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� � APPLICATIQ''"` FOR CONSTRUCT��N PERMIT <br /> TO BE COMPLETED IN BLACK INK—PLEASE PRINT � <br /> V-"' <br /> BUILDING DEPARTMENT HEATiNG SYS7EM: �'G`AS J ELECTRIC J <br /> 259-8810 � <br /> DEMOLITION V COMBINATION BUILDING MECHANICAL PLUMBING SIGN <br /> OWNER �dqILADDRE55 Citt Zip pHpryE <br /> T'71�f�5 7^���.J�� i.ri�i Kclfk'd n�c �rF--=. ��� '3:�i %59- '63� <br /> TENI.NT IAqILADORESS �ITV ZIP PHpNE <br /> ARGMiECT OF DESI�ryER MAIL ADDRE55 CITY ZIV PHONE <br /> J1�MAy !d T�NY �h�•t A• !,K%�vE <br /> GENERALGONiR— ACipR� ifq��qpDR[55 GITV pIP PHONE STA1ElICENSE� <br /> G � O �`]7�iG�p� {?o.,E�N'39aB EYrTtEr [.�A, 9Bz03 5/4-b/5/ �77P�__ <br /> MEp1ANiCALCpNTRA�TOR MAILADDPE55 dTV ZIP PIIONE S7ATEULENSE• <br /> /UoT �<Na.�N y�T <br /> PLUMBINGCONiRA�Tpq� MAILAD�FE55 CIiY ZiP i'HONE STATEIIC[NSE• <br /> GYiliyF� TJ G./O�ZlL <br /> CONiRACi PRICE OF WORK - <br /> 1p�DD0. 7fl <br /> DESCRiBE WOPN qND SOUARE f00 i�GE INVOLV D �CT PEFSON r1N�yONE NO. <br /> ReMoct�.. oC �x-rut�� �� �8:��'��,rc�vnVE�x�s N _ i , . M. N.i�9-:�ge w. Z3!-�i�� <br /> �Y'�� p' �,.t''K' <br /> ���' i NEFEBY CERTIfY THAT I HAVE READ AND EXAMINED THIS <br /> PROPOSEDUSEOFBOIIDING APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT.ALL <br /> R�� �' � PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF� <br /> �e,n�oescaiPnoHOFraovearvisNowr�enowoAarrncHTwocoaiesi lYORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br /> ioT� oicen �2� oc 1FFN�u6ToN 5 1`'� NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br /> At7D/77LY✓ TU E✓E+eE7T, �4CCOR���✓Fr Tv r�.-07 AUiHOAITV TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br /> OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br /> ��-''J i j PERFORA7ANCE OF CONSTRUCTION.THAT�AM AUTHORIZED BY THE <br /> ,�.t�OS oF�n/oNOMiSy �.� �'ASNi.v4TUN OWNER OF THIS PROPERTV TO PERFORM THE WOflK FOR WHICH <br /> vnatei�a�io.Nmneea APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> � 55�_ 2 _ Q� - CONTRACTOHS LAW 18.27 RCW AND 29620D N'AC. <br /> GONSTRUCTION LURN LENOER.FDDRESS,iELEPHONE NUMBER <br /> PROJECT ADDRESS s,�„�,i,q� � � ��r� ��_ <br /> 1521 �11U432 avF Eve�z_-rr+ (A,fi 1ai:o1 ci,�e�s�r+essuc�r+srao <br /> PLUMBING MECHANICAL <br /> � NO. TYPE OF FIXTURE OR REM FEE NO. riPE OF EQUIPMENT FEE <br /> � WATER CLOSET(TOILET) AiC—AiHNDLG UNITS—H.P. <br /> � dATHTUB FORCED AIR SYSTEMS—B.T.U. M E.A. <br /> LAVATORY(WASH BASIN) UNIT HEATERS—B.T.U. M <br /> SHOWER CLOTHES DFiVERS � <br /> KITCHEN SINK 8 DISP ' VENTILATION FAN <br /> • DISHWASHER RANGE HOOD <br /> LAUNDRY TRAV WATEF HEATER � <br /> CLOTHES WASHER WOOD STOVE <br /> URINAL ; METAL FIREPLACE(WOOD BURNING) <br /> DFINKING FOUNTAIN FIREPLACE INSERT <br /> FLOOR DRAIN HEAT PUMP <br /> BACKFLOW PREVENTERS GAS PIPING <br /> ROOF DRAINS—RAINLEADERS � E7(HAUST FAN <br /> SINK(SERVICE—BAR,ETC.) , <br /> SUB TOTAL S SUB TOTAL S <br /> PERMIT 5 PERMIT $ <br /> TOTAL FEE S TOTAL FEE 5 <br /> FOR OFFICE USE ONLY: ,y ,� ; � <br /> FqONt SETBRCN PEAR SETB�CK / SIDE SET9ACK PIAN CMECK NIIMB[� FEE �D RECEIPi N0. <br /> p , �/ � � Z� <br /> use zorve �ot naea VACFNTSItE FEES VALUATION FEE <br /> f Z � VES . NO BUILDING -9 � u �- �//��j <br /> TrPFOiCON51 NOUFSTORIES ocaoRxcr imc�aw[u��iewi�s '� 5� /" `+' � <br /> �—IJ � ��J� t PLUMBING � <br /> J_ <br /> SREOFBLDG FIRESPRINKLEFSREO'D BASEMENT MECHANICAL ?/� ; <br /> 25t 5f ,? - res �o � �_�� <br /> oCr,UPnNc��ono FiREAtaauaEOD HEiGHTUMiiATioN ADDITIONALPLANCHECK <br /> �V 2'S � OTIiER <br /> RERSON <br /> S7ATE BUILDING SURCHARGE <br /> INTAKEBV PLAYSAPPROVEDBV CITYOFEVERETT PUBLICWORK$ y <br /> JN' LOCALSALES <br /> onre e� 3 � TAX CODE IS 3105 rora� 22 9 �.� <br />