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APPLI�ATIC'7 FOR CONSTRUCT'"�N PERMIT � <br /> TO BE COMPLETED IN BLACK INK—PLEA�E PRINT <br /> HEATING SYSTEM: GAS �J ELECTRIC �J � <br /> r .DIN(� DEPARTMENT <br /> �.,d-8810 <br /> ! I DEqIGf.ITION / COMBINATION BU�LDING fJ MECHANICAL ❑PLUMBING ; SIGN <br /> OWNER NAILADDR65 CITY ZIP PHOHE <br /> `�� ` �� po� 6� y� �i��8ao3 �+�-7 �s4 <br /> TENAN— T AD�R[SS GifY ZIP I— PMOIi[ <br /> ARCHRECTORDLSIGNER MAILADDRE55 CITY ZiP °'�ONE <br /> 7/'o���-ctu� -r2,r'n�,�� �s/Ki <br /> GLNEPRLCJNTFACTOP �� IAAIlADL1iE55 STATEIICENSE <br /> ���_� �,� P ,f3 �,,, o� y_��nv�tT(,,la 98ao3 3u� �iX�l <br /> ASEGHANICALCONIRAGTOR MF ODRESS CITV DP �'HONE ST4TELIC[NSLs <br /> P��JMBINGGONTRACTOR MFIIAp�PE55 CITY ZIP PHONE STFTEUCENSE• <br /> CORTPACi CR�CE OF IYOAN T� ^ <br /> �7 �U�J - _ <br /> DESCRIBE WORN AND SOU4RE FDOTA INVOlVEO CONiAC PER��D P 10 C� N�No , i ��� �rJ' � — <br /> +,.71ZfLL�l� �%�—f <br /> �� — — <br /> J Ci � /� � HERE6V CERTIFV THAT I HAv��. ��D AND EXAMINED THIS <br /> paoroseouseoFom�oiNc APPLICATION AN�KNOW THE SAME TO 3[TRUE AND CORRECT.ALL <br /> PROVISIONS OF LAWS AND ORDINANCES GOVEFNING TNIS NPE OF <br /> �e�n�oescaivuor+oFanorearvisNowrvee�owoanrrncNnvocories WORK WILL 8E COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br /> � NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br /> �oT� B�anS� oF �'--� - �UTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br /> �(,(J � N W '���5 � T �_�_LY_--- OTHER STATE Ofi LOCAL LAW REGULATING CONSTRUCTIOM OR THE <br /> PERFORMANCE OF CONSTFUCTION.THAT I AM AUTHORIZED BV THE <br /> NeX�- �p�f ICf �� ZOI O IF�n ��S S+ ' pWNER OF THIS PROPERTV TO PERFORM THE WORK FOR WHICH <br /> .:.��._t�— APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> aar+cei Tnx i o.rvurneeR CONTRACTOflS LAW 18.27 RCW AND 296200 WAC. <br /> N�W Ye,$ � I� y �nelr� In Ju� <br /> ONSTRUCTI0�ILOANLENDEN.FDDRESS.TELEPNONENUIdpER 9 - rz - 9 <br /> � IS))f,cOX � � -- oloil / <br /> i sicru*unr _— — osr[ <br /> PRO`ECT ADDRESS <br /> C' CIIY OL151N!S$LILf NSE NO <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FI%TURE OR ITEM FEE NO. TYPE OF EQUIPMENT FEE _ <br /> WATER CLOSET(TOiLET) � A'C—A'HNDLG UNITS—H.P. _ <br /> a 3ATHTUB _ _ (r9S FORCED AIR SVSiEMS—B.T.U. M E.A. <br /> LAV�ITORV(WASH BASIN) UNIT HEATERS—B.1.U. M _T <br /> SHOWER CI.OTHE-S DRYERS <br /> KITCHEN SINK 8 DISP VENTILATION FAN <br /> DISHWASHER _ RANGE HOOD <br /> / LAUNDRY TRAV WATER HE�TER_ <br /> 1 CLOTHES WASHER WOOD STOVE <br /> URINAL _ METALFIREPLACE(WOODBURNING) <br /> DRINKING FOUNTAIN _ FIREPLACE INSERT �_ <br /> FLOOR DRAIN HEAT PUMP — <br /> BACKFLOW PREVFNTERS ' Gi.S PIPING -- <br /> ROOF DRAINS—RAINLEADCRS � EXHAUST FAN <br /> SINK(SERVICE—BAR.ETC) _ -- <br /> �T <br /> � —�T <br /> SUO TOTAL $ Q �; SUB�OTAL 5 _� <br /> PERMIT S PERMII� S _ <br /> TOTALfEE S TOTALFEE 5 �_ <br /> FOR OFFICE USE ONLY: <br /> ,.. rtFCEiPrr� <br /> PUq L��F. c NUMHER FEC <br /> FROHT�LTBACK� REARSETO� / SiDE5L1BPGN _ �� ,)�f �� //) `� �� <br /> 7 7 � L, <br /> V d <br /> US ONE ��T�A� <br /> VACANTSiiE FEES VALUATION FEE <br /> � �I� � .-- YES - N� BUiLUING 3 � ':J C <br /> L <br /> ivM�(LONSt NOOFSTORIES oc-'�`>i:.+ uoc.r,..ur,v,�s — �/1; <br /> _ J � PLUMBING _ �� <br /> /_ i <br /> S�ZFOF�LIXi FlRESPRINNLEPSREOD BASBdBdi � MECHANICAL _�� <br /> IZ SF � CJ �:-.� YES �I/NO — i,/; i ,n <br /> ADDITIONAL PLAN CHECK _��,(�y� <br /> OCCUP4GGYlO�D FlREALARIARWD HEIG11ilI�dliAtlON 1 _ /� ' <br /> 7 / <br /> � V� —___ OTHER �i. N/} .� — i <br /> !�V V <br /> R;ASON STATEUUILDINGSURCHARGE ���� <br /> INTAN6BY PI�NSAPf;fiOVCOC� CITYOFEVERETT PU6LICVJORK$ ,������ <br /> `�.��� LOCAL SALES <br /> p,,,� Z� � TAX CODE IS 1105 rorn� �J��lj <br />