br /> PERMIT S PERMIF $ I <br /> TOTALFEE $ TOTALFEE $ <br /> FOR OFFICE US� t`NLY: -�- ��I,✓aZ t � � . Q.�CL <br /> FRONTSE�BACK REA(i�SETBACR SIOESBT04GK PLANCHECNNUMOER FEE flECEIPTNO. <br /> ' �a s t �s' 37Z6 �/ , <br /> usezoNe LOTAREA V�CnNiSITE FEES VALUATION FEE <br /> '�.- � / � nw�owc � �" !� � ' � <br /> trr�ovconis.m�owneie trreoicaNst.ncmnt occu�.xr eaacvnu�xc�nms , <br /> � J _ lff°"�' I — PLUidBING 7 � <br /> �L <br /> S¢EOFALDO. f � NO.OFSTOf11E5 BASEMEN7 MECHANICAL GJn � <br /> 1`t'65 Sf G � r� `� ' <br /> __;�6L�5 � <br /> OCGUPANCYLO�� FIf+ESPRNKLE0SIIEOD MEIGNRRAIVQION AUOITIONALPLANCH[CK i <br /> —��-�- N� � f?AI�I�_ �D ; <br /> NE/SON FOfi aPAINKiF.�'�5 <br /> STA7E BUILDI�G SURCHARGE �U� <br /> INiAHEBV �'lANSAPPOV�DOY CITYOFEVERETT pUeLlcwOnKS ' _Q � <br /> LOCAL SALES <br /> 3��,� c� TAX COUE IS 3705 T�T�i �� ; �8 <br />