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�. <br /> APPLICATION FOR CONSTRUCTION PERMIT � <br /> TO BE COMPLETED IN BLACK INK—PLEASE PRINT ��T <br /> HEATING SYSTEA7: U GAS ❑ELECTRIC U <br /> BUIIDiiJG DEPARTMENT <br /> 259-8810 <br /> DEMOLITION COMBINATION ! , BUILDING XMECHANICAL I I PLUMBING SIGN <br /> GW��LP MAILAOOPE55 CIiY ZIP PHONE <br /> � ':. l%�C• -- - � 27l�-Sst��i,� /'',Cr s ? z r u� o E �-S'_ v��l <br /> iE!IANi MRILNO�RESS ' GTY LP PNONE <br /> ARCMitECTORDES�GN[R MARADOHESS CITv 21P PNpNE <br /> GR+ERRLCONTRAGION MR:LRDDRESS LITV iiP PNONE STAiELICENSE� <br /> ,�hJcci,�?��j'�57Fi»S�OC h/c 20T"' �3EuFvvt G4�/ LVCvFlst�cYlRw <br /> MCCMANICRIGONLPACTOR MAILApONE55 CITY 2iP �PHONE SLAiELICENSE• <br /> p� � PLUMBINGCONTRACTOR MAIL�OOPE55 CIiY LP P110NE STATEULENS[� <br /> L•l <br /> A� x C1n550F WORN <br /> ,�y y'y'y 'JCNEW I I ADDITION I I ALTERATION ! I REPAIR I I DEMOLITION i I WOODSTOVE/FRPL INSERT I I BUILDING RELOCATION <br /> y �y� CONiAGT PERSON ANp PMON[N0. <br /> 2i <br /> FC n CONTRACTPPICEOFWOFK �22Y /l7Ey�L�_C,f���O�r� <br /> 0 .�� �ESCRIpEWORKRNOSCUM[FDpiAGEn1VOLVED <br /> � v,H 1�sT,xc ��tc 5'naiviscrlC�S r' <br /> r PRO�OSEDVSEO OUR�iNG I HEREBY CERTIFY THAT I HAVF READ AND EXAMINED THIS <br /> x 7,3 APPLICATION AND KNOW THE SAME TO BE TFiUE AND CORRECT.ALL <br /> [s7 O C+] pROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYr'E OF <br /> yd IEGAL0E5CPIPTIONOFPPOPERLV�SNOWNBEIOWORAiiALNFOURCOPIES) <br /> O H WORK WILL BE COMPLETED VlITH WHETHER SPECIFIED HEREIN OR <br /> H � g ior p�ocK or NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br /> �„ n AUTHORITY TO VIOLA7E OR CANCEL THE PROVISIONS OF ANV <br /> z �� OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br /> � y PERFORMANCE OF CONSTRUCTION.THAT I AM�UTHORIZED 8V THE <br /> x OWNER OF THIS PROPERTV TO PERFORAI THE WORK FOR WHICH <br /> H H APPLICATION IS MADF. AND I COMPLY WITH THE STATE <br /> gy <br /> �..� CONTRACTORS LAW 18.27 RCW AND 296.200 WAC. <br /> C']C7�n <br /> ��y y TAx �S7G _O -GL'L�•02d7 x�/ 7 // •?�` 2 <br /> O fn aawecT^a�ooness y q styn, r - � ��' <br /> 3 / // S/'j�� • UIVPu5iM165UCR¢Elq <br /> PLUMBiNG MECHANICAL <br /> NO. TYPE OF FIXTURE OFi ITEM FEE N0. TYPE OF EOUIPMENT FEE <br /> WATER CLOSET(TOILET) NC—NHNDLG UNITS—H.P. <br /> � BATNTUB FORCED AIR SYSTEMS—B.T.U. M E.A. <br /> I '_� LAVATORY(WASH BASIN) � UNIT HEATERS—B.T.U. M � <br /> --r— <br /> `� SHOWER ' CLOTHES DRYERS ' <br /> KITCHEN SINK 8 DISP ; VENTILATION FAN � <br /> —� '—T <br /> . DISHWASHER RANGE HOOD <br /> ' LAUN�RYTRAY WATERHEATER <br /> I �� CLOTHES WASHER � WOOD STOVE <br /> UfiINAL METAL FIREPLACE 8 CHIIy1NEV <br /> DRINKING FOUNTAIN FIREPLACE INSERT �_ <br /> ' � FLOOR DRAIN ; _ HE�T PUMP <br /> �I I BACKFLOW PREVENTERS i GAS PIPING <br /> � —�— EXHAUSTFAN <br /> � ROOF�RAINS—RAWLEADERS <br /> SINK(S6RVICE—BAR,ETC.) ' <br /> '�� — f NC�-DS �s2-;-� <br /> �� <br /> ---� <br /> SUB TOTAL 5 ' SUB TOTAL 5 <br /> � ' 1 PERMIT 5 —�— PERMIT 5 <br /> �� TOTALfEE $ <br /> TOTAL FEE $ <br /> FOR OFFICE USE ONLY: <br /> fRONTSEiBACK REABSElOALH Si0E5[i�nGK PLRNCNECHNUMBER FE[ p� RECEIPTNO. <br /> �C-�� 6 70. 7S� �nSU :_O <br /> usezone �oranen wcnHrsrte FEES VALUATION FEE <br /> BUILDING <br /> 11PFOfCONiS.AIlOW,1BlE IYPEOfCON51PCNRl Occwer[r xoofownuVGuxnS <br /> �, I �Jv� ��' �.� � ��° - � PLUMOING <br /> I II•� <br /> SiZ[o,F)pIDG. No.OFSTORi[S AS'M�E/Ni MECHANICAL ' <br /> IE�LZ'L� �'� 2 I�'�'� L_ <br /> OCCt1PANG/Y�LOAD FlPES1P,RNKLERSFE00 MEIGHTIIMItAtiON A�DITIONALPLANCHECK <br /> J�/� � l�L� SPRINNLEf7 � <br /> � <br /> P[ASONFORSPRItIXLERS <br /> STATE�UILDMG SUHCHARGE <br /> iNIDK[�Y PL�NSRPPROYEDBY CITYOFEVERETT PU�LICWONK$ <br /> ��/�,, ,)�� LOCAL SALES <br /> TAX COOE IS 3105 TOTAL <br />