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�R� <br />� <br />R <br />H <br />� H N <br />O � O <br />ro N H <br />� H � <br />°z � o <br />� :' R <br />t� y '1 <br />M rj <br />N <br />G O N <br />[� �y trE <br />H O ai <br />��� <br />� �� <br />1 j"'j <br />APPLICATIO.d FOR CONSTRU�T�JN PERM17 ''`�''°" <br />TO BE COMPLETED IN INK—PLEASE PRINT � <br />n��•r� � � <br />cnvor , <br />evereit I�{EATINGSYSTEM: !,JGAS I.]ELECTRIC J_____ __ 1 <br />BUILDING DGPARTMENT L— <br />259-8810 <br />DEMOLITION Y COMBINATION BUILDING MECHANICAL PLUMBING SIGN <br />�V�u� Mni�nom�[Ss ci�r ]iv �rrohE <br />��fiNESY RNo Ft?Rff �,.>,�. �oll W�'-h�r�l-�t'�NPti� �) L7.,i L_i2_!L�'%( <br />cnr ziv ruor�E <br />tln.�vt MnRPODnusS <br />nrv:�rul[GTORDESiGNFR MAiLA00PE55 CrtV ZiN •'^"^'- <br />Lllf/� — — <br />�111;IiiALCCWLRRCTOR MAIIADDRE55 CRV 21P PIIONE LICEN$[• <br />�-ius.,�� r,��n; �� �,. Nr�r, �f,n .cu ;=�fi brr �o � t�J �-5�- 9 y�_�c_��->c �y z��h <br />ilttuN�iGLCON1RPCiOR MAIL�DDHL55 GITY ZIP PHONE UC[NSE• <br />1`LWd�INGCONiRAGTOR 1AA':R�ORE55 OLY IIP PNONE LILENSE� <br />p f 3r��crc_� y,�i�`z� <br />�+�r 156�H,� �� <br />CLA55 OF 1YOHN <br />NEW ADDITION ALTERATION Y RE°AIR DEMOLITION WOODSTOVE;FRPL INSERT BUILDING NELOCATION <br />COHiRLT PEFSON PHD PMONE N0. <br />3�i 1%> ' i�.�_%�r•'v�� N/��2lia � s�. -9vsa <br />CGNI RACT PRILE OF WORK -. <br />Ct %RID(: WORN ANO WUARE FOOINGE INVOWEO <br />Fti ��Mnrc�: <br />t I Grtl U[SCR�PiION OF PROPERiV 5110W i. ELbW <br />It]t��_ BLOCK OF <br />Cl.�i�'fMoNi lil"iG��i.f <br />I��li(1Jf.Ci AO�RES$ <br />.7�' 11 W i! Hlr�(.'NN OR, <br />PLUMBING <br />'10 TYPE OF FIXTURE OR ITEM <br />WATER CLO�=f ITOILETI <br />LAVATORY � WAS <br />SHOWER <br />KITCHEN SINK 8 <br />DISHWASH[R <br />LAUNDRY TRAV <br />CLOTHLS WASF <br />UR�NAL <br />DRINKTG FOU� <br />fLOOR DRAIN <br />BACKfLOW PRE <br />ROOF DRAINS— <br />SINK ISERVICE- <br />SU� 70 <br />PERMI7 <br />TOTALF <br />FOR OFFICE USE ONLY: _ <br />FPONi5ET0�GK REARSEIpACK <br />❑ti[2ONE IOLARER <br />tM[ Of LON15. LLLOWRBI( iM[ Of CON51 �GN�L <br />92[OFBIOG HOOFSIDRIES <br />OGCUPANGYLORO fIqESCRNNL[RSREOD <br />REPSONfOPSPRINKLERS <br />ieineeev r�nr�sarrnovroev <br />FOIIR CqPIES� <br />I HEREBV CERTIFV THAT I HAVE RE�D AND [XAMINED THIS <br />AFPLICA?ION AND KNOW THE SAME TO OE TRUE ANO COFFECT. ALl <br />PROVISIONS OF LAWS AND ORDINANCES GCVERNING THIS TVPE OJ <br />WORK WILL OE COMPLETED WITH WHETHER SPLGFIED HEREIN OR <br />NOT. TNE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br />AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANV <br />OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br />PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br />OWNER OF THIS PROPERTY 70 PEFFORM THE WORK FOR WHICH <br />APPLICATION IS MADE AND I COMPLY 1NITH THE STATE <br />CONTRACTORS LAW 1827 RCW AND 2962U0 W�C <br />SiGNAiU��EO�CONiRAC10RORPUiMOtiiZEDAG[NT OPiE 7 _' t ;�` <br />,J� q i;:,L�!.C;i GOI:"�.�:i^.;�IT_0:1 <br />X .� ,��,/�_/�,,/��. L13: 1'IGI:L:�fID AV'�. <br />—,�� _.,G ,._,,...,�, t..�„� 9G'nl <br />nrrucm�tscrtvnusN[SSIIGENSENOAN0�U51N[SSNAM[ � ir)7 <br />) <br />NO. I TYPE OF EOUIPMENT FEE <br />A;C—A�HNDLG UNITS—H.P <br />FORCED AIR SYSTEAIS-8: <br />UNITHEATERS—B.TU. M <br />CLOTHES DPYERS _ <br />VENTILATION FAN <br />RANGEHOOD <br />GAS PIPING <br />8 <br />siues�roncr � i�iA�+o��cwumnom � rEE <br />vncnntsrte rcea <br />BUILDING <br />ocm��rr. nonexmr.su•,.s — . <br />�PMo PLUM�ING <br />BASEM[NT MEGHANICAL <br />HHG�rt uMrtnTiON ADDITIONPI PLAN :HECK <br />OTHER <br />STA7E P,UIL�ING SURCHARGE <br />CITY OF EUERETT ruouc wonks <br />LOCALSALES <br />TAX COUE iS 3105 TOTA� <br />SUB <br />7nTAL FEE <br />� I, <br />5 � <br />iE ctmr rvo <br />FEE <br />-�� <br />'_-- A/li� <br />