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8 <br />APPLICATIOt: FOR CONSTRUCT'r:`�� N PERMIT � <br />TO BE COMPLETED IN BLACK INK—PLEASE PRINT • � <br />BUILDING DEPARTMENT � HEATING SYSTEM: U GAS ❑ ELECTRIC ❑ �� ' <br />259-8810 <br />I DEMOLITION I_I COMBINATION I I BUILDING IJMECHANICAL LIPLUMBING ❑ SIGN <br />OWNEfl M41L ADORESS QLY ZIP ��, `_� � PHONE <br />t.�ec�ti-e> �vcEN�l.� 55��SeUN� �k�2 C—Jt�.'uY' '`�` � --r1-! 3c^ Z <br />1[ ANT MAIL�DDR[SS CIIY ZIP PIIONE <br />�BCIIIIEGTORDESIGNEB MAILA�ORE55 <br />cirv zm <br />GENEMLCONTR�CiUO MnIIA�Of1E55 CITY ZIP P110NE STATEUCENSE� <br />IdECNANICALCONTiiACTOR MAILADORE55 CITY ZIP PlqNE ST�IEUCENSE� <br />�LUM�INGCONTP4CTOf1 MAIL�ODRESS CI7Y 21P PIIC'E STRTELICENSE• <br />CL�SSOF WORK <br />� I NEW I I ADDITION I I ALTERATION I I RFP�IR I I DEMOLITION � WOODSTOVElFRPL INSERT I I BUIL�ING RELOCATION <br />cor+rncr rensor+nNo ri+w+� No. <br />ca+rnncT vnice oF wonK <br />OESCRIBE WORN AN� SOUAAE FOOTAGE INVOlVEO <br />. 1 11 � . . . . .. _ .., <br />PRO�'OSEU USG OF OWLDING <br />S rl� <br />ior <br />rnaecr <br />� <br />� vnorenrv is�owN oe�ow on nirna+roun coriesr <br />oiocK or <br />NO. TYPE OF FI%TUHE OR <br />WATER CLOSET (TOILET) <br />BATHTUB <br />LAVATORY (WASH BASIN) <br />SHOWER <br />KITCHEN SINK 8 DISP <br />DISHWASHER <br />LAUNDRYTRAV <br />CLOTHES WASHER <br />ly[�:�7:1�7:1il1@I <br />'� k� <br />PERMIT $ <br />TOTAL FEE $ <br />FOR OFFICE USE ONLY: <br />f1iONT5E78AC1: REARSEiO�CH <br />USE 20NE lOi ME4 <br />IYIFOfCONISALLOWnVLE IYPEai[ONSIAC' <br />SRE Of BIDG. KO OF SIORIBS <br />OLCIIPqNCY L04D <br />nr.nsoN ron srnir�Kiens <br />nirnec nr <br />FEE <br />nccvru¢r imaownu�uxiis <br />cnwr <br />9ASEMENt <br />FIRESPRNNLGRSfiEOD � IIEIGHILIMIIAIION <br />rinr�snrrnoveonr CITYOFEVERETT <br />LOCAL SALES <br />TAl( CODE IS 3105 <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br />APPLICATION AND KNOW THE SAME TO BE TRUE AND COHRECT. AlL <br />PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br />WORK WILL BE COMPLETED WITH WHETHER SPECIfIED HEREIN OR <br />NOT. THE GRANTING OF A PERMIT DOES NOT PRES�IME 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 AU7HORIZED BY THE <br />OWNER OF THIS PROPERTV TO PERFORM THE WORK FOR WFIICH <br />APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />CONTRACTORS LAW 18.27 RCW AND 296.200 WAC. <br />� }� 1 <br />X '�Il avs+.u.,,{-�, l°� 1`i. � 9( <br />s�GN��unc o�iE <br />NO. <br />A/C—NHNDLG UNITS—H.P. <br />FORCED AIR SYSTEMS—B,T.U. M E.A. <br />UNIT HEATERS—B.T.U. M <br />CLOTHES DRYERS <br />VENTILATION FAN <br />RANGEHOOD <br />WATER HEATER <br />FAN <br />BUILDING <br />PLUMDING <br />MECNANICAL <br />ADDITIONAL PLAN CIILCK <br />SPRINKLER <br />STATE OUILOING SUPCIIAfiGE <br />ruouc wo�Ks <br />TOTAL <br />SUO TOTAL $ <br />PERMIT $ <br />TOTALFEE $ <br />PECEIPT NO. <br />