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APPLICATIC�`1 FOR CONSTR�UCT )N PERMIT � <br /> TO BE COMPLETED IN BLACK INK—PLEASE PRINT <br /> BUILDING DEPARTM[NT �EATING SYSTEM: �GAS �,J ELECTRIC J _ l <br /> 259-8810 <br /> DEMOLITION COMBINATION � BUILDING MECHANICAL PLUMBING ' SIGN <br /> owuEn nini�r,00�+ess crtv [ia r�n�r:t <br /> Will;o,,.�i_�e�e 53o11�e�..>K��a��- }' �'er�1i q �,� �3 �S �i —GS-t/� <br /> TEN4Nl MAILADDRESS 7— p'V ZIP PHONE <br /> �NCHrtECTORDES�GNER MRiLADDPE55 LITY ZiP Ph!OYE <br /> �v� �-�li"�l� Gh�'l II(o}�1 AVk N� }31-1 L�1'U� \�/A �i�D4 �%O JSh2 rZk�LE-IT•15- <br /> \(�' NEFAL�CqNTPACiOR MAIL4DDRE55 CITV ZiP PHONE STAiE'.ICENSE� LC�Z� F� <br /> X (`',.U�'�Pi1/ <br /> �6{ECHniJiCnw�rvinn�ium m�iLqO0RE55 CITY IIP PNONE STqTEUCENSEM <br /> PLUM6ING CONTRACTOR MAIL AOORESS C�TY IiP PMONE SiATE LIL[NSE t <br /> ONTRaCi PqiCE OF 1VDRN <br /> �,o0 4 .00 <br /> � �ESCRIPE WORK AND SOUAPE FOOIAGE INVOLVE� CONTFGT PEFSON RND PHON[NO. <br /> ��� 4� h�Jr�II-tJv -�-o LxI�J1�NCh I')OUSI: ��Yt�Yt= �—L- 11'Z.K� �}�>U 0��2 <br /> U1�U2br7L �NSuI., �X��j��i.�(1G�<)(,I(�(� I HEREBV CERTIFY THAT I HAVE READ AND EX.4MINED I�HIS <br /> vaoaoseo use oF eui�oiNc APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br /> �IZ���t�(Sn.iG�$ . • PROVISIONS OF LAWS AND ORDINANC�S Gt,✓EFlNING THIS TVPE OF <br /> iecn�oeSCmm�or�oFaaoaEaiviSHOwnee�OwOnpTtacHiwOtOrieSi WORK WILL BE COMPLETED WITH WHETHER SPECIFlED HEREIN OR <br /> �or-<<'r�' � o�ocK pF I���i2f?c2 V 11=1V NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br /> � AUTHORITY TO VIOLATE OR CANCEI THE PROVISIONS OF ANY <br /> �1"J i I �'I ON OTHER STATE Ofl LOCAL LAW REGULATING CONSI RUCTION OR THE <br /> PERFORAIANCE OF CONSTRUCTION.THAT I AM AUTHORIZEP BY THE <br /> OWNER OF THIS PROPERTY TO PERFORM THE WCAK FOR WHICH <br /> APPLICATION IS MADE AND 1 COMPLY WITH THE STAT-F <br /> anaee�inz i o Nue+eea CONTRACTORS LAW 1827 RCW AND 296.200 WAC. <br /> CONST�UCTIONLORNLENOEF.ADDRE55 TELEPHONE NUMBER <br /> H � � � <br /> ' CLx���.,� �17 �'"-�'f,e , �3_�9�-/�', <br /> PROJECT ADORESS , u�vac nniF <br /> SD G A� ���7d l�+ nt nusir�csucnrsr r�a - <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM FE[ NO. TYPE OF E�UIPMENT FEE <br /> WATER CLOSE7(TOILET� A�C—A:riNDLG UNITS—H.P. <br /> BATHTUB FORCED AIR SYSTEMS—B.T.U. M E.A. <br /> _ LAVATOFY(WASH BASIN� UNIT HEATERS—B.T.U. M <br /> SHO'NER CLOTHESDRYERS <br /> KITCHEN SINK 8 DISP ; VFNTILATION FAN <br /> DISH WASHEF flANGE HOOD T— <br /> LAUNDRYTRAY WATER HEATER <br /> CLOTHES WASHER WOOD STOVE <br /> UHINAL METAL FIREPLACE(WOOD BURNING) <br /> DRINKING FOUNTAIN i � FIREPLACE INSERT <br /> FLOOR GRAIN HEAT PUMP �-- <br /> BACKFLOW PREVENTEFlS GAS PIPING <br /> ROOF DRAINS—RAINLEADERS EXHAUST FAN <br /> SINK�SERVICE—BAR. ETC.) <br /> ; <br /> sv <br /> SUB TOTAL S SUB TOTAL 5 <br /> PERMIT 5 PERMIT $ <br /> TOTALFEE $ TOTALFEE 5 <br /> FOR OFFICE USE ONLY: <br /> naor�r s��� aeaa sEr�' sioE sETen� ri.nH cr�E K rvuy�ea FE�� �� necEi T `c, <br /> l�r� ' 3a� .� <br /> usezoNe �oTnaen VqCANT5ITE FEES VALUATION FEE <br /> /Z.�' ��. YES �, . NO BUILDING � O D ' /C', <br /> 1V"F Of LOVSi NO OF STOPIES oc[dxvcr r.0 0°�wC.uqc uxrts - -1 � ' <br /> 'L ��0vc PLUMBING <br /> �r� <br /> SIZEO��LDG FIRESPRINKIERSR60'D BASEMENT MECHANICAL <br /> "ly `� N� - vEs �o <br /> ocCUPANCYLOno FlREntnaM��tOD HEIGNrurdQrtnnDN ADGITIONALPLANCHECK <br /> 1v U �v , OTHER <br /> afnsoN <br /> �— <br /> STATE BUILDING SUflCNARGE �;�i�/ <br /> s1 <br /> ��+,��en� a�nNsnvrr�oveoer CITYOFEVERETT PUHLICWORNS <br /> JI� LOCALSALES <br /> o�,e 3 2 S y TAX CODE IS 3105 rorn� <br /> Z ; � <br />