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APPLICATIG.J FOR CONSTRUCT.,lN PERMIT � <br /> T7 BE COMPLETED IN BLACK INK—PLEASE PRINT <br /> BUILDING DEPARTMENT HEATING SYSTEM: J GAS J ELECTRIC J <br /> 259-8810 <br /> X DEMOLITION COMBINATION x BUILDING MECHANICAL PLUMBING SIGN <br /> 01':N[R 61All�DDRESS CrtY 2�P PNONE <br /> ��c�ms��. �� �tiT�ef. ��f�irr, w�. �e���-�Sz� ?�6 3�8 9513 <br /> TErun t M anoDaess eirv zia r�� r�e <br /> �iAm� <br /> ARCHIiECi0RDE51GNE M4R�D�RE55 CIiY ZIP PHONE <br /> ���c,r i�z� 61x wti �1 �anaS ,t�+• 94,109 �od Z���oo <br /> GGN[RALCONiRACTON IAAILADDRE55 CITV ZiP P��ONE STAIEIICENSEb <br /> IJECMANICALCON1i4CT0A IdNLAODRESS CIiY pIP pi!ON[ STATEIICENSE♦ <br /> PWMDINGCOM1IRACTOti h1AILAD�RE55 GTY ZIP PHONE STA7EUCENSE� <br /> CONTRACiPRICE 1YORkl�/, <br /> U(/v <br /> D C AE1Y KAllD UAREF OOV[0 �p .p��N�ryno1��Fun. .� �� �,`� <br /> n N 1�1 H��� J� <br /> 1 <br /> i HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br /> anoaosco oF �m�j�� ` APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT.ALL <br /> ��/���+fV�� � 1�/� �JXIST� PROVISIONS OF LAWS AND ORDINANCES GOVEFNING THIS TVPE OF <br /> iecn�oesca�?nonoFvaovearv�sHowr+ee�owonaT CNT\ OCOPiE51 WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br /> NOT. THE GRANTING OF A PERMIT DOFS NOT PRESUME TO GIVE <br /> �o� ���K oF AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br /> OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OFi THE <br /> PERFORAIANCE OF CONSTRUCTION.TH4T I AM AUTHOFI2ED P.Y THE <br /> OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR IVHICH <br /> APPLICATION IS MADE AND I COMPLY WITH THE S7qTE <br /> ❑nace�rnz i o Nun�eEa CONTF R L t8.27 RCW AND 296200 WAC. <br /> � <br /> CON57RUCTION IOAN LEN�EP.�ODRESS,TELEPHONE NUTABER � <br /> I �� <br /> PROJECT RESS s��cr�nmac wtC" — — <br /> � cnvousivrssu� � F�rio <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM FEE N0. TVPE OF EOUIPMENT FEE <br /> WATER CLOSET(TOILET) A;C—A�HNDLG UNITS—H.P. <br /> BATHTUB FORCED AIR SYSTEMS—B.T.U. M E.A. <br /> LAVATORY(WASH BASIN) UNIT HEATERS—B.T.U. M <br /> SHOWER CLOTHES DRYERS <br /> KITCHEN SINK 8 DISP VENTILATION FAN <br /> DISHWASHER RANGE HOOD <br /> LAUNDRYTRAY ; WATER HEATER <br /> CLOTIIES WASHER WOOD STOVE <br /> UHINAL METAL FIFEPLACE(WOOD BURNING) <br /> DflINKING FOUNTAIN FIREPLACE INSERT ; <br /> FLOOR DRAIN HEAT PUMP <br /> BACKFLOW PREVENTERS GAS PIPING <br /> ROOF DRAINS—RAWLEADERS � EXHAUST FAN <br /> SINK�SERVICE—BAR.ETC.) <br /> _ SUB TOTAL $ SUB TOTAL 5 <br /> PERMIT $ PERMIT 5 <br /> TOTALF[E $ TOTALFEE S <br /> FOR OFFICE USE ONLY: <br /> FR^Ni5[iBALK REARSEfBACK 510[SETBALK P�qNCHECHNUM�[R fEE RECEIPiNO <br /> n3 >2v, 3 i��s�z <br /> us�zoNe ioraqen vncnrvisire FEES VALUATION FEE <br /> --. YES �- NO ��J <br /> ivPE �p C01l5[ No.oPSTOPiFs awrnncv riom BUILDING '/l�'�� � ��� � i— <br /> 01tt11'.AGJ4q5 1 <br /> 1G`/ _j'�aour PWM�ING <br /> SIZEOFPI�G FIRE FSPEO'D BASEMENT IdECHANICAL <br /> � � ;� `-. YES "- NO <br /> OCCIIPANGYlO/D FIFEAUqMR[OD HEIGHiLIMITAT10N ADDITIONALPLANCHECK <br /> OTHEFi <br /> FEASON <br /> STATE DUIL�ING SURCHARGE � <br /> iN�nKeov N�nNsnPaaoveoor CITYOFEVERETT PUBLICWORNS <br /> �X+� LOCAL SALES <br /> un,e � � l • TAX CODE IS 3105 TOTAL z� �J� <br />