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D �.���' �FOR CONSTRUCTI.�N PERMIT e°e�P« <br /> ,,,�E,,,,Q,��,� t991 BE �OMPLETED IN INK—PLEASE PRINT <br /> �„�oF MAR 4 e <br /> everet _ ....... ..... .......................... — <br /> BUILDING DE ���A��VERETT HEATING SYSTEM: U GAS ❑ELECTRIC ❑�(/�� <br /> 259-8810 it Counter o <br /> UEMOLITION � COMBINATION BUILDING xMECHANICAL I I PLUM@S:�G I I SIGN <br /> OWNC❑ IA�ILRDUIICSS QIY ZIP PIIOfl[ <br /> ,7ni.CQ• Sni. Cs. Ciar`}�v_v:c �ei.��1t 9f�zal <br /> iei+nNt n�nitnooness _,_/� eitt zm r��or:e <br /> 5n4����co�f if�.Co��o�!I-r/o4�1�EiLcrc[!`7Srto�_ <br /> nnc�urecionnesicnr:n um�noon�ss citr zm r�wr+e <br /> G��'r�r..k�Xs� z�ia Co/6Y /��� �'�ev�tf 9�zol 2.5'z-Z153 <br /> c�r+enn cor�innao� MhII�ODRE55 crtv ZII' PIIONE UCENSE� <br /> MECIUHIC" ONIR�CiOq M4R/DOR[55 CITY ZIP PIIONE LICENSE� 7 C <br /> ��i�coHmnc��Cf7 Mn��_L�QJ MG7[�/$I✓Y��e J�z-7� —6Jr��yLLL �/N/{GG' ' �3J�! <br /> c�nss or wonK -- <br /> � � NEW � '� ADDITION ' ALTERATION ! � REPAIR � I DEMOLITION � ' WOODSTOVEiFRPL INSEPT I I BUILDING RELOCATION <br /> CONiR�C:PRICE OF WO�N �OO� �ONi�C P�0^ON�NO P 1![NO. / / '] <br /> O[SCi110E W011K AND SOURRE FOpiAGE INVOIVED �Q R{�y es (� �����b ` <br /> � �fr,�-,.��..���++��M—�f/' ���� `i,F <br /> �noroseouseoF W/LD-IN. / I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br /> _� G` APPLICATION AND KNOW THE SAME TO BE TRUE AND CGHRECT.ALl <br /> LEC�lUESCRIPiIONOFPROPEHTY�5HOIYNBELOWOf1�I1pC11fOM�jC019CS1 PROVISIONSOFLAWSANDORDINANCESGOVERNINGTHISTYPEOF <br /> ior�_�Q���o�cen �O oF �jLC/G/! WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br /> NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br /> y� ,L AUTHORITY TO VIOLATE OF CANCEL THE PROVISIONS OF ANY <br /> //1Y S/1 . GO. �I ' �^7 OTHER STATE OR IOCAL LAW REGULATING CONSTfiUCTION OR THE <br /> n �y PERFORMANCE OF CONSTRUCTION.THAT I AM AUTHORIZED BY THE <br /> �� �/�, ,y_ �/�-� G'Ve OWNER OF THIS PROPER7Y TO PERFORM THE WORK FOR WHICH <br /> -/�gG� -G= APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> ('�^/ CONTRACTORS LAW i8.27 RCW AND 296200 WAC. <br /> Y�v(�,fDy ��e. Go,:_�� SIGNNUf1EOFf,ONiRnCIOf10RAU1110NIZ[p�GENT DA7E <br /> '�Y�� �� <br /> r��� �' 3�S- 7T� ��ZZ ��OD,� X //J %�__//�J��jyJ� (� q / <br /> rnaecr nnoHess =J���t:_�:s�(' l�f.P..< � ' 7 ^ / I <br /> 3�Z� B{" ✓G VGdC A�PdCANiSf,tlVpU5ME55UCEN5[NORNDBUS�NESSNRME <br /> PLUMBING MECHANICAL <br /> NO. TVPE OF FIXTURE OR ITEM FEE N0. TYPE OF EOUIPMENT FEE <br /> WATER CLOSET(TOILET) � NC-NHNOLG UNITS-H.P. , <br /> BATHTUB ; FORCED AIR SYSTEMS-B.T.U. M E.A. � <br /> _ LAVATORV(WASH BASIN) � UNIT HEATERS-B.T.U. M ; <br /> SHOWER � CLOTHES ORYERS <br /> KITCHEN SINK 3 DISP ; VENTILATION fAN � <br /> DISHWASHER � RANGE HOOD , <br /> LAU�DRV TRAY � W�TER HEATER � <br /> CIUTHES WASHER � WOODSTOVE ; <br /> URINAL � METAL FIREPLACE 8 CHIMNEY � <br /> DRINKING FOUNTAIN _ i FIREPLACE INSERT � <br /> FLOOR ORNN � HEAT PUMP � <br /> BACKFIOW PREVENTERS GAS PIPING � <br /> ROOF DRAINS-RAINLEADERS � EXHAUST FAN T— <br /> SINK(SERVICE-BAR,ETC.) ; � <br /> —-- � � <br /> � T <br /> 1 � <br /> T � <br /> 1 � <br /> � SUB TO7AL $ ; SUB TOTAL $ � <br /> PERMIT $ � PERMIT $ <br /> TOTALFEE $ ' TOTALFEE $ � <br /> FOR OFFICE USE ONLY: <br /> Ff10Nf5EID4CK REAli5Ef04CK SIDES[i[1ACH PUNCIIECHNUMUC.f1 fGE RECEIPiNO. <br /> Z C,S'[o Z <br /> USEZONE �ornnen vncnNrsne FEES VALUATION FEE . <br /> BUILDING � <br /> IYP[OffONI$11101VA91[ IVfEOfL01: " ACIUAI �pCeMv nnrvpw�LLINGUNIfS <br /> G9qP � <br /> PLUMBING <br /> i <br /> 512[OPOLDG NOAFSTORI[5 [fASEAIENI �— <br /> MECHANICAI � <br /> � <br /> OCLUi'�NCY lOnO r'N[SPRNKLE05 REOD IIGGIII LIMI1AilON �DDITIONAL P��N GH[CK � <br /> i <br /> i <br /> OTNER i <br /> i <br /> nensor+ronsrninn�.Ens — —� <br /> STATE OUILOING SUf7CHAfiGE ' <br /> nnnki nr---- rinNsnrrnov�nnr CITY OFEVERETT auoucwonks � <br /> - LOCAL SALES ' <br /> , �� L,�! TAX f.O�E IS 3105 70TAL ; <br /> — � <br />