Laserfiche WebLink
APPLICATIQN FOR CONSTRUCTION PERNiIT `'``'"'" <br /> �,, � , <br /> TO BE COMPLETED IN INK—PLEASE PRINT � <br /> arv ei"�� <br /> eve rett �HEAIING SYSTEId J GAS U ELECTRIC U_—— � <br /> BUIL�ING DEPARTMENT <br /> 259 8810 <br /> DEMOLITION COMBINATION BUILDING MECHANICAL PLUMBING SIGN <br /> IAAiIPDDF65 CIiV 1�� PHON <br /> (,.�,C�, W �a„1 �{3tb'- TQriucP o�/ ,� �T 5�42�3 � �Z� Y35 - - --- <br /> if.'�dtll <br /> MPLLP�DRF55 CITY JP P�iONE <br /> A��b�liWiOFOESGFCR M�Il�0�PE55 <br /> CIiV ZIP PNONE <br /> G(NERPLLONTNRCiOR MRiLAD�RE55 LIiY IIP PMONF UCE:iSE• <br /> !!tCNAHIULC06)�PCiDR / MPILAD�ii[55 CIiV 2iP PMON[ LICENSE• <br /> �J4fN1w.�-G,. 3//o f�i/� Adt t✓7 /`y2c�' ZS3'fldi Np,.-/�c�%/03 /1Z <br /> ��'y� N-w• ��r� Z�� �.,o�< «��SE <br /> I`IIIMBiNGCON1NALiOR MNLAD�11[55 <br /> �"- H C SSOF WORK <br /> 9�-7 tB �NEW . ADDITION ALT[RA110N REPAIR DEMOLITION WOODSTOVE/FRPL WSERT BUILDING RELOCATION <br /> y <br /> � � 1 r .q� � Q� ��� CO`JiACTP[RSONAN�PIID4EN0 <br /> lll�� <br /> y! Q CONiRACiVRICEOG1VOfn ����� <br /> y� �ESCaiBE wOnrc RNO SCU�Rt��xJT�����+vaveo <br /> �y� fa t�—W qvL � Rt,e <br /> �x� vi�s[ouseoremion�c I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br /> APPLICATION AND NNOW THE S�ME TO BE TRUE AND CORRECT.ALL <br /> C PROVISIl7N5 OF LAVJS AND ORDINANCES GOVERNING THIS TVPE OF <br /> O y Cy iecn�oescn °rior+o r�aorearr siwwr�eE�owoner�.cHvouncoriesi y.�URK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br /> .�n�y i��, Aia,c oF NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br /> H LC O AUTHORITV TO VIOLATE OR CANCEL THE PROVIGIONS OF ANV <br /> �" n OTHER STATE OR LOCAL LAW REGULATING�ONSTR'JCTION OR THE <br /> x�„� � PERFORIdANCE OF CONSTRUCTION.THAT I AM AU7HORIZED BV THE <br /> y y OWNER OF THIS PROPERTY TO PERFOF7IA THE WORK fOR WHICH <br /> t' H y _ qppLICATION IS MADE AND I COIdPLY WITH THE STATE <br /> �y CONTRACTORS lAW 1827 RCW AND 29G200 WAC. <br /> �..� SiGNAi0HL0[CONTPACiqRORPUiHOIaZE�AGCIi [14iL C//fl�� <br /> ��� -- X ►�� ►� -- <br /> H �y ri�a�ecrnoueess nrr�ucnr�iscrtvouswe ucEr�scr,omv�s�.,srtrtssrvneE <br /> 3� ' GU <br /> �. P W MBING MELHANICAL — <br /> N0. TYPE OF F�XTURE OR ITEM FEE NO. TYPE Of EOUIPhIENT FEE <br /> WFTER CLOSET(TOILET) A'C—A'HNOLG�!NITS—H.P. _ <br /> 1 p�THTUO FURCED AIR SYSTEMS—�.TU. M E.A. <br /> I �� LAVATORV(WASH BASIN) UNIT HEATERS—B.T.U_M _�__ <br /> SHOWEF CLOTHES DRVERS <br /> �. NITCHEN SINK 8 DISP VEN1lLATION FAN <br /> DISH WASHER RANGE HOOD _ <br /> . � LAUNDRVTRAY � WATER HEATER <br /> I �'• WOOD STOVE <br /> � CLOTHES WASHER <br /> URINAL ME7AL FIREPL4CE 8 CHIMNEY <br /> , DRINKING FOUNTAIN FIqEPIACE INSEflT <br /> FLOOR DRAIN HEAT PUMP _ <br /> �I `,_t BACHFLOWPRLVENTERS GASPIPINu _ <br /> ROOF DRAINS—FAINLEADERS EXHAUST FAN <br /> SINK(SERVICE—BAR.ETC.) � h�'u <br /> r <br /> —;-- <br /> �' --� <br /> o �' <br /> SUBTOTAL $ SUBTOTAL 5 �; _ <br /> �1 1� P[RMIT 5 __ PERId1T S __ �� <br /> ` iOTALfEE S TOTALFEE S <br /> FOR OFFICE USE ONLY: <br /> fROHiSR�ACK P[ARSETBAGK S�ESETBACN P1ANC11[CNNUMBER !f[ HEGC�Pi'AO <br /> usclor�e iotaaEp vncnrvTsrte FEES VALUATION FEE _ <br /> �UILDING <br /> iro[OftONLSAILOWABIE 1VPEOFCONS1�G10t1 o¢Fn�n�+ xoaowLuecue�s ----- — — <br /> PLUM�ING <br /> 91EOF6LOG. NOOfSTOR�ES BASEMENI MECHANICAL ys^ <br /> OCCIIPANGVLOAD FIPESPf1NKLERSREOD MEGMTIIMITAT10N ADDITIOIJAIPLANCNGGK <br /> OTHER <br /> — ---r— <br /> REASONFORSP9INKLERS <br /> STATE BUILOING SIIfiCHAHGE <br /> aunKenv vinusnrr�ov�onr CITYOFEVERETT PUBUCwoFiKS <br /> LOCALSALFS <br /> TAX COOE IS 3105 TOTA� YS����� <br />