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! <br /> APPLICATIC 1 FOR CONSTRUCT )N PERMIT � <br /> TO BE COMPLETED IN BLACK INK—PLEASE PRINT <br /> BUILDING DEPARTMENT � HEATING SYSTEM: J GAS U ELEC7RIC J _ I <br /> 259-8810 <br /> DEMOLITION COMBINATION BUILDING \ MECHANICAL PLUMBING SIGN <br /> O1YN MAiL ADD5i,55 � Cliv LiP PHONE <br /> ��.(.���to� ��/ � <br /> TLNANi MAILA DRE55 CIiY ZiP PHONE <br /> MCNITEGTOFpESIGNER MNLADDRESS GITV 21P PH�N[ <br /> GEN[RALCONTqqCiOR MAiLAODRESS CITY 2iP PNONE SiATEUCENSEa <br /> M[CNANiCALCONTRFLiOR M/II.FDDRE55 CITY DP PMONE STATELILENSE� <br /> PWMBING GONTRACTOR MAIL ADDRESS GTV ZiP PHONE STFT[UCENSE• <br /> CLASS OF WORN <br /> NEW ADDITION AIiERAT10N REPAIR DE1v10LITION WOODSTOVE'FRPL INSERT BUILDING RELOCATION <br /> � ��// O pj CONTACT PERSON AND f'HON[N0. <br /> CONTRFCI PRiGE OF WOPN • ! S ^�— <br /> D[SCRIBE WORK AND SOUARE FOOTAGE INVOLVED <br /> PROPOSED eoFeuaortuc �L i HEREBY CF.RTIFY THAT I HAVE REA� AND EXAMINED THIS <br /> < — �{�,� ��/7 Z� APPLICATIUN FND KNOW THE SAME TO BE TRUE AND CORRECT.ALL <br /> �tcn�oescRivnorvoFaaoreerviAHowne[�owonarTacHFouacoPiesi PROVISIONSOFLAWSANDORDINANCESGOVERNINGTHI3TVPEOF <br /> WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br /> �ot s�ocK oF NOT. TH[ GRANTII.G OF A PERMIT DOES NOT PRESUME TO GIVE <br /> AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br /> OTHER STATE OR LOCAL I_AW REGULATING CONSTRUCTION OR THE <br /> PERFORMANCE OF CONSTRUCTION.THAT I AM�UTHORIZCD k3Y TNE <br /> ON/NER OF THIS f ROPEFTY TO PER�ORM THE N/ORK FOR WHICH <br /> APPLICATION IS MADE AND I COMPLY N�!?H THE STATE <br /> CONTRACTORS LAW 1827�'CW��ND 296200 WAC. <br /> X ��^ ��"� ��-_3 O - `/'.� <br /> /PRQIEGT ADDRE55 5•cieieq[ o�i[ <br /> �\ �3'J'da - 3 ,�2 l�.+cse. 1�,�.��i « :n _ — <br /> � �(� f.IIVPi'SMFSSIi�.1�NGF�I'1 <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OP�TEM � FEE NO. TYPE OF EOUIPMENT FEE <br /> WATEF CLOSET (TOILET) A�C—A�HNDLG UNITS—H.P. <br /> BATHTUB FORCED AIR SVSTEMS—B.T.U. M E.A. <br /> LAVATORV(WASH BASIN) UNIT HEATEflS—B.T.U. M <br /> SHOWER CLOTHES DRVERS <br /> KITCHEN SINK 8 DISP ; VENTILATION FAN <br /> DISHWASHER RANGC HOOD <br /> LAUNDRVTRAV WATER HEATER <br /> CLOTHES WASHER � JOODSTOVE <br /> URINAL M[TAL FIREPL�CE 8 CHIMNEV <br /> �RINKING FOUNTAIN i FIREPL/�CE INSERT <br /> FLOOR DRAIN � HEAT PUMP —T <br /> BACKFLOW PREVENTERS GAS PIPING <br /> ROOF DRAINS—RAINLEADERS ExHAUST FAN � ��,� �*h y,,cv�( � <br /> SINK(S�RVICE—DAR,ETC.) <br /> i— <br /> i <br /> i <br /> � <br /> SUB TOTAL S SUB TOTAL S ' � <br /> PERMIT S PERMIT $ �S� � <br /> TOTALFEE $ TOTALfEE $ <br /> FOR OFFICF USE ONLY: <br /> FRONiSF.TLiPCH RGARSEi0AC1< SIDESETBRCN PLANCII��1Ai3� F[[ RECEIPTNO. <br /> 3 S <br /> us[ioNe �ornaen vaenNrsire FEES VALUATION FEE <br /> DUIL�ING <br /> iYPEO'f.ONi5ALl01'ipBlE iYPEOfCONSi.ACiUAL accuvz4cr voa�ox!w!n.��.ns <br /> enouc ?LUMBING <br /> 91EOFBLDG. NO.OFSTOFIES BASEMENT MECHANICAL 3b � <br /> �C�IIPANCYLOAp FIR[S�RNKlEFSfl[O'D MEIGMTLIMITFTION ADDI(iONHLPLANCHECR <br /> i <br /> SPRINKLER <br /> R[ASON FOR SPRINNlERS --T— <br /> STA7[DUILDING SURCHARGE <br /> iNrnKeev av,N,narAoveoov CITYOFEVERETT PUBLICWORHS <br /> LOCAL SALFS <br /> TAX CODE IS 3105 rora� <br />