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APPLICATIO'� FOR CONSTIUCTI`�N PERMIT � <br /> TO BE COMPLETED IN ULACK INK-PLt:ASE PRINT � <br /> -- - ------ __ _ ---. <br /> �HEATING SVSTEH�. J GAS J ELECTRIC kJ , uON� __=_I <br /> BUILDING DEPARTMENT - <br /> 259-8810 <br /> DEMOLITION COMBINATION BUILDING MECHANICAL PLUMBING SIGN <br /> OWNER Mnh ADDRE55 -- —� C iv —�----_—�lR' ---- PnONE "� <br /> TN�� Qo��N� cu .. P.O. �x 3�0� Mjs n�-'7�, S�a-TriE , WA . 4�IzV -- Z4.h - J"6 �- <br /> 1ENRNL 1dRILA00RE55 CI1V 71v f110NF <br /> ��M 6 Ii'S O(N N��'� ---- -- -- <br /> R9CHrtECTORpESiGNEF M�iIADDA[55 ::'�'� 7��' l�'HJNE. <br /> �✓A y �.lo,[.Y��,.iiS3r /N� •,�n`L� • SPP.a6uG �5i°'�"'C �u.tA SM'i1-14''� <br /> GENERAI.WNilIPCiOR AI�IL�OD�[55 Uiv Ji� ^NONF ST�TE LICENSE• <br /> MEGHAqiC�LCONiR�CiUF M�IL��ORE55 Liiv Z�� P��ONE SIRTEIICENSE� <br /> �WMBINGCONTRAGT06 M�RRCJRF.` U1Y Z��' PMONF StAtEIIGENSE• <br /> CONLRAGT PRIC[O�WOiyN <br /> Y �S ��(. �� _.- __.__-_ __ <br /> LESCRIBE WOFK RNC F^"�oc rmnr.c•NdC iAEO �������«PEIISUN ANDP��ONF NO <br /> c� O=�_- _ — - _ <br /> _ _�__—__ �G Nf�/L i� .�J��i�i QO/L.$/c � 2 C c-3�6 � <br /> Tan..�OK STU/-n-x.C --- -- L---�- - — — <br /> ____ i HEREBV CERTIFV THAT I HAVE FiEAD AND EXAMINED THIS <br /> rno�osro use or eunoiNa APPLICATION ANU KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />' j7�OC ST J �-e-�-C PROVISIONS OF LAWS AND OFDINANCES GOVFRNWG THIS TVPE OF <br /> i.ernin[stamuoNorrno;rnrvis��owHeEiowonnr*n<�.��Twor.oriesi WORH WILL BE COMPLETED WITH WHETHEF SPECIFIED HEREIN OR <br />� NOT THE GRANTING OF A PERMIT UO[5 NOT PRESUME TO GIV[ <br />�. iot-- nixx ---- �'� --�--------- AUTFIORiTY 70 VIOLATE OR C�NCEL THE PR(?VISIONS OF ANV <br /> OTHER STATF OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br /> ---�--�-- ---- PEFFORMANCE OF CONSTRUC?ION.THAT I AM AUTHORIZEO BV THE <br /> OWNER OF THIS Pf�OPERTY TO PERFOFM THE WORK FOR WHICH <br /> ---� APVUCATION IS MADE AND I COMPLV WITH THE STAT[ <br /> a�aCE�r�X�0 NUMBEn CONTRACTORS LAW 1821 RCW�ND 296 200 WAC <br /> _ ___ _"____— '__ ^ , <br /> �['.Nti�RU�.'��)'���nN�INIJF� ADD�E55 iCLLP��O4E I�u6i0FN / . f� / / . <br /> _ y °'rf>t.���l, lJ'�c,�✓�?.- r.,� �y_'��J . <br /> - --- — --- <br /> - - _ _ _ - - <br /> PROJECT ADDRESS . �,��) ��� _ . <br /> ��o� � L �inz� Rn l� ,,,,- . r:, _ _ - - <br /> PLUMBING MECHANICAL <br /> N0. TVPE OF FIXTURE OR ITEM FEE NU. TVPE OF EOUIPMENT FEE <br /> WATER CLOSET�TOIUcTI A�C-A�HNDLG UNITS-H P <br /> _. . .____._'-_._ _._. .._ ____ <br /> _--.__-___— _--.-__ <br /> .. _._._______ <br /> BATHTUB � _ FORCED AIR SVSTEMS-B_?U M _ __ <br /> LAVATORV�WASH BASINI _ _ UNIT NEATERS-6 T.U. M _ _.__ <br /> __,_ -- .. __-___ . <br /> SHOWER CLOTHES DFiVERS __ _.. <br /> KITCHEN S�NK 8 DISP VENTILATION FAN _ L <br /> _�— <br /> DISHWASHER RANGEHOOD ____ _.. <br /> LAUNDRVTRAV ' WATERHEATER ______ ____ <br /> CLOTHES WASHER —�_-_ _ WOOD STOVE _ ____ _ _. <br /> � URiNAL ____ METAI FIREPLACE �WOOD BUPNINGI _.__ <br /> DRMKING FOUNTAIN _ FIqEPLACE INSEFT . _ <br /> � f-LOOR DRAIN HE�T PUMP _. <br /> BACKFLOW PRCVENTERS ; GAS PIPING . ____.. <br /> FOOF DRAINS-RAINLEAOERS - --� [XHAUST FAN __ _ ._. <br /> SINK �SERVICE-BAR_ETC.1_ _ __ _ .,__� __ -._ --.--- — ---'--� - <br /> _ _ __ .-___--- <br /> _ -_..__ _ <br /> _-----___ -.__.__- � _____ __--__- _-_T_. . <br /> _ --___ <br /> SUB TOiAI. $ SUB TOTAL S `- <br /> ._ . . _-._�. __ . ____.. . _._.._ __.__--.—__-____ . -_.. <br /> -.- ------- - -� -" PERMIT 5 <br /> . .___-._ PERMIT $ ' _ ._.____-_._______ _ _.- __-_�-"- <br /> -__ __.____.___ __ .-__-__ __..—__'_. _--_- ._ TOTAL FEE S ' <br /> iOTALFFE 5 ,__ <br /> FOR OFFICE USE tNJLY: - <br /> ___. __._.- <br /> .. _ . .._-_ ____. ._ nrcru���r.:� <br /> i��OMSETO�CN nfnnSftPnr� � SitlFSFtR.�..� r�a�r.�4`� au�in[a� . <br /> � �����' -- <br /> ���.r rnrrt —. .- -�or nnrn vncnr�i Srtp---���--- f EES VALUATION FEE <br /> VES NO p�u'.f�r� .�_�_'.`_;_. . <br /> -- -- <br /> __--- . � �. „ w �r�.ux . _ .. _.._ . .. .__. _ _ . -- , <br /> hPf�!LfIN51 r NO Of SI OpIES '✓� ^ ` -- --'- -" ---- --- "- <br /> 7 � ` f1�:e�`!G <br /> � SQ � L_1- - <br /> �dJ�F/OFAt��f/ iIRESP�INNlER5RE0'D BASEMFNt MI:..�t+HICAI I <br /> V N /�I� ' . VES �. NO -.___� __-__ ._-._ -____. <br /> OCLUPANC�IO�D fIRE RL�RM RE00 ��E�GMT LIMPRTION a�i�ITG�NAL PLAN CHECK - -_ _- /�� ' �'��I <br /> !�� �� __ SldiR <br /> _"__-_-_-_ ' � <br /> -"____'_ _ ___.__-'__ _ -__- t._ _. <br /> �FASON ,�J <br /> ti A7f. NUILGING SURCH�RGF __ _ ��� <br /> '"—'—_.______ '"_.__—__-- — � <br /> ��;u���� � "�^�,�'°��°"���'� --�-� CITYOFEVERETT PueucwoH�s <br /> �/M I TAl(CODE SL3105 rorn� ��1L� ;5(� <br /> nnr�_ r' � IS ��'� <br />