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/�PPLI�AY1� ' FOR CO�IS'6'6�lJC'9" �!�! PEIRlM17' �� -, <br /> TO BE COMPLETED IN BLACK INK-PLEASE PRINT <br /> ----------- i <br /> rHEAI�ING SYSTEM: fj GAS U ELECTRIC U ________ ; <br /> BUILDING DEPART�AENT <br /> 259-8010 <br /> '. ! DEMOLITION ! COMBINATION In BUILDING � I MECHANICAL I . PLUMBING ' SIGN <br /> OJ ' � F 1.1r i�A00R[55 CII! ZIP FHOtlG . <br /> ! � (�/�� 4 � i i' ' / % �C�'/1�/ <br /> �� <br /> /� . i,.� �u.e 4S . � �!,y_J.c✓�L r,''y: �� v"'�� ln�. ,�q ��•/ .!.> <br /> iLN�Ni IARILAOORtSS Q1V PY PHOtlE <br /> �ru('�PS .���1.; ?_7'� .5�: f i�e � " � SS'��oi ti3„ `,��i �i C� <br /> �� crv tiv r��or�e <br /> n1i�HilECtOFDE5IGNER IANLA�ORE55 <br /> �(�H G[t![BALCONtRt�Ci0I1 6�NLAGORE55 CITV ZIP PHOt1F. — :'TAT[LICENSEe <br /> ��� <br /> i <br /> �y IdECHANICALCOIITRACiOR AINLADORE55 GTY 2�P PMONE STATELICENSEM <br /> � � <br /> H <br /> �-9i yx9� PLU�ABiNG CONTRACTOF IdAiL A�OpE$5 GiTY ZiP PHONE STATE UCENSE v <br /> H z H _ -- — <br /> CONiRPCT PRICE OG 1YORH <br /> � r'1"i� . ��/M -_ <br /> ��S . <br /> � yH DESCqiBEWORKqN�SOUAREF00T�GEIt�VOLVEO . COBTACTPEFSCIlMJ�PNONENO — <br /> . -r � / ' o�� /'c n '�n� � vr ni i� i� <br /> � z ..�,.,; � <br /> y Cy 3'-�z��-cu�/. �"S /-s .�c ,� .:.� '�n�� _ . <br /> O Fi <br /> � �� :y, �� 7 �' y��f f I HEREBY CERTIFY THAT I NAVE READ AND EXAMINED THIS �. <br /> 4'�� OQ rnoaoseouseoFeuiiou+c p APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT.ALL . <br /> x H 3 .'t /�>, i%.c� �r� ��!_r nL i PROVISIONS OF LAWS AND ORDINANC[5 GOVERNING THIS��YPE OF �, <br /> � �7z �ecn�oesc�ianoiroF�eoaea�.v�sr+ewrio�iowoenrrnc��n•roccr.es� WORK V'ILL BE COMPLETED WITH WHETHEF SPECIFIED HEREIN OR <br /> H y ci '��� �"��.,� �, �5�,�� �.��j�� NOT. THE GRANTING OF A PEFId1T DOES NOT PFESUti1E TO GIVE <br /> � +.Z — AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF �NY i <br /> y!-1 1 OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br /> O C W t�'- h -------- PERFOFiMANCE OP CONSTFUCTION. THAT I AM AUTHOPIZED BY THE �, <br /> �r / /'� � � S.t, ,(� O�VNER Of TFIIS PROPERT`! TO PERFORI.1 THG WORK FOR WHICH '� <br /> [i1 /I'���yl+//' �4/1f.I '1�J./'nY1�,L�.1_1_—._-/-5� APPLICATION IS G1ADE AND I COMPLY WITH THE STATE <br /> x �y ��ance�Tnx i o r.urnoea CONTR�GTORS LAW 18.27 PGW AND 296200 NlAC. � <br /> 5 iC,S-,�3`I- o3u-o3�6 --- <br /> CQISiFUCTiOtlLOAHLENDER.RD�PE55 �EI.F.PHO�' �� �� L'C�� ' � �j . � - <br /> X. ��� �-�.,��i� _`�/� � / :� �� . <br /> _ —_ —.__ _ " —_ u>rt � <br /> PROJECTADDRESS ,. . .___.__-_-------� - � <br /> � �I �> I.S �'_� ��C �J��r� L�C. 'ry�J. -- .--'�,�. , <br /> PLUMBING MECHANICAL � <br /> N0. TYPE OF FIXTURE Ofl ITEM FEE NO. TYPE OF EOUIPM1IEIVT FEE <br /> '�� — VJATER CLOSET(TOILET) _-___--_'-_- — A�-A HNDLG U�91TS-HP. <br /> BATHTUB FORCEDAIRSYSTEMS-BT.U. M E.A. <br /> LAVAIORY(WASF��ASIN) � _ UNIT HEATERS-6.T.U. h1 �_ <br /> SHOWEF ' _ CIOTHESDRYERS <br /> � KITCHEN SINK 8�ISP ' VEMTILATION FAN � <br /> _. T T <br /> �� DISHWASHER _ RANGEHUOD <br /> LAUNDRV TRAV ' WATER HEATEF _ <br /> —T WOODSTOVE <br /> '�� CLOTHES WASHER — � <br /> � URWAL M1IETAL FIREPLACE(WOOD BURNING) <br /> DHINKING FOUNTAIN FIR[PLACE INSERT <br /> FLOOR DRAIN HEAT PUMP <br /> '='�' BACKFLOW PREVENTERS __ � GAS PIPING - <br /> ROOF GNAINS-RAINLEADERS —�- [%HAUST FAN <br /> SINK(3ERVICE-BAR,ET0.) _ —— <br /> _ — _�_ <br /> �' -- --- —_ ___ <br /> —_ —. _.—___�— <br /> '�� SUB TOTAL 5 _ _ ____ ______SUB TOTAL S <br /> '��� -�-�-- P[RA11T 5 ____ __ PERId1T 5 <br /> TOTAIFEE 5 TOIALFEE S <br /> FOR OFFICE USE ONLY: <br /> ---_ r��nucr�FCKuu�.men :�_i r�ec�iv�r.o <br /> �I?0'Ji5[7�ACK REARS[1�ACK fiQfSEil3ACN <br /> u;•,iorie iornnen vncnNrsrE FEES VALl1ATAN FEE <br /> _ , - <br /> . '� VES . NO [7uu.uiuG ---- �=)� --.. <br /> __ <br /> — No.GFsronies �ncovu¢. 5uc�uruu�,.qi:,�n, . _ . ..__.-_. —__- — — �— <br /> fii'I 0'i CONSI. Lllcvlv <br /> � PLUhdPING <br /> Sili:C�f1L�G FIRE SPRINHLERS REO'0 HASFA1ENt �dECHANICAL <br /> '..' YES .�: NO __ .--_-- � <br /> AD�ITIONAL PLAN CHECK <br /> OCGUPANGYLOOD FlRE4tAFildIIEOD HEIGNiIItAlt4ilON _ _ <br /> OTHER <br /> _ I <br /> arn��,n — -- ---- i�� <br /> STAT[[3UILDMG SUaCHARGE <br /> _ _'.___—_. —___ <br /> _____" —"—__— ' <br /> viunto4 � � �inNsaP�novrnuv I CITYOFEVERETT E�uuucwor�Ks <br /> LOCAL SALES <br /> �,,,,� TAX COOE IS 3105 TOTAL � i,>`f �,_- - <br />