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AP�LICATIO�` FAF: CONSTFRUCT;")N P�RIVrIT � <br /> TO BE COMPLE7EU IN BLACi: INK—PLEASE PRIPJT � <br /> HEATING SYSTE`�1� fJ GAS �ELECTRIC O <br /> BUILDING DEPARTMENT <br /> 259-8810 <br /> DEMOLITION COMBINATION ✓BUILDING MECHANICAL /PLUMBING SIGtd <br /> OYlNER IdAILA�ORE55 CITV ZIP PHON[ <br /> 7 � <br /> Jotl 13earc���'A <�ae� M'L�rz�ur �'�II II'F� 5{ �Jtrc� -�j�j�01 �3`1- 13� , <br /> TENANT ldAI.A00RG55 CITV ZIP FMONE <br /> ARGHRECiOR DESIGNER MML 4DDRESS CITY 21P PHONE <br /> GE ER�L ONTRACTOR IMIL PDDBE55 CITV ZIP PHONE STATE LIGENSE k . <br /> MECHANICFL CONTRACTCR MFIL ADDRE55 CITY ZIP PHONE STATE UCENLE F <br /> PWMBINGCONTRACTOR lAAILADDf7E5S CITY 21P f-MONE STATELICENSEa <br /> CI ASS OF WORN <br /> � � NEW �� �. ADDITION ALTERATION . �. REPAIR � DEMOLITION WOODSTOVE/FRPL INSERT -�. BUILDING RELOCATION <br /> n \ GON7ACT PERSON AND PHONE N0. <br /> CONTRPCT PRIGE OF W09K �L'l.. �� �/�� a 9 X� — <br /> �ESCR'BE WORK AND 5�1JARE FOOTAGE INV1O W ED I <br /> -�4.n,, s� 1.. c<,- cc..c�' �M1T'J ha�Iu.c�Utb✓vcir. (•�a-��. <br /> PROPOS DUSE FauaoiNc ' I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br /> /� � �n-� APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT.ALL <br /> �� (�l� C'(n r0(''��« �� `�Gty'u'� / PROVISIONS OF LAWS AND CRDINANCES GOVERNING THIS TYPE OF <br /> LEGALDESCRIPTIONOFPROPEAN�SHOWN�ELOWORATfACHFOURCOPlCS� yyORK WILL BE COMPLETED WITH WHETFIER SPECIFIED HEREIN OR <br /> �oT�_ e�ocK � oF NYir(..�s ��� � �O e�`��� NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br /> � AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br /> � _(w-� ��������� ��„ ���� 3 J ��a"f5 ir[Cs OTHER STATE OR LOCAL LAW R.GULATING CONSTRUCTION OR THE <br /> � Y ��^ PEHFORMANCE OF CONSTRUCTION.THAT I AM AUTHORRED BY THE <br /> r I II OWNER OF THIS P90PERTY TO PERFORM THE WORK FOR WHICH <br /> � �I [a�G�S E �i+�kv�b�' �«U��� as^`6 f"` APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> S � � � � r , r s, n �1,� CONTRACTORS LAW 18.27 RCW AND 296.200 WAC. <br /> � UG �x��l U� n..r,�,���-� � <br /> �Hii �i+`� s-�. F�t��if , w,'A- �is� � X � S �� � l�G I93 <br /> sicr+n.unE onrE <br /> FFOJECTADDfiESS <br /> - cirr ousrt+�;s ucer+se rro <br /> PLUMBiNG MECHANICAL <br /> FEE PJO. TYPE OF E�UIPMENT FEE <br /> ryp, TVPE OF FIXTURE OR ITEM q��_p,�HNDLG UNITS—H.P. <br /> �, WATER CLGSET(TOILET) ' � <br /> � FORCED AIR SYST�MS—f1.T.U. M E.A. <br /> BAT{iTUB ; ; <br /> ( LAVATURY(WASH BASIN) _ � UNIT HEATERS—B.T.U. M <br /> � CLOTHES DRYERS � <br /> ( SHOWER ' <br /> KITCHEN SINK&DISP ; VENTILATION FAN <br /> DISHWASHER RANGE HOOD :-- <br /> LAUNDRYTRAY ; WATER HEATER � <br /> CLOTHES WASHER � WOOD STOVE ' <br /> METAL FIREPLACE&CHIMNEY ' <br /> URINAL '� ' <br /> FIREPLACE INSEFT ' <br /> DRINKING FOUNTAIN ' � . <br /> FLOOR DRAIN � HEAT PUMP � � <br /> BACKFLOW PREVENTERS ; GAS PIPING . ; <br /> ROOF DRAINS—RAINLEADERS EXHAU�T FAPJ <br /> SINK(SERVICE—BAR,ETC.) ; <br /> - —*-- <br /> � <br /> � <br /> � <br /> -- i -----i---- <br /> SUB TOTAL 3 SUB TOTAL S �� <br /> PERMIT $ PERMIT 5 ' <br /> TOTAL FEE 3 <br /> — TOTAL FEE 5 <br /> U�TrLC..�G �,�(�1 I � C_ <br /> FOR OFFICE USE ONLY: .S(yl v �` �5 � �Z", �� RECEIPT . <br /> PLINCMECRNU6IBEF FEE ` <br /> FRO4TSETBACK RE/.RSETBAGK SIOESE�� 39/77 ��•�J ����� <br /> � � <br /> �� , �� � VALUATION FEE <br /> USEZCNE— � LOTARE� VACANTSITE FEES <br /> i� BU�LDING �S��lt� l ���� <br /> E�•' , <br /> ttPEOFCONiS.A:LOWABLE 1YPEOFCOtlSi.AC1UAL ottuva:cv nuarb'+flutieuu!is ^/ � <br /> 3 PLUM1IAING �� � <br /> SIZEO�G. � NO.OFS!ORIES B�SEAIENT MECHANICAL �� <br /> �Q�f_S�� � ADDITIONALPLANCHECK � <br /> Oi.Gl1PANCYL04D fIRESPPNK�EF5RE0'G HcIGHiLRAliA71CtJ <br /> /�l�� � - <br /> �p r� SPR�NKI.ER ' <br /> ir <br /> PEASON FOR SPRINK�ERS �� <br /> S1ATE BUILDING SURCHARGE <br /> i <br /> INTAKEBV PUINSAPPPOVEDJv CITYOFEVERETT PUBLICWORKS � <br /> � �rl i/ LOCAL SALES � ' ,— <br /> � TAX CODE IS 3105 T�TA� `�� ' �� � <br />