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APPLICATIQ : FOR COI�STRUC`Tf �N PERMIT �� <br /> TO BE COMPLETED IN BLACK INK—PLEASE PRINT ��%+�T <br /> I-- ----- — ----------- - –------------ — - <br /> HEATING SYSTE�4: J GAS J ELECTRIC J _ _____ _ <br /> BUILDING DEPARTMENT ---- � <br /> 259-8810 <br /> DEMOLITION COMBINATION BUILDING MECHANICAL PLUMBING SIGN <br /> owr,rn n�ai�noo�rss ci�v nv rucv�e <br /> /� �' ;-� r J > / . " i . .T S" � %' ,�.�t�-S'.�,�'S�1'.9�' <br /> ,�/ , .>.,r;/Is��r -;112� SF,b�, <,a��c_.4 " -- — <br /> lE�:�4i ( � MAILPDORE55 / U1Y 2�P 1'110N[ <br /> 1 PniEGiOR005IGNER IdAILA�DRESS LITV 21P PHONE <br /> ei:Yi:nnLCONiRPCTOR MAiIpDDRE55 UTY 21P PMONE STAtEUCENSE� <br /> 1.5P�ANiCALCONLRAC*OR MAiIA�DRE55 C�iv ZIP PNON[ SiATEIICENSEY <br /> � �� <br /> PIUVGtiGCONiR�CiOH MA:�ADDRE55 LI1V ZIP PHON[ SiAiEIICENSE• <br /> D �x <br /> q �� CPIiRnQFPIGEOFWORK <br /> h �a Cr- , <br /> yx�y C. Ri0 W/�t RrcANDSOVAR fOOiAfNNVOIVED / CONiACTPER50NPNOFNONENO <br /> Ifi y� ����'�G-� �� t / . /� . <br /> �{I H �{I ✓ i i .., ' . <br /> (A N <br /> � z� _ I HEREBV CERTIfV THAT I HAVE READ AND EXAMINED THIS <br /> Qy � craoroceouse ov awiowc APPUCATION ANO KNOW THE SAIdE TO BE TRUE AND COFFiECT.ALL <br /> O H PPOVISIONS OF LAlNS AND ORDINANCES GOVERNMG THIS iVPE OF <br /> H �g �[cn.ocscAicnor+oFrAoaenrr�sHownee�owonnrucHrv�ocorres� WORK WILlBE COMPLETE�WiTH WHETHER SPECIFIED HEREiN OR <br /> ,n,• n 3G� �J F� B a T� NOT. THE GRANTING OF A PERMIT DOES NOT PRESUIdE TO GIVE <br /> x H� �ot e�ocK ov J `�— qUTNORITV TO VIOLATE OR CANCEL THE PqOVIS10NS OF ANY <br /> � y — OTHER S7ATE OR LOCAL LA1V REGULnTMG CONSTRUCTION OR THE <br /> PEFiFORMANCE OF CONSTRUCTION.THAT I Atd AUTHORIZEC BY TH[ <br /> �"� y OWNER OF THIS PROPERTV TO PERFORM THE bVORK FOR WHICH <br /> gN APPLICATIGN iS MADE AND I COMPLY WITH 7HE STATE <br /> H <br /> �ty y rr,;v,i i.rne�o yumn[g,�v CONTRACTORS LA1Y 1827 qCW AND 29620G 1'!AC <br /> ��r ui!�% Y � —O`.3� — DOO`' /� <br /> �YJ CCNSIauGLONl04��L[NDERPVDqE55iClC�NOelCI:II510FR <br /> . '�,— ^ <br /> �� PRO ECT ADDRE55 X���fL���1/ "�"=� G � <br /> � �.�.`) , �t.'i[' OY'f' . C �e� ..G. � �— .r��.•,_ _ _ _— <br /> PLUM6ING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM FEE N0. TYPE OF EOUIPMEIJT FEE <br /> � WATER CLOSET!TOILET) � A C—KHNDLG UNITS—H.P � <br /> AATHTUB - � FORCEDAIRSVSTEh15--B.TLL Id EA. <br /> 1 �� __ LAVATORVIWASHBASIN) NITHEATERS—B.T.U. M __ _ <br /> , � SHOWER C�ORVERS _ _ <br /> KITCHEN SINK 8 DISP \'ENTRA71ON FAN <br /> DISHWASHER RANGE HDOD <br /> �—— <br /> � �� LAUNDPYTRAY WAIER HEA — <br /> CI.OTHES WASHER �YOOD STOVE <br /> , URINAL IdETAL FIREPLACE 000 BURNMG) <br /> ' DR!NKING FOUNYAI FlREPLACE INSERT <br /> � ' FLOOR DF7AIN I1EAT PUMP <br /> ��i �'�1 �ACKPLOW PREVENTER GAS PIPING __ <br /> ROOF DRAINS—RAINLEADER$ E%HAUSTFAN <br /> SINK(SERVICE—BAR,[TC.) � <br /> �=1 _— — — _ <br /> — —�__ <br /> ,_� SUB TOTAL c SUB TOTAL 5 <br /> � PERMIT 5 PER�dIT S <br /> TOTAL FEE 5 TOTAL FEE 5 <br /> FOR OFFICE USE ONLY: <br /> �R�It5Et0ACN R[AqSP�AC✓. SIDES[LOACK PlANC11FCH�lA'�L FCE HECPP�I:O <br /> 3 <br /> u�,i�;omc iornqtn vncnNTsn[ FEES VALUATION FEE <br /> i! VES �� NO BuaomG '//JT1 � — <br /> ?..rf(qCONSt NOOFSTOFIES occuvu.cr eao�-�:iniv.nv.�y ----_—'__._ —. _ _. —.—�c�!_�y—_ <br /> ecou� PLUM6ING <br /> sVl.O��LDG. FlRESPRMKLERSPEO'D 845EME�:t MECHANICAL <br /> i i VES � NO — � <br /> OCCIf'lNCY LOAp FlRE RUFId REOD MBGNT LIMITATION ADDITIONAL PLAN GH[CK <br /> OTHER <br /> nl�sOn — � <br /> STATE BUILDING SURGHARGE — ��L� <br /> ;v,<erm r:nm,nrrern�i�onv CITYOFEVERETT PU�uCWoaKs <br /> LOCALSALES � <br /> oa,F_ TAK CO�E IS 3105 Tnrn� i ,-l� ; :— � <br />