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APPLICATI� .d FOR CONSTRUC710N PERaVI1T �� <br /> TO BE COMPLET� )IN BLACK INK-PLEASE PRINT �� <br /> i HEATING SYSTEM�. 1!GAS J EL[GTRIC J _ _ _ _ --=J <br /> BUILDING DEPARTMENT <br /> 259 E810 <br /> DEMOLITION COMBIIJATION BUILDING �YMECHANICAL PLUMBING SIGN <br /> - - �.,-.- <br /> M�ILACOiiE55 UiV ZIP <br /> '�'!!EP / -�JU � <br /> �c�c-ic c,�s .��G ��w �i,v - D,�' �ivfi-� 9�'�03 P��lS <br /> ifNANt <br /> MAiLA0DRE55 CrtV Z�P <br /> ARCNIiECiORDESIGNER MAIL�O�RE55 <br /> CIiY 21P PMONE <br /> ��n. ZiP PHONE STRTELICENSE• <br /> ,[NEMLLONiPACiOR MMLP�DRE55 <br /> i.�CLHA�N(iCRLCONiRAGTOR MAIL��ONE55 <br /> ��ry 21P PNONE SiRTEUCENSE� <br /> 1-3 O H v w�� ���y IIP PNONE STAiE LICENSC t <br /> `.0 � � oiUMBiNGLONTRACTOR MAIIADDRE55 <br /> �� y <br /> �1 y <br /> c�assor woae <br /> � yy NEW ADDITION ALTE(iATION REPAIR DEMOLITION WOODSTOVE�FRPLINSERT BUILDINGRELOCATION <br /> N � � CONIACTPERSONANDPMONEHO <br /> y H - <br /> y� Q CONLR�CT PFiCE OF WOAK <br /> O�O OESGPIBE WORH ANO SOURFL Pt�tAC.E 1NVOlVEO <br /> 'i7 H ^� <br /> y y r viacvcser �eo�ou��o�r�c i HEREBY CEF�TIFV THAT I HAVE READ AND EXAMINED THIS <br /> � O� �5 /J_NQL APPLICATION/4D KNOW THE SAME TO BE TRUE ANO COF7(�ECT A�L <br /> �r�` PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br /> y ty ��r;;n�u�;eniPno�vo�PAorenrr,sHowrvoe�owoaarr:�vvouneovies� yyORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEFLiN OR <br /> OH <br /> � n � i�,; ��o�K oc NOT. THE GR�NiING OF A PER1dlT DOES NO7 PRESl1ME 70 GNG <br /> N CT7 AUTHORIiV 70 VIOLATE OR CANCEL THE PROVISIONS OF ANv <br /> �` Cn, OTHER STATE OF LOCAL LAW REGULATING CONSTRUCTION OR 7NG <br /> z H 3 --- PERFOHMANCE OF CONSTFUCTION.THAT I AM AUTHORIZED BV THL <br /> 9 H Lz OWNER OF THIS PROPERTS TO PERFORM THE WORK FOR VJHICH <br /> t� <br /> �„� y . APPL�CATION IS MADE ANO I COL9PLV W�TH THE S1A <br /> l7 V1 CONTRACTORS LAW 1827 RCW AND 29G200 WAC. <br /> C�] Cy f/� � <br /> � e�� -- "-;-����Li �e..; /la � z- _ <br /> �O Uj PHO4GTA DPE55 _ --- - — <br /> �jyG �'1Gtv �ieb� Dt'- l�itz.e47r �Lufi ., , . .., <br /> PWMBING tdECHANICAL <br /> � FEE NO. TYPE OFEOUIPMENT FEE <br /> NO. TYPE OF FIxTURE OR ITEM � <br /> WATEA CLOSET ITOILET) A C-A HNCLG UNITS-NP. __ _ _ <br /> .- — FORCED AIR SYSTELIS-�T.�. M EA. _ <br /> � BATHTUB <br /> � �� LAVATOflV IWASH BASIN) UNIT HEATERS-L'TU. M __- <br /> _� . _ SHOWER CLOTNESDRYERS - - <br /> KITCHEN SINK 8 DISP VENTILATION FAN <br /> DISHWASHER RANGE HOOD —. <br /> • LAUNDRYTRAV WATEF HEA7ER __ <br /> I CLOTHES WASHER WOOD S70VE - - <br /> URI�AL METAL FIREPLACE 8 CHIMNEV <br /> DRINKING FOUNTAIN FIREPLACE INSERT <br /> PLOOR DRAIN HEAT PUMP <br /> �' ✓ GAS PIPrvG <br /> I ` 1 BACKFLOW PREVENTERS =_— <br /> � ROOF DRAINS-RAINLEADERS E%HAUST FAN <br /> SINK(SERVICE-BAR.ETC.) --� <br /> �� — <br /> I SUB WTAL S SUB TOTAL 5 ��_ <br /> ' PERMIT $ _ <br /> �1+' TOTALIFEE 5 TOTALFEE 5 � " <br /> FOR OFFICE USE ONLY: <br /> a[c[miHo <br /> {�JIliSEtpAGx REARSElOAGK SIDESEiB�CK PIANG� .'Nl1�Ea �tl <br /> i�,;,zou� �otnaen wcnr+Tsi�e FEES VALUATION FEE <br /> OUILDMG _ <br /> ��'�i01tONRALIOWRBLE tYPEOFCONSt.ALiWI �qouo� �oaori[u�.s.x,'s ---� � —— <br /> PWIABING <br /> �c[OF BtW. NO OF STOPiES BASEMENT 1AEGHANICAL ��� � . <br /> ADDITIONAL PLAN CHECN <br /> �'.LUPpNCYLOAD PINESPPNNLERSREOD HEIGMiIIA!ITAiIpN ' <br /> SPRINKLER � <br /> ___--�— <br /> ��IASON FOR SPPMKlERS <br /> STATE DUILDING SURCHARGE <br /> —T,,,,,,,ca, ��A�,s�o���o�m�r- CITYOFEVERETT PUBLICWORKS <br /> LOCAL SALES <br /> TAX COOE IS 3105 TOTAL <br />