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APPLICAT101_ FOR CONSTRUCTI� AI P�RMIT ,��/v���"' <br /> TO BE COMPLETED IN BLACK INK—PLEASE PRINT `'�,�� <br /> HEATING SYSTEM� GAS J ELECTRIC J --- _I <br /> BUILDING DEPARTMENT � <br /> 259-6810 � <br /> DEMOLITION COM8INATION BUILDING /�MECHANICAL PLUMBING SIGN <br /> owrvca iani�aooacss c��r zm ���o�E <br /> /lcw� 5waros� yy��%L T�^�s�,u„�}✓✓ Lu�r 9sr as9�i <br /> T[NANi <br /> MAII RODRE55 ���Y I P <br /> ��n. Z�P PHGNE <br /> •RCNRECi0A0E51GNE� MPILAODF[55 <br /> GFNCFALCONTRACtO� MARAODRE55 CITY ZIP P110NE SiAiEUCENSE� <br /> IACbNNICALCONTBACiOR IAARADDR[55 C�iY Ziv PIION[ STAiELIC[NSG� <br /> � �� �,J� /p p� s�2v t,� i%�Uk 9�fZ7S �s3 33Y/ `�viNo9�'O L <br /> ���� j�p PIIOJE STAiELGEISC <br /> V'LIIIABINGLONTRACiOR MA�LpODHE55 <br /> p�x �_�(�/�Jq-S GOni✓�rLSto�J <br /> � y � c�n,sorwoRe <br /> NEW ADDITION �TERATION REPAIR DEIJ.OLITION WOODSTOV6FRPL INSERT BUILDING RELOCATION <br /> y � CONIACT PERSON ANp PHONE ND <br /> z M /' <br /> �y� LO4IRALTPRiLEOF1Y0�K OV' `D <br /> O�M O� OESCRIpE WORK M1NO OUARE FOJtAGE iNVOtV[0 <br /> w H 5/=/� <br /> �,.,� rr�oaosmus�ocom�oiHc � HEREBV CERTIFY THAT I HAVE READ AND E%AMWED THIS <br /> APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT.ALL <br /> O N� PROVISIO�S OF LAWS AND OFDINANCES GOVEiiNING THIS TYPE OP <br /> �ccn�oescemrioHOFPaovEervry�avmoe�owoanttncHFouncoviEs� yrORK WILL BE COh1PLETEO WITH WHETHER SPEGFIED HERGIN OR <br /> M� g iar B�p�k oF NOT. THE GRANTING OF A PEFMIT DOES NOT PPESUME TO GIVE <br /> �„ n AUTHORITY TO VIOIATE OR C�NCEL 7HE PROVISIONS OF ANY <br /> ZH �y' O7HER STAiE OR LOCAL LA\N REGULAT'NG CONSTRUCTION OR THE <br /> �y a pLRFORM1IANCE OF CONSTRUCTION THAT I AM AUTHORIZED 8�THE <br /> � OIVNER OF THIS PROPERTV TO PERFORM THE WGRK FOR WHICH <br /> �"� y APPLICATION IS MADE AND � COtdPLV WITH Tt�E STATE <br /> gy <br /> H CONTRACiORS LAW 18 27 RCW AND 296.200 WAC. <br /> oaCm <br /> � �'� ��/ �ll-J�'y <br /> O� X ., — ' " — ���� <br /> reo�Ect no�n�ss ���� ,��� � /J i _ <br /> � m� �.,� ._..,.s�.,,. ..., <br /> PLUMBING MECHANICAL <br /> NO. TVpE OF FIX7URE OR ITEM <br /> FEE NO. TYPEOFEOUIPMENT FEE <br /> WATERCLOSETITOILET) _ A�C—A.HNDLGUNITS—HP. _ <br /> � PORCED NR SYSTEMS-8 T.I;. h1 EA. <br /> I BATHTUB — — — <br /> �� LAVATORYIWASHBASIN) _ UNITHEATERS—B.T.U. M <br /> SHOWER _ CLOTHES ORYERS <br /> KITCHEN SINK 8 DISP _ VENTILA710N FAN <br /> � DISHWASHER RANGE HOOD <br /> � ,__• LAUWDRY TRAY _ WATER HEAT[R <br /> I ��1 CLOTHESWASHER _ WOODSTOVE <br /> URINAL _ METAL FIREPLACE&CHIMIJEY <br /> DRINKING FOUNTAIN FIREPLACE INSERT <br /> �. �1- FLOOR DRAIN HEAT PUMP <br /> BACKfLOW PPEVENTEI7S � GAS PIPING <br /> I, EXHAUSTFAN <br /> P.00F DRAINS—RAINLEADERS __ <br /> SINK(SERVICE—BAR.ETC.) _ <br /> �_'-' — <br /> —�' <br /> SUBTOTAL 5 SUBTOTAL S <br /> PERMIT 5 PERMIT 5 <br /> TOTALFEE 5 TOTALFEE S �— <br /> FOR OFFICE USE ONLY: <br /> PlA4G1LGHNUTApE F[E PECEIPTNO <br /> PRONT SETFIACN REAR 5[lOACK S�LE SLIDACK `���� <br /> usezor�[ imaAen vncnNtsire FEES VALUAT�ON FEE <br /> OUILOING <br /> LYPEOit�NISFIlOWABIE tYPEOFLON9.ALIUAL o¢90Upcv boaimvuu•.,ux�rs --- <br /> PLUMBING <br /> 9Z[OFBLDG. NOAFSiONiES BAS[NENT MELHANICAL _, <br /> OGCUPANGYLOAD FlRESPRNRlEflSREOD MEIGMiUMIiAT�ON <br /> A�DITIONAL PLAN CHECK <br /> SPRINNLER __ <br /> R[ASON FOR SPNMKLERS <br /> STATE BUILDING SURCHARGL <br /> r�.nKcnr r�nnsnrar�ovmov CITYOFEVERETT PuauCwo�Ks <br /> LOCALSRLES <br /> TAX CODE IS 3105 rorn� <br />