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APPLICATIO� " FOR CORfSTRUCTI �N PERNlIT , ,.�_ <br /> TO BE COMPLETED IN BLACK INK-PLEASE PRINT ����� <br /> � HEATING SYSTEM: i.J GAS �LECTRIC Cl __ _ -- I <br /> DUILDIIJG DEP�RTI.9ENT � � <br /> �59 C810 <br /> DEMOLITION COMBIR'ATION BUILDING ✓INECHANICAL PLUMBING SIGN <br /> c,wv�a � ��nni�aooa[ss crtv z�P r��orv��— �S� - <br /> � � �I'IrX� JuNGE 40/ 1��2E���YE—��Y-,S'��. J. �v�ec�1�s,7o3 _ <br /> � TEN4Ni IARILADDF[R — Cliv ]iF FNONE <br /> p � N�LHIiLCIORDE5IGNEP MRILAD�RES� G*Y /iP PHOhL <br /> ��b���jpjpjp <br /> � Gf N[fAl CONTNAC40R MAIL R�DPE55 CITV ZIP PHONE SIRiE LICENSE• — <br /> N <br /> � IA��f N�Cn CONiRA�iOR M�ILAOpRE55 Cltt ZIP PNONE SiAi[uf[NSE� <br /> �� � _�i�i.✓r sct�F����✓/�1w,ea�y�1�.2_�94-z3ab—G'�cJ14ZT�_ <br /> (A PllIM01NGGU4iRAL10R 11AILNODRE55 CI1Y 2��' PIIONE SiA1LLIClNSCX <br /> H� <br /> OO� cuss onvonn � � <br /> H NEW ADDITION V ALTERATION REPAIR DEMOLITION . WOODSTOVE'FRPL INSERT . BUILDING RELOCATION <br /> M�A 'q/ ��/� CONiACT P[PSON ANDPIIONE NO. <br /> ���^^ CUNfBI.CTFRIC[OPWORh G.�(/(/ _. <br /> �y� Df SCnIDE WORN AN�50U4RE FOOiAGE INVOLI'EO <br /> �� w,orwEousEOFow�owu i HEREBY CERTIFV THAT I HAVE READ AND EXAtdWED THIS <br /> � APPLICATION AND KNOW THE SAIdE TO BE TRUE AND COHRECT.ALL <br /> @ f~q PROVISIONS OF LAWS AND ORDINANCES GOVERNING TNIS TVPE OF <br /> i.[GnL DESCRiPTiON OF PROPERiV�SMOWN BELOW ON ATTAGN�W R COPIE51 <br /> �R�� — WORK 7JILl BE COMPLETED WITH WHETHER SPEGFIED HEREIN OR <br /> iw BLOLK 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 LOCAL LAW q[GULATING CONSTRUCTION OR THE <br /> � PERFORMANCE OF CONSTRUC710N.THAT I AM AUTHORIZED 8V THE <br /> OWNER OF THIS PROPERTY TO PERFGRM THE WORK FOR WHICH <br /> APPLICATION IS MADE AND I C061PLY WITH THE STA7E <br /> CONTRACTORS LAW 7027 RCW AND 296200 WAC, <br /> llP l�r�.l �c�.��c���-� q-�7��— <br /> vnaectnooae+,s � � — _ °" _ <br /> -Y �:-�,:�•,, <br /> ! PLUMBING MECHANICAL <br /> I � ■ NO. TYPE OF FIXTUPE OR ITEM FEE NO. TYPE OF EOUIPMENT FEE <br /> �'a' WATEH CLOSET(TOILET� 0.C—A�HNDLG UNITS—HP I <br /> BATHTJB __L FORCED AIR SYSTEM1IS-6.T.U. h.��— <br /> 1 ' — _ <br /> I � LAVATORY IWASH BASIN) UNIT HEATERS—B.TU. M <br /> ��' SHOW[R CLOTHESDRVEPS <br /> � KITCHEN SINK 8 DISP VENTILATION FAN ' <br /> DISHWASHER RANGE HOOD —� <br /> � LAUNDRV TRAY �_ W�TER HEATLR <br /> '�� CLOTHES WASHER WOOD STOVE <br /> i �I URINAL A9ETAL FIREPLACE 8 CHIMNEY _ <br /> DRINKING FOUNTAIN FIREPLACE INSERT <br /> FLOOR OFAIN HEAT PUMP <br /> '�`� BACKFLOV!PREVENTERS 1S� GAS PIPING ' <br /> . �1 ' ROOF DFAINS—RAWLEADERS EXHAUST FAN �— <br /> SINK(SERVICE—BAR,ETC.) <br /> � — <br /> �� <br /> � SUGTOTAL 5 SUBTOTAL S <br /> .50 ' � _ <br /> PERMIT 5 —r— PERMIT S - <br /> Ir�� TOTAL FEE 5 TOTAL FEE 5 - - <br /> 1� <br /> FOR OFFICE USE ONLY: <br /> i PONi SETB/•CK REAF 5[1pACN 51�[SCipALN PI AH O�I CH NII�Ea� fEE RCGHPi NO <br /> � � �� <br /> ucczorve LOTAREA wcu�TsrtE FEES VALUATION FEE <br /> --T— <br /> owioir�c <br /> IrfCO!CONLS.ALIOWFBtE 7YPE0lCONSt.AL70Q o¢uw,ucr x0aex2��rvs��u — ' - <br /> cnow � pWId�ING <br /> F¢E OF BLD3. NOAF STORIES OASEMENT MEC4IANICAL <br /> OCCUPRNCYLOAD FlRESPPNKlER5RE0'D ME�GHTL�M�tATION A�DITIONALPLANCHECK <br /> SPRINKLER <br /> nCn50NFOiiSPPiNKLERS " --T- <br /> ST4T@ OUILUING SURCHARGE <br /> imrnKcov r�nr�snrPaaveoev CITYOFEVERETT ruoucwor�ns <br /> LOCALSALES <br /> TAX COOEIS 3105 TOTAL ' <br />