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�. <br /> t <br /> APPLICATI�,�I FOR CONSTRlIC7 .ON PERMIT �� <br /> TO BE CQMPLETED IN BLACK INK—PLEASE PRINT es�n' <br /> ��' <br /> i HEATING SYSTEh7: �J GAS J ELECTRIC LI . - - 1 <br /> BUILDING DEPARTMENT <br /> 259-8870 <br /> DEMOLITION COMAINATION BUILDING �MECHANICAL PLUMBING SIGN <br /> OWNER / NNLA/D�ORESS GiY �/ 1�v q�ONE <br /> ' � �� ..� �V�lrp:�� / n f70y �SOS Eur�- P// .�i�o, `7;�.U1 .z���j-�.��tr `— <br /> ENANT M1IAILAODRE55 CIiV ?I� PNONE <br /> �f�lf��?Yd51GNER"//lv`AILROOPESS �'PC ����vie ZIP PMONE <br /> S <br /> GENENALCONTFAG/IOR MAILAD�RE55 CITV ZiP PNONE SiRiEUCENSE� <br /> �Sr-r fOn ��_ �OwHE�� <br /> N[CH�NICAI CONTPACTOR MnIL qpDRESS LILY 21P PNONG STATE IIGENSE� <br /> ��� d w—�— <br /> PWMBiNGLONLRACi0f1 MRILAO�NESS GTY ZIP PNOHE STATELICENS[I <br /> C�H <br /> H «ASSOF WCRK <br /> y y p1 �NEW ADDITION ALTERATIJN REPAIR DEMOLITION WOODSTOVEFRPL INSERT BUILDING RELOCA7ION <br /> 4 <br /> GONLACL PERSON AND PIIONE NO <br /> � � CONiRPCiPR�L[OfWORN _ _ <br /> Fj"jJ �FSCRiBE 1YOBK AND 50UAFE FOOtAGE INVOlVEO <br /> �M�il ? .� <. ��.- �,i Y a.�i.`u�Y�✓ <br /> yNr m�oaoseouseoFomiort:c i HEREBY CERTIFV iFIAT I HAVE FEAD AND E%AMINED THIS <br /> x � 3 ��i� y_ �l1FC-�: APPLICATION AND KNOI'J THE SAME TO BE TRUE AND COFPEC7 ALL <br /> [sl O L*1 iccnioescaivnor� FPROPCRtV15HOYM0ElOWOHATfALMFWHGOPIES� PRO\'ISIONS OF LAWS AND ORDINANCES GOVERNING THIS TVPE OF <br /> 0 H d WOqK WILL 8E COMPLETEO WITH WHETHER SPEGFIED HEREIN OR <br /> H� ry iot e�ocn ov _ NOT. THE GRANTING OF A PERMR �OCS NOT PRESUME TO GIVE <br /> �� n AUTHORITV TO VIOLATE OR CANCEL THE PROOISIONS OF ANV <br /> 1-1 � O7HER ST.4TE OR LOCA'_LAW REGULATING CONSTRUCTION OR T�iE <br /> � y PERPOP^dANCE OF CONSTRUCTION.THAT 1 A1d AUTHO(iIZED BV THE <br /> �i OWNER OF THIS PROPERTV TO PERFOR.'d THE IVORK FOR VJHICH <br /> �N H APPLICATION IS MADE AND I COI.iPLV WITH THE ST4T[ <br /> �„� CONTRACTOR/g LAW�1g/,27 R W AND 296200 WAC <br /> ��O N _ % ,� ,% .�/ . <br /> �� ' � - - <br /> � x 4 ;v��= .t��� s�� �. <br /> H� �� PROJECI AODRE55 .... v�n �; ' � cn-[I / <br /> 0 <br /> �q�� r���. ��f�� ����N-� - <br /> .����.,,« ,:., ... <br /> PLUMBING MECHANICAL <br /> � NO. TYPE OF FIXTURE OR ITFM FE� NO. TVPE UF EOUIPMENT FEE <br /> � � WATER CLOSE7�TOILETI .��C-A HP:DLG UNITS-HP. <br /> � BATH'iUB FORCEDAIRSVSiEA1S-BS.U. M -CA. <br /> � �� LAVATOAV(WASH BASIt�) _ Q UNIT HEATERS-B.T.U. M <br /> SHOWEii CLOTHES DRYERS <br /> � KITCHEN SINK 8 DISP �VENTILATION FAN <br /> DISHWASHER RANGE HOOD —T- <br /> , � � LAUNDRV TRAY __� Wi\TER HEATER <br /> I `_1 CL0IHES WASHER _ WOOU STOVE _ <br /> � URINAL 1.'ETAL FIREPLACE 8 CHIMNEV <br /> � ORINKING FOUNTAIN FIREPLACE INSERr <br /> FLOOR DRAIN HEAT PUIdP —T <br /> ' BACKFLOW PHEVENTERS GAS PIPING <br /> I �� f100FDRAINS-RAINLEADERS E%HAUSTFAN <br /> �� _ SINK�SERVICE-BAR,ETC.) <br /> __ y 4�s�!_ i- a«„r� � C•o%....� 3vo�;_--- <br /> T <br /> SUB TOTAL S SU6 TOTAL 5 �y� ;� <br /> I_1� PEFMIT $ PERMIT 5 ir ; - <br /> ` TO�fAL FEE $ TOTAL FEE S f'"1'�- <br /> FOR OFFICE USE ONLY: <br /> FROMSRpACK ftEAR5E1Hn�e SIDESEIpACK PLANCHECKNUA�FEF fEE PEC[IPTNO <br /> 3C�3i <br /> usezorve �orna[n vncar�rsrte FEES VALUATION FEE <br /> BUIIDING <br /> iYPEOiCONIS.ALIOWABIF IYP[OVC�NSiALiORI wcv>eNGr NOO�.+.vc�=ixuwK — — <br /> "0L� PLUM�ING <br /> SRCOFBIW NO.OFSTORIES B.15EM[Ni MECHANICAL �i—s�i� <br /> OCGUVANCT LOAD FiHE SPRNntEPs 9t . HE�GNt Ln.ninmN ADDITIONAI PLAN CHECK <br /> SPRIN��LER <br /> HERSONFORSPRINNlEFS — — — <br /> T <br /> STATIi DUILOING SURGHARG[ <br /> iHrnKeor rinr�snncaovEoor CITYOFEVERETT ruouc�voaKs <br /> LOCAL SALc'S �— <br /> TAX COUE IS 3105 TOTAL 3 �- ,— <br />