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APPLICQTIOh F�R CONSTRUCTI.iN PERMIT' ��"°" <br /> r,�n E�r�Q��� TO BE COMPLETED IN INK—PLEASE PRINT � <br /> arv or <br /> eve rett ( HEATING SYSTEM O G�S ❑ELECTRIC ❑ ---� <br /> BUILDING DEPARTMENT <br /> 259-8810 • <br /> ' DEMOLITION COMBINATION BUILDING : MECHANICAL f 7 PLUMBING : SIGN <br /> �l.�c�E"CCAf'��.�oa�55 !A�[� !✓�� L�Exc:.�i' ��i1 9s�p/ �"a-a�z-� <br /> tEN�Ni M��l ADDA'S5 CITV 21P PNONE . <br /> �R�MITECTORDES�GNER MAIL�DDRES$ ��TY ziP �HO�E UC � <br /> GEN l�l COMT �GtO MaL AD�RESS GITV ZIP PHONE IIGCNSE� (��� Y� ' <br /> �c.o �D ��'N� Co.�sTR- �?�� �G!�T,��- 4��•O oR,e,o,�iX�eti L�s-�i�?� <br /> MEGHNIICI�LGGMJiR�CTOA MARADDAE55 GITY 21P PHCHE UGFf.SE� <br /> MUMBiMGGp/TN�GTOR M�R�ODRE55 QTV ZiP P�E IICENSE• <br /> LLASSOF WIXIK / <br /> ,� NEW C ADDITION .- ALTERATION f1 REPAIR .., DEMOLITION D WOODSTOVE'PRPL INSERT '.� BUIIDING RELOCATION <br /> �/y"� GONi�GT PEASON�ND CNONF NC. <br /> CANTIV�CTGRiCEOf WO�K /� Q / / •�� <br /> pES�q�Wp4;�NO Sd1�AE FOQTAGE�NVOLVED <br /> a��r � S,c;N� f���;�� Amo�, s����� <br /> anoroseo sEoveu��oina I HEREBY CFNTIFV THA7 I HAVE READ AND E%AMINED THIS <br /> APPI.ICATION AND KNOW THE SAME TO BE TRUF.AND CORRECT.ALL <br /> �Ew�p($�pIPTqNOf PNO�ERttISHOWNBELOM'OR�n�CHFOUNCAFiE51 PROVISIONS OF LAWS AND ORDINANCES GOVEANING THIS TVPE•OF <br /> WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br /> wr e�a�. oF NOT. THE GRAN7ING OF A PERMIT DOES NO7 PRESUME TO GIVE <br /> AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br /> OTHER STATE OR LOCAL UW REGULATING CONSTRUCTION OR THE <br /> PERFORMANCE Of CONSTRUCTION.THAT I AM AUTHOHI2ED BY THE <br /> OWNER OF THIS PROPERTV TO PERFORM THE WORK FOR WHICH <br /> APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> CONTRACTORS LAW 18.27 RCW AND 296200 WAC. <br /> SKiN�TlIHEOiGCNT ACTORORAUTNOH2EDAGENT D�TE <br /> �' �t�/u 4 /'aCh� Co.a�� <br /> �, �/I�•�., P7'/L 0 t /,bL/z/d r✓ <br /> PRO.IFGT�DUAE55 �pp���NTS C�TY BUSMES��CENSE NO��ND BUSMESS N�ME <br /> (R �4 G✓��''/ ST t'�c.�t�fi' <br /> ���� MECMANICAL <br /> pp, TYPE OF Fl7RURE OR REM FEE N0. TYPE OF EOUIPMENT FEE <br /> WA?ER CLOSET(TOI�ET) � A/�A/HNDLG UNITS—H.P. T <br /> BATHTUB ' FORCED AIR S`.'STEMS—B.T.U. M E.A. ' <br /> LAVATORY(WASH BASIN) UNIT HEATERS—B.T.U. M � <br /> SHOWER CLOTHFS DRYERS <br /> KITCHEN SINK 6 DISP � VENTILATION FAN _T_ <br /> DISHWASHER RANGE HOOD <br /> LAUNDflVTRAV ; WATEF HEATER � <br /> 'CLOTHES WASHER � WOOD STOVE ' <br /> URINAL ; METAI FIHEPLACE 6 CHIMNEY <br /> DRINKING FOUNTAIN � FIREPLACE INSERT �_ <br /> FLOOR DRAIN HEAT PUMP <br /> BACKFLOW PREVENTEflS GAS PIPING _ <br /> ROOF DRAINS—RAINLEADERS EXHAUST fAN <br /> SINK(SEFVICE—BAR,ETC.) <br /> i <br /> i <br /> SUB TOTAL 3 SUB TOTAL S G ' s <br /> PERMIT $ PERMIT 5 <br /> TOTALFEE S TOTALFEE S <br /> SD <br /> FOR OFFICE USE ONLY: nEceiarr+o <br /> FRONT SETB�CN REAR SETBACH SIDE SETB�CK PUN CHECK NUTA9ER FEE <br /> use ior�e lOT RRE� vnceNr crtE FEES VALUl.TION FEE <br /> BUILOING 3 , 1 ^ <br /> TYi'E Of CJN75 AIlOW�BIE TYF[Of LON4.AQW'� nc[uv�rKv x0 a D'MuixGuxrS <br /> ceav P�UMBING <br /> SRE OF BtDG NO OL STORiES B�SEMENT MECHA�UCAL <br /> A�DITIONAL PLAN CHECK <br /> OCGUPRNCY lOPO FlRE SPRNNIER$REO'D NEIGHi UMITPTION — <br /> OTHER � S�� <br /> qE�50N FOA$PRINKlEAS <br /> S7ATE AUILDING SURCHARGE <br /> INIPY.EBV PLP�ISFFPFOVEOBV CITYOFEVERETT PUBLICWOPKS <br /> LOCAL SALES <br /> TAX COOEIS 3105 rorni �► <br /> �y�. o� <br />