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� � �I APPLICATIC ] FOR CONSTRIICT' �N PERMIT � <br /> TO BE COMPLETED IN BLACK INK—PLEASE PRINT <br /> � <br /> BUILDING DEPARTMENT C�'EATING SYSTEM: U GAS �.1 ELECTRIC .J —� <br /> 259-8810 <br /> ! DEMOLITION ! COMBINATION BUILDING ! f MECHANICAL PLUMBING iJ SIGN <br /> OIYNf�R IdAll/AODR[ S // � CiTV rIi�P �/ PHONL <br /> �.1L���A.G/� ���i-5T. ���� `7/^X—/(�n LL4,[, `7i�1'��! U�7�� <br /> T[NANf MAII ADDRFSS tiiY IIP PI�ONE <br /> ARCMITECTOROEStGNER MAILADDRE55 Gltt ZIF PHONE <br /> GENERALCONTRACiOR MAILqODRESS CITY 21P PNONE SiAiELICENS[� <br /> fdECHANIC41_GONTRACTOR MAILADDRE55 CITV ZIP PHONE SiFTFLICENSEt <br /> PIUMBINu CQNTR4C10R MAR pDDPE55 dTV 21P PNON�J -' STAiE IICENSE/ <br /> %/,�/�? C 1. "7 �- 'F .G'L �,�'� 9d'�7 /�-CL = y <br /> CONTRqCT PRIGE OF WOfiN <br /> DESCRIBE WONK AND SOURRE FOOiAGL INVOLVED CONtaCT PERSON AND PHONE NO <br /> Pi�,� - - <br /> I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br /> vnoaos��/e���u"""s�''e o/F�ouaoiNc APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br /> � �r.�/✓I Q� PqOVISIONS OF�AWS AND ORDINANCES GOVERNING THIS TVPE OF <br /> LEGaLDESCRI�tIONOFPROPERTY�SHOWNBELOWORATtACNTWOGOPIES� WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br /> NOT. THE GRANTING OP A PERMIT DOES NOT PRESUMF TO GIVE <br /> �.or e�ocK oF AUTHORITV TO VIOLATE OR CANCEL I�HE PROVISIONS OF ANY <br /> OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br /> — PERFORMANCE OF COIJSTRUCTION. TNAT I A1.1 AUTHORIZED B'/THE <br /> OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br /> APPLICATION IS h1A0E AND I COMPLV WITH THE STATE <br /> rnace�rnx i.o.rvun+eea CONTRACTORS LAW 18.27 RCW AND:96.2C0 WAC. <br /> CONS�RUCTIONLOANLENOER.AODRESS.iELEPNONENUMBER - <br /> �nii. {s-t._�.l �� <br /> PROJECTAD,DR7ESS � � ur.'.rvnny � ���, � o�r� � <br /> �.�J�� / 7 LiiYOVS,YF55VC!L.!I:o <br /> PLUMDING MECHANICAL <br /> NO. TYPE OF FI%TURE Ofi ITEM FEE ND. TYPE OF EOUIPMENT FEE <br /> WATER CLOSET(TOILET) A�C—A�HNDLG UNITS—H.F�. <br /> BATHTUB FORCED AIR SVSTEMS—L.T.U. M E.A. <br /> LAVATORY(WASH BASIN) UNIT HEATERS—B.T.U. M <br /> SIiOWER � CLOTHES DRYERS <br /> KITCHEN SINK 8 DISP ; VENTILATION FAN <br /> rl DISHWASHER � RANGE HOOD <br /> LAUNDRYTRAY WATEF HEATER <br /> CLO�:HES WASHER WOOD STOVE <br /> URINAL METAL FIREPLACE(WOOD BURNING) <br /> �RINKING FOUNTAIN FIREPLACE I�.",ERT <br /> FLOOR DRAIN HEAT PUMP �— <br /> BACKFLOW PREVENTERS GAS PIPING <br /> ROOF DRAINS—RAINLEADERS � EXHAUST FAN <br /> SINK(SEFVICE—L�AR,ETC.) <br /> � � <br /> "� ' �tfer %on�cf>Un ' --�— <br /> — — � —� <br /> SUB TOTAI S SUB TOTAL 5 <br /> PERMIT S PERMIT $ <br /> TOTAL FEE S TOTAL FEE $ —�— <br /> FOR OFFICE USE ONLY: <br /> FRONi5ET8�LH R[ARS[TDACK SID[SEiBhGK PLANCHECNNUMflER FEE fi[CEIPTNO <br /> (Zji <br /> usezoN[ to�naEn vncnNrsrte FEES VALUATION FEE <br /> C YES 'i7 NO puauwc <br /> iYPEOiLONSi. NO.OFSTORIES octucax[r nomn.vuuru4n5 — <br /> eio��o p�UA7�IN� <br /> SIZE OF BIDG. FIRE SPNINNLENS REO'D BASEMECT —� <br /> ❑ YES '. NO MECHANICAL — <br /> OCCUPRNCY IOAD FlRE ALAPM PEO'D NEIGHi LIMITATION ADDITIONAL PLAN CHECK <br /> OTHER <br /> P.[ASON —�— <br /> STATE BUILDING SURCNAflGE � <br /> ivin�eor rinr�snrr�oveoo� CITYOFEVERETT ruouewoaKs <br /> LOCALSALES <br /> onre TAX COOE IS 3105 TOTAL <br />