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APPLICAZ'IC" 1 FOR CONSTRUCT' �PI PERMlT � <br /> TO BE COMPLETED IN BLACK!NK-PLEASE PRINT <br /> BUILDING DEPARTMENT HeATING SYSTEM: ,�,GAS �ELECTRIC J <br /> 259-8810 <br /> DEMOLITION i COMBINATION X BUILDING X MECHANICAL KPLUMBING SIGN <br /> ewruea i.ina nooaess ciTv zir rHorve <br /> �j�/rr �Uin /'c; l'o�c 3.�//_ �vov.�l/ 9R,�o3 3 �7-76�.�- <br /> i[N� h'AILPODRE55 C�1Y DP PHONF. <br /> ARf,MREG*OR�ESIGNER 1GILqDDPE55 GITY 21P PHONE <br /> I�1l�:-VG�ilon DY��Y u'��'!g C�L•� I��nI0. n+vf2 C✓l�li�/f 4E',�1G�/ e25oZ- 9,200 <br /> GEN:RRLCONTRACTOR MAILADORESS CITY ZIP PNONE STATEIICEflSE• <br /> G' ��� �11$_��-/� /�nx 3 �l/ Fv�v�fJ� %R�03 �3�-7l��2 �o�4ti-�C��_��_� <br /> MEG A��ICALCONiRI.CtOR MAllA0DRE55 /� GiV 21P CIIONE STNtLICENSE�Y c� �.5 <br /> FYc'Y9r'�PAi S� }'P lI) .O�YIC'Ll'mI �SL�// �C4�AS/' rYl ,iOliP// �YJ.s�Grj o�5'� _ �//'y 5/� /K '1 <br /> PWMBING ONTRACiOR �dAILRDDR[SS GIT� ZiP PHON[ STAiELiCENSL� <br /> /�m v�-, ,� y i . Ii h 4� % , a 3 Y 3 s'-5's-�— <br /> LONT .CT PRICE OF\YORN // p <br /> a a s�� �o n �e.- IDS�Oc� c� - / � - ��-�- <br /> D[SCRIPEWOR NO OUIREFOOTAGEINVOWE�� CONTA PERSpNANDPNONENO. <br /> � / Cl i f � <br /> L �y � �- , i A v _ <br /> � � I HEREBY GERTIFV THAT I HAVE READ AND EXAMINED T41S <br /> PPOPOSE�lISE OF BUILDING APPLICATION AND hNOW THE SAME TO BE TRUE AND CGRRECT.AI.L <br /> PROVISIONS OF LAWS AND OFDINANCES GOVERNING THIS TYPE OF <br /> :cn�oeScaiPnoruoFraoaearvis��ownee�owoannncHTwocoaies; WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br /> �� �� Q�,�� �:� NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br /> wT--.-,-- o�ocK � oF AUTHORITY TO VIOLATE OR CANCEL THE PAOVISIONS OF ANV <br /> �n / ap(��� ���� 7'r� � e AIa �' 7_Ja.�// G F OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br /> '7 PERFORAIANCE OF CONSTRUCTION.THAT I AM AUTHORIZED BY THE <br /> OWN[R OF THIS PROPERTV TO PERFORM THE WORK FOR WHICH <br /> I��.C'D_Y�P�J�� V�Mr' ��' L'���-�`�9�-�� APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> P.4PCEL T�%I D.NUMO[R �/1 v C o� �o�}' CONTRACTORS LAW 10.27 RCW AND 2962D0 WAC. <br /> .3 `�a -�'JnH_ . <br /> LON51 RUCTION LOAN L[NDER.A�DRE55,i ELEPHONE NUMBEIi <br /> PROJECTADDRES�� se,vnni� '�—� ou� " ��'� <br /> � T7"�s C�IVPtlSiNFGSI�CINs�VJ �J <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM FEE NO TYPE OF EOUIPMENT FEE <br /> WATER CLOSET�TOILET) � AiC-A'HNDLG UNITS-H.P. <br /> BATHTUB FORCED AIR SYSTEMS-B.T.U. M E.A. <br /> � LAVATORV(WASH BASIN) UNIT HEATERS-B.TU. M <br /> � SHOWER CLOTHES DFYERS <br /> HEN SINK 8 DISP NTILATION FAN .r�i ' <br /> --i— <br /> � DISH 6 ER R ,E HOOD <br /> LAUNORY TRAY WATE EATER <br /> _� CLOTHES WASHER WOOD ST _ <br /> URIN�L METAL FIREPL C(WOOD BURNING) <br /> DRINKING FOUNTAIN FIREPLACE INSER � <br /> FLOOR DRAIN HEAT PL'MP <br /> --� <br /> BACKFLOW PREVENTEflS GAS PIPING <br /> AOOF DRAINS-RAINLEADEP.S � EXHAUST FAN +- , ,�( <br /> SINK(SERVICE-BAR,ETC.) � <br /> — � <br /> SUBTOTAL 5 '�� ;DO SUB fOTAL 5 �7' O, �� <br /> PERMIT $ p�D �OJ PERMIT S <br /> TOTAL FEE S ,� '/�1 ;00 TOTAL FEE S —T <br /> FOR OFFICE USE ONLY: L°_, � `' ' <br /> FRONiSETBACK FE�RSETB4CK SIDESE7BACN PIANCHE KNU �R FE�// � iECE�iNO �� <br /> use mr� tor a�e� � vacANr siiE F� VALUAT ON G � FEE <br /> �� / Qi 9�S �r: YES i ! NO BU�IDING O� �IC7Z. �f'IT)� �li ,) <br /> ivPEOiCONSi NOOFSTOPIES owvoµ�� r�00'VxauNCWrB <br /> /' � �caouo PLUIdAING a')a � t�'� <br /> V �— <br /> 512E OF�LW �9n FiRE SPPINNLERSRE00 BISEMENT ./ MECHANICAL a�'v �� i r� <br /> *" I�fO �- YES �O r <br /> � /�Cl. <br /> oC�, � t AD FlREA�n MREOD �! L NEiGriTuldlTniioN I ADDITIONALPLANCHECK J`� i(�, ; <br /> � �-�Q'�Y �V 7 � L� O7HER , , .. � � � <br /> HEASON � �� �� <br /> STATE DUILDING SURCHARGE � � <br /> iri.nKeev rinNsnr�rpvEoer CI'fYOFEVERETT PUBLICWORKS � - <br /> �M LOCAL SALES / <br /> onre� 4 _ IS -5`i TAX COOE IS�a'':; Tora� � 7 .- , <br />