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APPLICATIC _� FOR CONSTRUC7 >N PERMIT �� <br /> TO BE COMPLETED IN BLACK INK—PLEASE PRINT �r <br /> f HEATING SYSTEM: J GAS .J EIECTRIC :L�____�_- _ ____ __� <br /> BUILDING DEPARTMENT <br /> 259-8810 <br /> DEMOLITION COMBINATION � BUILUING MECHANICAL PLUMBING SIGN <br /> o�v:tR �,�pi�npoREss crtv 1�1' rr�oNl <br /> 1 . � - ' _ <br /> .I.. .��_ i���1i ,;� i� iv )r' � � �� f`Y'" �j�0i� '�..nV-;�vE`n'=�.� � J:. ._ �; i _�-?�' , " <br /> 1f3LtNt MAILROONE55 LIIY ZIP PMONE <br /> n�r,:�ntECtOR0E5iGNE(i MAIL�OORESS CIiV ZiP PHONE <br /> % F�-Es�;a+� Dc<� �� ;. `�1`6'�rx��� E�.'��rE�LI �� 7� ' - -'a '�� <br /> LGi�i[RnLCONTRRCTOR MAILR011ESS CItY )' �21P ' PHONE � STqTELiCEM1SE� <br /> ��,1 � '- i'�!= ^iU� LD. �� �7,1'" %04� �e(.L��i (7'F:9 �_� !n�C- a !'G/.�nl:' �EA�$�EC.'�;/��� <br /> NECHnNICALCONiRACTOR t1AILR0�RE55 CIiV ZiP P��06EV StAtEUCENSE+ � <br /> ��� PW61piNGCONiRACTOR �IAR�D�RE55 Ci1V ZiP ���01�[ 5*�*EUCENS[• <br /> A � x <br /> Q H <br /> 9 y y cussarwoan <br /> � � NEW ADDITION AITERATION REPAIR DEMOLITION WOODSTOVEiFRPL INSERT BUILDING RELOCATION <br /> - C GONiACiP[I15CNAHpPHOYFNO <br /> K o Q.?(C c!9 �Z/(n � <br /> H �I CON1qALi PFKE Of 1YOBK ,�� OO <br /> D[SCRiB[1YOPRRNDSOUAq[FOOTAGEM10lVEU � <br /> '�v"1 r• r-�s�e�. 4 �.Wi.h c S%G - -- <br /> � "�' •Pn0�O5ED 'SEOFBUR i c i HEfiEBV CERTIFV THAT I HAVE FEAD AND EXAMINED THIS <br /> � d �w�/ i �a APPLICATION AND KNOW THE SAM11E TO RE TRUE AN�CORRECT.ALL <br /> ON iecn�oescnivTroHovpp PERiVISHOWNBEIOWORAfTALHFWRCOViES1 f PROVISIONSOFLAWSANDORDINANCESGOVERNINGTHISTYPEOF <br /> �"� �� �or I eiocK S oF S k0`rE �}(��/ �= WORK WILL BE COh1PLETEU WITH WHETHER SPECInED HEREIN OR <br /> y�� n NOT. TH[ GRANTING OF A PEFP,tIT DOES NOT P�7E5 �ME TO GIVE <br /> x y� /-!rl� � `�"U � IJ � V'E T7 �UTHORITV TO VIOLATE OR CANCEL THE PROVISIJNS OF ANY <br /> � _ OTHER S7ATE OR LOCAL LASV REGULATING CONSTRUCTION OR 7HE <br /> x PERPOF7�dANCE OF CONSTRUCTION.THAT I AM AIITHORIZED PY THE <br /> �"�y - OWNER OP THIS PROPERTV r0 PERFOR�d THE WORK FOR CJHICH <br /> gy APPLICATION IS IdADE AND I C061PLY WITH THf STATE <br /> N <br /> O l7(/� CQ�TRACTORS LAW 1827 FCW AND 296.200 WAC. <br /> �� � \\ �/ <br /> ) �/� <br /> HOfO _ __ _ X•� ,I_� �/' L� II� 2p � C� l <br /> PPQIECTRDOA[55 , � '"" <br /> � =' lb �a �' �� n� � ` � E . --.,,,. ,.. ., — -- <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FI%TURE OR ITEM FEE NO. TYPE OF EOUIPMENT FEE <br /> � WATER CLOSET(TJILET� A C-A HNDLG UNI7S-NP <br /> � �_1 _ BATHTUB FORCEDAIRSVSTEMS-B.T.U. M E.A. �_ <br /> LAVATORV(WASH BASIN) UNIT HEATERS-B.T.U. M <br /> � SHOWER CLOTHES DRYERS � <br /> KITCHF.N SINK 8 DISP VENTILATIOII FAN <br /> . DISHWASHER RANGE HOOD <br /> � LAUNDRVTRAV W�TERHEATER <br /> I � CLOTHES WASHER WOODSTOVE <br /> URINAL h1ETAL FIREPLACE 8 CHIMNEY <br /> DRINKING FOUNTAIN FIREPLACE INSERT <br /> fLOOR DRAIN HEAT PUMP <br /> �� BACKFLOW PREVENTERS GAS PIPING <br /> ROOF ORAINS-RAINLEADERS ExHAUST FAN <br /> SINK�SERVICE-BAR.ETC.) 1_ <br /> 1 - <br /> �� <br /> —i— <br /> �� SUBTOTAL 5 SUBTOTAL S <br /> ����� PERMIT 5 PERMIT 5 <br /> . TOTAL FEE S TOTAL FEE 5 <br /> FOR OFFICE USE ONLY: <br /> FPONiSCiQACK_� REABSEIpACe 5'�D[5[LpAfH_. . PL0.N01ECKtNbBFB �F[ - NELEIPiNO <br /> 2s ?.S� �o'�.`7 5' 28/70 7L� �' ' . ,; 7 '�, ' <br /> useza+pe ior�nen vnc>rrtsne FEES VALUATION FEE <br /> fL� n./ D�o N� euaow� $� 21 � �T[�_� <br /> fVPEOf[ONIS RIINY.B4 ISPE�f t�':5�R:tOAI ttF:.�•.� .__. .. . --1-�—�-'-•� <br /> cxv,n '�:• PLU6101NG <br /> �AI — <br /> SRE OF BLDG HO OF SLORi[5 dlSEGEid IAECHANICAL <br /> 57U 5 I � <br /> OCCUPANGvIo�� FiP[SCNrIXlER5HE0�� HE�GHtL�1.nl.�➢ON A�DITIONALPLANCMECK <br /> / <br /> N N' � SPRIIlKLER <br /> REASON FOR SOqiHNLE85 — � <br /> STATE BUILDING SUFCNAqGE � � <br /> � <br /> unnnEer a�nr�sarrnovmin CITYOFEVERETT puoucwOaKs <br /> /].0 LOCALSALES ' <br /> �� �t�� TAX COOE IS 3105 TOTA� / 2 / ;'J(j <br />