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APPLICATIC 1 FOR CONSTRUCT _ JN PERMIT ; ,.� <br /> � <br /> TO BE COMPLETED IN BLACK INK—PLEASE PRINT . �� <br /> HEATING SYSTEM: :J GAS �J ELECTRIC J _ __ __ - - I <br /> BUILDING DEPARTMENT I --- — �" <br /> 259-8810 / <br /> C':MOLITION COMBINATION �BUILDING MECHANICAL PLUMBING SIGN <br /> owi+r.n i.ini�nooHess cnv zir r��or:e <br /> � H ��Fi''IES v''1. O�N 3311 SNu� I�vE• Cvrz.�Tfw�. S'g�3 3N8- G�GS_ <br /> ro r�mnr„ rnnn nooaess cnv ,u� a��orve <br /> C � y ..r'ry�11f.10PDE51G'1[R MAILAD�PESS QIv :.iP -- � ����`�f - ����� <br /> N � � _ IIN 1 LT�6'1Z <br /> � �;E.tii/P�ALLONiHAGiO/q1 /A�I�M�LR�DRE55 �/ (/� CItY 21C PMONE STAIE4CENSEf <br /> bF] � �r I.I�IJ�C�` i�S7GKG�ON GSfJ (���I�Y �V�Z�`��•`� p110NE S��GY��TPiELICENSE• __ <br /> C� 7�i 2 <br /> � Q � PIUI!��NGCDNLRACiOl1 IA11lAUDRE55 CI1Y :�� ���C�IE $TATEIICENSE• <br /> .a <br /> C�ASSOf IYORN � <br /> N <br /> �+ � = NEW ✓ADDITION ALTERATION PEPAIR DEMOLITION WOODSTOVEFFPL INSERT BUILDING RELOCATION <br /> N <br /> y z -- CONi�CiPCR50,1MiDPHOtJFNO <br /> N H � d Cr, !�9/Z ,� <br /> cor+rnnc�rnicE cF woax � V 7� ��0� �� <br /> " o�scniee wonK n�vo sounne rooince i�vvowco 77/ —/Z �( <br /> � � r Il`�u?_,'�.��N ' �Ooi'fiuN 7D ��L�= -- <br /> y tv r r o r o s E o i i s�or o mioinc I HEREBV CERTIFY THAT I HAVE READ AND EXAMINFD THIS <br /> p r�n —yjti,� ��,�5 _ APPLICATION AND KNOIN THE SAME TO BE TRUE AND CORRECT.ALL <br /> �`����� PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TVPE OF <br /> LCGAI DE$CRiP11CN OF PFO('CHI�i 9101':1!t3Cl G1V 0{1 A1 iApM FO;R GOi'IESt <br /> 77 OF LO'f �' 'h'ORK WILL BE COMPLEiED WITH WHETHER SPECIFI[D NEREIN OR <br /> im e,ocrc __ or � NOT. THE GFANTING Of A PERh11i DOES NOT PRESUME TO GIV[ <br /> n AUTHORITY TO VIOLAIE OR CANCEL 7HE PROVISIONS OF ANV <br /> � E �� OF WT lal AS rn���J OTHER STATE OR LOCAL LAW REGULATING CONS7FUCTION OR 11iE <br /> ? PERFORIdANCE OF CONSTRUCTION.THAT I AM AUiHORIZED BV THE <br /> a�,pN�O yIOLE �VE. /N UGO�� � OWNER OF THIS PROPERTV TO PERFORM THE 1':ORK POR VJHICH <br /> APPLICATION IS �dADE AND I COI.iPLY \YITII THE STATE <br /> r?�F+�BE �GGES /7UDN � TO LV�E� CONTRACTOiiS LAW 1027 RCW AND 296.200 WAC <br /> --Vf�-. 15 a F �i�A�S — X ,'✓) `+; -t'-- j c. "' ,. l ��' � � `�� <br /> ���,�33i fss S� �v� . ��rr�a, _�y���c *� , �� z � -- <br /> �,��^ PLUMBING MECHANICAI <br /> NO. TYPE OF FIXTUFE OR ITEM FEE NO. TYPE OF E�UIPMENT FEE <br /> - WATER CLOSET(TOILET) A-0—A HNDLG UNITS—H P. <br /> 1 BA7HTUB _ _ _ FORCED AIR SVSTEMS—B.T.LL M EA. _ <br /> �� LAVATORY(WASH BASW) UNIT HEAiERS—B.T.U. M <br /> '�� SHOWER CLOiHESDRYERS _ <br /> KITCHEN SINK 8 OISP VENTILATION FAN � <br /> OISHWASHER <br /> qANGEHOOD �— <br /> LAUNDRYTRAY WATER HEATER <br /> � �,� CLOTHESWASHER WOODSTOVE _ <br /> � URINAL METAL FIREPLACE 8 CHIM1INEY _ <br /> DRINKING FG:INTAIN FIREPLACE INSERT � <br /> __ —r <br /> '�� FLOOR DRNN _ HEAT PUMP <br /> 1_� BACKFLO�N PREVENTERS _ GAS PIPING <br /> � ROOF DRAINS--RAINLEADERS E%H�UST FAN <br /> SINK(SERVICG—BAR,ETC.) <br /> J <br /> a-_ � <br /> _—_ --f— <br /> I1 SU6TOTAL 5 SUI3TOT�L 5 _ <br /> �I_� ' PERMIT S PERM1IIT $ _ <br /> TOTALFEE 5 TOTALFEE S <br /> FOR OFFICE USE ONLY: /�� �� �� � � � <br /> rnoutseioncH nennsrron���c� smesc�n� rinHa¢r,r:r�ug�n� � '�' �� __(� ��c��j�L��l�� <br /> 3 �' <br /> ZS' Zs ,�,,,��_ L <br /> usezo �ornacn,/ vncnHrsne FEES VALUATION FEE <br /> �� � ° _�gt .� �` 1�0�3U <br /> ��- T E�� � BUILOING L -�` <br /> i•%(Of CONIS RLION'P6lL ivP[OIL�I:Si AGIVFL n:u.rpr.� Au n�c::!u':.c'.b — -1 <br /> •j']b) •TI 1 �`�'i� /� ��. PLUMf31NG _� <br /> �Y�a -�r�v ,., <br /> 7[OPe G ��OOFstoRns o.�SP.�lN1 MECHANICAL �— <br /> $�4'SF ���fTll•1V r IJJ — — . <br /> �7-`k/�C- <br /> occuonNCY AaAD FiRESN�iNNlEn5nE0�0 r1Eic�rtu,�n�umLnc'u �D�ITIONALPLANCHECK ` <br /> /'1 �'U ,LT�� SPRINKLEfl <br /> RGSON FOR SPPINrcIEPS � <br /> SiATE�UILD�NG SUPCHARGE <br /> unnKeor rtnNsnrrno�;rnuv CITYOFEVERETT rUBUCwo�KS —'-- <br /> LOCAL SALES <br /> .q/ �y JM TAX CODE IS 3105 TOTA� ; Q <br />