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APPLICATIO�FOR �ONSTRUCTInN PERMIT �✓� <br /> TO BE COi��r'LETED IN BLACK INK—PLEASE PRINl <br /> ' HEATING SYSTEM: GAS ❑ELECTRIC ❑ —� <br /> BUILDING DEPARTMENT <br /> 259-8810 <br /> DEMOLITION COMBINATION BUILDING XMECHANICAL PLUMBING SIGN <br /> � , r I� mi nn ^�v iiP PnONE <br /> �� � K',���13o_y�W��dqt�i.�E�..���.3 as�-i�o��, <br /> TEN�NT r MAILADDRE55 QTY ZIP FnVNE <br /> ARCHITECT OR DESIGNER MAIL nODRESS GITY 21P PHONE <br /> G� E�+ERAI GONTRPGtOA Mnil ADDRE55 GTY 2�0 ���ONE STniE UCENSE <br /> NC'�r-i:�c �5-1��� h � i..i 3110-�i1� �ai� > � N:�r -� ��i�/-`733) ,IZT�I��IU'� 2� <br /> MECNAYICAL WNTRr1CiOd MAIL PDDRESS GTV 2iP PMONE STAiE LI�ENSE� <br /> PWMBINOCOMTR�CTOiL_ M�II�DORESS C�TV 21P �PMONE STATEUCENSE� <br /> �1/LI�(� S7� <br /> ���� <br /> p�eT PRICE OF WDfiN ' ^O . . <br /> \� <br /> �oG �i <br /> �ESGA�6E WORN AND 5 UARE�OqTAGE W VOLY D GONIAC��ENSON�ND PHONE NO <br /> � — <br /> � I <br /> � . '�-�.�--�`�— <br /> � � I HEREBY' CERTIFY THAT I HAVE READ AND E%�MINED THIS <br /> PROPOSED lISE OF OUILOMG � APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT.ALL <br /> PROVISIONS OF LAWS AND ORDINANCES GOVERNING THI$TYPE OF <br /> �ecaoea.n�ariOr+OFraoPeaTr�sHownoetowoaarrncM*'�ocoaiesi NOT THE`GRANT�ING OF A ERMITy OES NOT PRESUMEETO GNE <br /> �oT--- e�aK aF — AUTHORITY 70 VIOLATE OF CANCEL THE PROVISIONS OF ANY <br /> OTHEP. STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br /> PERFORMANCE OF CONSTRUCTION.THAT I AM AUTHORIZED BY THE � <br /> - OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br /> APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> „p,���_ _'. ln_ w h i � � D „�., /7�,� CONTFACTORS LAW 18.27 RCW AND 296.200 WAC. , <br /> lp•�latn � Y .. (.f"j 7 <br /> ^ � ���9�- <br /> WNSTNUCTIONLOANLENDER.AOOR SS.TELEPMONEHUMBER f <br /> Oni[ / <br /> PROJECTADDRESS "E - - I <br /> CiTVPU5�NE55nCEVSE u0 <br /> PLUMBIN4 MECIIANICAL <br /> N0. TVPE OF FIXTURE OR ITEM FEE NO. TYPE OF E�UIPMENT FEE <br /> WATER CLOSET(TOILET) A/C—AMNDLG UNITS—H.P __ <br /> BATHTUB � FORCED AIR SYST[MS—B.T.U. M E.A. <br /> LAVATORY(WASHBASIN) UNIT HEATERS—B.1 U. M <br /> SHOWER ' CLOTHES DRVERS I <br /> - KITCHEN SINK 8 DISP VENTILATION FAN <br /> DISHWASHER RANGE HOOD <br /> LAUNDRYTRAY WATE HEATER __ <br /> CLOTHES WASHER � WOOD STOVE _T_ <br /> URINAL METAL FliitPLACE(WOOD BURNING) <br /> DRINKING FOUNTAIN FIREPLACE INSERT <br /> FLOOF DRAIN HEAT PUMP <br /> BACKFLOW PREVENTERS GFS PIPING _ � <br /> ROOF DRAINS—RAINLEADERS EXHAUST FAN <br /> SINK ISERVICE-9AR.ETC.) __ ___, _ ____.__ _ " I <br /> --F— � <br /> ' <br /> SUB TOTAL $ SL'B TOTAL 5 --J�— I <br /> — PERMIT $ ___ PERMIT S _(S � ' <br /> _ TOTALFEE 5 TOTALFEE 5 I <br /> FGR OFFICE USE ONLY: aece�Pr ao <br /> FFOYTSETAACK REARSETBAGH SIDESETBACN PLANGM�EG�HfN�l1�M-B-E�R FEE I <br /> — WCANTSITE FEES� VALUATION FEE j <br /> USE 20NE LOT ARER � <br /> ❑ YES ❑ NO gUi�DirvG ' <br /> TVPFOfCONSi NO.OFSTORIES acmAHtr x00�mv[urvsuxrts 1 �I <br /> c°Wo PIUMBWG <br /> --T— <br /> SIZEOFBIDG FIPESPRINNlER5PE0D BASEMENT MECHANICAL , <br /> - VES NO — <br /> OCCUPANCYIOAG <br /> �IREALARMREO-D MEIGHTLi�AITAT10N ADDITIONALPLANCMECK <br /> OTNER __� <br /> REASON <br /> STAfE BUILDING SURCHARGE <br /> -�r;�nveev - �— ��nvsnrv��veoe� CITYOFEVERETT Puouewonks <br /> LOCALSALES <br /> �„r� TAX CD�E IS 3105 T�TA� <br />