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� <br /> � i�iJ�il��h.r�.t�� 11 '� d u���f�'�l7 �\.^.�L:Y��.l� ��Il�..,�� I��J J , r,u.� u'I ..�� 1io�� %J �; .._ , <br /> (, �Y TO BE COMPLETED IN BLACK INK PLEASE PRINT ���`rr <br /> �� <br /> HEATING SYSTEM: �GAS �.J ELECTRIC U —_____ , <br /> BUILDING DEPARTMENT — <br /> 259-8810 <br /> DEMOLITION CONIDINATION BUI�DING �MECHANIC.L PLUMBING _ SIGN <br /> OCiNEfl MAll4DCAF55 CiiY ZI�' rMONE <br /> ,!� Ll meS 3fy� t L,� Al� E S�� �e z� S� �R/o z <br /> i[NANT MAILApDFE55 CITV 21P PHONE <br /> A�iCHITECTOaDESIGNEF lAAILAODRESS CITY ZIP PHONE � <br /> r�y+L-ni:y GENERAL CONTflACT �dALL A�DRE55 CITY 21F PNONF $iATE LICENSE� � <br /> C� <br /> A�3 ��� �m�C �i9 h'�— - <br /> .O�Ix R1 i�AICALC TRACTOR �AIA�OPE55 CiTY ZiP PHONE ,STA�ELIGENSEn � <br /> �y� [��5 ,rn��}� /��� � o �e� ���.-�? �y7-���'� B��itr r2 r��3cH ; <br /> H a� PLUldpINGCONiRACTOR 6NlADDRE55 CItV PP PHONE STATELICENSLa <br /> y zH <br /> r� o <br /> y'{f CL SOFYlOFK <br /> � H� �NEW � ApDITION ALTERATION REPAIR DEMOLITION WOODSTOVE.�FRPL INSERT BUILDING RELOCATION <br /> (n�..� coNTAcr Fso'1arIDFNONEN /� `/ � <br /> i7. Y.� rONTRAGi PRiCE OF WORN �/V� �C+• r , � �" � ���'/�`'�v � ' <br /> t-� � CBSCF!�EWO�MANDSOUAREFOO1AGErtNOWED C �� 'Y <br /> H t7 <br /> � �o (i�C�A�L 0)2wc��cf - �_ + c — i � <br /> i'HOPOSEDUSEOF�UILDiNG i HEREBY CERTIFY THAT I HAV[ FEAD AND EXAIdINED THIS � <br /> 4]� � � _ � r �m ��{Q� APPLICATION AND kNOW THE SAtdE TU BE TRUE AND CORRECT ALL II • <br /> �"� PROVI�IONS OF LAVJS AND ORDINANCES GOVERNING THIS TYPE OF <br /> ay� l[G4LDESCPIPTIONOFPHOPERTV�SNUYlNOE�OWORATTALHFOl9COPIESi <br /> WORK WILL BE COMPLE'ED WITH WHETHER SPECIFIED HEREIN OR <br /> C H� �o. ZU_ e�ocK oF NOT. THE GRANTWG OF A PERMIT DOES NOT PRESUME TO GIVE . <br /> AUTHORITV TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br /> O �H �' �'�j'J ..T`r OTHER STATE OR LOCAL LAVJ FEGULATING CONSTRUCTION OR THE ' <br /> O C7 V� PERFORPAANCE OF CONSTRUCTION.THAT I AM AUTHORI2cD BV THE �- <br /> OWNER GF THIS PROPERTV TO PERFOR�d THE WORK FOR WHICH � <br /> [r�7 APPUCATION IS h1ADE AND I C0V.IPLV WITH THE STATE <br /> y �� CONTRACTORS LAW 18.27 RCW AND 296200 WAC. '�. � <br /> �/ ��9 Z I <br /> �2 - y/% �A� --- -- -- " .� � � ' <br /> vi�ae rnonv�ess �� <br /> � ' PLUMBING MECHANICAL <br /> NO. TVPE OF FI%TURE OR ITEM FEE NO. TYPE OF EOUIPMENT FEE <br /> o'�► WATER CLOSET�TOILET� A C—A'NNDLG UNITS—HP <br /> '� BATHTUb FORCED AIFi SYSTEMS—B.T.U. M E.A. , <br /> LAVATORY(WASH BASIM UNIT NEATERS—B.TU. M � <br /> SHOWER f�_ CL.OTHES DRVERS i <br /> '_� KITCHEN SINK 8 DISP :_. I�1� VENTILATION FAM <br /> _ DISHWPSHER I__� RANGE HOOD i <br /> LAUNDRV TRAY , � WATER HEATER <br /> � WOOD STOVE I <br /> '���� CLOTHESWASHER __ ___ <br /> �� �I URINAL METAL FlREPLACE 8 CHIMNEV <br /> DRINKINP FOUNTAIN FIREPLACE INSERT � <br /> FLOOR DRAIN HEAT PUMP _ �' <br /> BACY.FLOW P.7EVENTERS GAS PIP!NG <br /> � ROOFDRAWS—RAINLEADERS � EXHAUSTFAN __ ___� � <br /> SINK(SERVICE—BAR.ETCJ __ <br /> I���a � <br /> �� <br /> -� <br /> ��� SU0 TOTAL 5 ' SUB TOTAL S " ' Ii <br /> PERMR S —� PERMIT 5 ��— �. <br /> . � TOTALFEE 5 ' TOTALFEE S �� <br /> _ FOR OFFICE USE ONLY: I <br /> iPOt1T5[1BAGK REARSETpPCK SiOESEipnGK PLANGHECrcNuh�OfR Rf REC[IPT1lD i <br /> 5 _ � 7.� � <br /> us[zorv[ �otnnen V�C�NTSIIE FEES '�LUATION rEE <br /> Bl11LDING <br /> iYPE0iCO4i5 AILOWABIE IYPf0iC01lSt ACIUAL ectW'u�cr �ia orP�ni,i::.v.��5 ----' -- ---- --� --- � <br /> Gqp1° � PWh1BWG � <br /> SREOFBLDG N�.OFSTOflIES 9ASF.ldENT �,�[CHANICAL �� <br /> OCGUP�NCVL04D FIRESPRNN�EFSRE00 HHGHTUMITA➢ON ADDITIONALPLPNCHLCK i <br /> ___. SPRINKLEIi — ' I ' <br /> '�EASON fOR SPRINNLERS --� � <br /> STATE�UILOING SURCHARGE <br /> i11f:aCEIY �'LANSAPPFOVEDOY CITYOFEVERETT PUBLICWORKS � <br /> LOCAL SALES <br /> TAX CODE IS 3105 TOTAL � � cG - <br /> °�1 <br />