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APPLICATIC�I FOR CONSTRUCT'�N P�RMIT � <br /> . TO BE COMPLETED IN BLACK INK—PLEASE PRINT <br /> BUILDING DEPARTMENT HEATING SYST�M: iJ GAS J ELECTRIC J <br /> 259-8810 <br /> xDEMOLITION ! � COMBINATION ! i BUILDING I MECHANICAL i ' PLUMBING SIGN <br /> owr�ea ninanooaess <br /> � CITV IIP PHON[ <br /> '��tZf✓�- U/.'.. Ca rY �0 r3vi ',�.2/(, � v r�Y/ 5�;1o,i- 3" <br /> ) )( 2 � <br /> �`-��ANT IAAIL�ODRESS CITV ZIP PNONE � <br /> AqCHITECTORDE5IGNEF MAIL�DDRESS CITY 21P PHONE <br /> � GENEFAI CONTRACTOF MFI�qDDRESS QTY ZIP PHONE STATE LIC[NSE r <br /> _��s.�.r �/ ,... _( sr� ,.� .� � <br /> MECHq CAICONTRACTOR tdA1LA00R[SS CITY ZIP PHONE STATELICENSE4 <br /> flUh191NGCONiRACTOF MAIIADDRESS CIiV 21P PHONE STATELICENSE� <br /> CONTqALi PRICE OF WOqK <br /> �DESCRIBE�:'OAK AND SOUARE FOOTAGE iNVOLVEO CJNiACT PEii50N AND PHONE N0. <br /> - s�e ..... � /��_i� /, � S <br /> I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED iHIS <br /> 1'ROPOSEDUSE OF BW!�ING APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECL ALL <br /> PROVISIOMS OF LAWS A�D OPDINANCES GOVERNING THI°TVPE OF <br /> �ecaioesca�anouoFPNeaearv�sr�owNoe�owoNnrracMrnocoP�esi WORK WILL BE COMPLETED WITH WHETHEH SPECIFIED HEREIN OR <br /> � �or- � V etocrc oF NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br /> AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br /> OTHER STATE OR IOCAL LAW REGULATING CONSTRUCTION OR THE <br /> PERFOR�IANCE OF CONSTRUCTION.THAT I AM AUTHORIZED BV THE <br /> OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR INHICH <br /> rnacs�,Tnxi.o NUMoea APPLICATION IS MADE AND I COMPLY WITH THE STA7E <br /> � J 5 � 5' ' G U �I - O/ UD U � CONTNACTORS LAW 1827 qCW AND 296.200 WAC. <br /> LONSiRUCTi0NL0�NLENpER.ADDRE55.TELEPHONENOM9EB % <br /> ' /L `` / / (� t <br /> X�i�LtiC.( t (�-l� d �..Z - / �� <br /> PROJECT ADDRESS � scru.une ��r� <br /> t - <br /> . '� ii �, l e , o�<� ��..��s��«t�, t:.,.:, <br /> r PLUMBING MECHANICAL <br /> S NO. TYPE OF FI%TURF OR ITEM FEE N0. TYPE OF EOUIPMENT FEE <br /> N'ATER CLOSET�TOILET) ArC-AiHNDLG UNITS-H.P. <br /> BATHTUB FORCED AIR SYSTEMS-B.T.U. M E.A. <br /> LAVATORY(WASH BASIN) i UNIT HEATERS-B.T.U. M <br /> SHOWER CLOTHES DRYERS —T <br /> KITCIIEN SINit 8 DISP VENTILATION FAN <br /> DISHWASHER RANGE HOOD �— <br /> LAU�DRY TRA\' WATER HEATEF <br /> CLOTHES WASFfER WOOD STOVE <br /> URINAL METAL FIREPLACE(WOOD BURNING) <br /> DRINKING FOUNTAIN i FIREPLACE INSERT <br /> FLOOR DRAIN HEAT PUMP <br /> BACKFLOWPREVENTERS ; GASPIPING <br /> ROOF DRAINS-RAINLEADERS � EXHAUST FAN <br /> SINK(SERVICE-BAR,ETG) - <br /> —:- �-_ <br /> SUB TOTAL S SU3 TOTAL 5 <br /> _ PERMIT $ PERMIT 5 <br /> TOTAL FEE S TOTAL FEE $ —T- <br /> FOR OFFICE USE ONLY: <br /> FPONTSETBALN R[ARS[Tp4CK SID[SEiB4CH PIANCn�G(Nl1MB[R F[[ qECEIPTNO. <br /> / ��� <br /> usezoNe �orpaen vncnrvtsrtE FEES VALUATION FEE <br /> `- YES .^ NO pU:LDING ' <br /> rv1°EOFCONSL NO.OFSi0RIE5 ocGu��rvcr �,anor:[urt�6u�n5 i�_ <br /> caow PWMBING <br /> �— <br /> '.VEpFBLUG FlRESPRINHL[RSREO'U BASEMENi lAECHANICAL . � <br /> f- YES �-� NO _ <br /> /',4nppCVLOFD FIREnInqMqEO� HEIuNTLI'AIinT10N A��ITIONALPLANCHECN � <br /> OTHER <br /> <vAi _ <br /> _ — _ " T <br /> STATE BUILDING SURCHARGE <br /> ��� ev aur�snranoveonv CITYOFEVERETT PUBucwoaks <br /> LOCALSALES <br /> _ _ �.au TAX CODEIS 3105 I TO7'AL <br />