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- <br /> APPl.ICAT�)N F(�R CONSTRl1C�-`'IOId PERMIT � <br /> TO BE C0�.IPLETED IN BLACK INK—PLEASE PRINT <br /> BUILDING DEPARTMENT HEATING SYSTEM: �GAS ELECTRIC ❑ <br /> 259-8810 / <br /> ❑ DFMOLITION (v� COMBINATION ❑ BUILDING ❑MECHANICA� ❑PLUMBING ❑ SIGN <br /> 01YNER MAILAODRESS CITV ZIP PIIONE <br /> 3o1,n P,�� ne�� �$3\ Cr��� � fjue Cvete�a- 9a c- � (20 12ri) �nn <br /> TENANi Id�ILAODRESS CIiV IIP PHONE <br /> N (� <br /> ARCNITECTOROESIGNER fAAILA�DRE55 CITY ZIP PHOf1E <br /> flt��nv. l.�,ne �°11� Mwl�..on S> . Gv�re3k 9R7t�i �2b61 :.,'_�3 -C�53 \ ' <br /> GENEq CpNTflACTOR MNL ADORE55 CIN . _IP PHONE STATE UCENSE p <br /> F�ne�,oa �'�hs� Tnr. I�3I �\I,�„ Au� C�erNF{__��8201 (zcGl ^<52.25c�n flp�F c�nSsZ <br /> MECHANICAL CONTRACTO MAIL ADD 'S5 GTV ZIP PHONE STATE LICENSE t � <br /> pue�=�C 1� �.a,�„ P.0.�3�6Lk.5-��veh� � g25$ 1k�61�3v-vrii P�a�t1�)(,4�n <br /> PLUM G CONTfIACTOR MML�ODRESS CITY ZIP PHONE STP E UCENSE I <br /> ��w_� � e! r.sl�r�< _ 2oi 13 - �C� — <br /> CONTPACT PjjICE OF WORK <br /> ?��S��c- 8 � <br /> DESCRIBE WORK FNO SOUARE�OOiFGE INVOLVEO CONTAC7 PEFSON�ND PHOhE NO. <br /> S.F.C�' 1�51 s��. �k . <br /> ��SlG �2-C> <br /> . I HEREBY CERTIFV THAT I HAVE READ ANO EXAMINED THIS <br /> . PROPOSEDUSEOfBUILDING APPLICATION AIJD KNOW THE SAME TO BE TRUE AND CORRECT.ALL <br /> � 5 F•R. PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br /> �ec escr+irnoruoFaaoaearv�sr+owr�eeiowoann�rrnc4HTwocories� � WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEFiEIN OR <br /> �o � ��— e�ocK —�.� oF —1=1a' �t' E'�*'��� � NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br /> AUTHORITY TO VIOLATE OR CANGEL THE PROVISIONS OF ANY <br /> (��u�5� ,ay��'"j ( ,'��;� F,�rrra .V- OTHER STATE OR LOCAL LAW AEGULATING CONSTRUCTION OR THE <br /> � PERFORMANCE OF CONSTRUCTION.THAT I AM AUTHORIZED BY THE <br /> O'NNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br /> APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> rnAce�Tnx i.o.uu•ieea CONTRACTORS LAW 1�P7H''N AND 296.20D WAC. <br /> �t�R3- z�_q - 01 _oOb 5 x��-. --->� <br /> COHSTflUCTION LOhN LENDER,AODRESS.TELEPHONE NUMOEF / <br /> CaSc,�.�SAo;+wS Z328 Co�hU �Pce4_} wR��7o � � �.-�,1 6��-ys <br /> PROJECTADDRE .339_,� tiqYALUNE o.�e <br /> NO� Y CIIYOUSVIF.SSLICENSENO. <br /> PLUMBING RIECHANICAL <br /> N0. TYPE OF FIXTURE OR ITEM FEE hi0. TYPE OF t�UIPMENT FEE <br /> WATER CLOSET(TOILET) � Q A/C—A/HNDLG UNITS—H.P. ; <br /> BATHTUB ; 0 FORCED AIR SVSTEMS—B.T.U. M E.A. <br /> LAVATORY(WASH�ASIN) � UNIT HEATERS—B.T.U. M ; <br /> p SHOWER � ( CLOTIIES DRYERS � <br /> KITCHEN SINK 8 DISP � VENTILATION FAM ' <br /> � DISHWASHER � � RANGE HOOD —;— <br /> � LAUNDRYTRAY � WATER HEATER <br /> CIOTHES WASHER � WOOD STOVE ; <br /> p URINAL ' METAL FIHEPLACE(WOOD BURNING) � <br /> ('j DRINKING FOUNTAIN � � FIREPLACE INSERT ; <br /> FLOOR DRAIN � HEAT PUMP �� <br /> BACKFLOW PREVEIJTERS ; GAS PIPING � <br /> ROOF DRhINS—RAINLEADERS EXHAUST FAN � <br /> . _Q SINK(SERVICE—BAR.ETC.) ; �— <br /> � � <br /> � <br /> � � <br /> � <br /> � <br /> SUB TOTAI $ � SUB TOT.4L $ <br /> PERMIT $ � PERMIT $ ; <br /> _ TOTALFEE 5 ; TOTALFEE $ � <br /> FOR OFFICE USE ONLY: .��l� �v <br /> FRONTSE�/ FEFq�qCK� SIOES�AC, PLANCHEC��Mg�q reJ�� //E� �/ - D I <br /> / / <br /> �f _J` �i' <br /> usezor��� LOiANEA VACANTSIiE FEES VALUATION FEE <br /> Ci <br /> f7 YES �] NO BUILDING � � •> > /� q /��r '"'7 <br /> IYPEGiWNSi. NOOFSiORIES Otarpy�r x0awifwHOUbue � �'" "- / �� Z ` �1.'J —' �'\r=� <br /> �0� PLUMBING 7 i I <br /> 3�i� `-3 J , <br /> SREOFOLDG. FIOESPRRINLERSFE00 BASEMENT �,�ECHANICAL / 1 � I <br /> I� Z �,t%. ( r? I1 YES [ rio '�' ' <br /> OCCUPANCYl0�0 FIRE t�RA1REOD HEIGNiLIMRATIU% AODITIONN_PLANCHECK — � <br /> � � OTHER ' <br /> R[ASON _ ��__ � <br /> STATE BUILUING SURCHARGE �/ �� � � <br /> MtnrcEev p�nNSnrpnoVEDev CITYOFEVERETT PUBLICWORKS �-- <br /> JkI" LOCAL SALES � <br /> °"'"' S/13�95 iAX COUE IS 3105 rora� � <br /> - �G .� <br />