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APPLICATIf-�1 �OR CONSTRUCT"-7N PERMIT � <br /> TO BE COMPLETED IN BLACK INK-PLEASE PRINT �rr <br /> - ---- ---- -' - - - - - - <br /> HEATING SVSTEM: �GAS J ELECTR�C J____ <br /> BUILDING DEPARTMENT - --- ____� <br /> 259-8810 <br /> DEMOLITION COMBINATION � BUI DING MECHANICAL LLpLUMBING SIGN <br /> u'.vNFn 1,IApa[�nnf,: --_ "—__�,��--_--.—��r_____"'___'rHrqF —_—'______'_—_____' <br /> �_r�-.-=''=i--�/�__����_1�: :� _=_,,,-' � -_--�'-i''- -- -J_��i;�-=��------- <br /> n-nma rnnn noon�ss r,nv / i�i� v��or�e <br /> !�n�N C�t -. a <<�r <br /> Y'r^[�/.:_ <br /> n�Crui[r,}pqDES�GNER M�IIADDRC55 CITY Z�P PNONE <br /> Gfr�In4lCtk7iRACfOq AV.II �OpRE55 CiTV ZiY PHONE SiATEIIGFNSEt <br /> . `�.y •'�'< <._ llt�f+5•iN7 /J.' /./� <br /> Id�Cr�ANiCQCONIIiACTOH M�II.ADDRE55 �iTY ZIP PHONE STA1ElICENSE� <br /> P�UAIAINf CONTP�GiOR I.IML AODRE55 �IIV IiP PHONE Si�iF IiCEMSE� <br /> C.�•I�R/.Cl^RiGE O� 1YDRK — -'--" <br /> ❑!ti(.p19E KOPN ANU�i(�O�NVOIVEU WNIACT PERSON RND PHONE NO <br /> -- . 6�N�e,� C r1 �sb'� <br /> _ l.3 `/ `� '� /-' P A.J�� �/..,�^•� -- ---�'1�_�'d��-� ---- . . <br /> `��'3 � --'��s"' � - i HEREBY C[RTIFV THAT I HAVE READ AND EXAMINED THIS <br /> vHovosen use o�nw�oiN, APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br /> � � �� • PqOV1510N5 OF LAWS AND ORDINANCFS GOVEFNIPIG THIS TVPE �F <br /> �r���a.oe,enmtroNGFORo�enrv�sNowqeeiewonnrrn:Hnvocoaiesi WORK WILL BE COMPLETED WITH WHFTHER SPECIFIED HF.REIN OR <br /> ior� eiocK-- ov ��C� -�.S ') � NOT. THE GRANTING OP A PERMIT DOGS NOT PRESUMF TO GNE <br /> AUTNORITV TO VIOLATE OR GANGEL THE PROVISIONS OF AN1' <br /> ._ ___S P•tI Y ,3_Ts� z ZR��____ OTHER STATE OR LOCAL LAW REGULATiNG CONSTRUCTION OR TNE <br /> -- �-- PERFORMANCE OF CONSTRUCTION THAT I AM AUTHORIZED BV TI IE <br /> OWNER OF THIS PROPERTV TO PERFORM THF WORK FOR WN:CH <br /> rnncru�KioquMnen . -�--�-- �PPLICATION IS IdADE AND I COMPLV WITH 7HE STAiE <br /> %�,��_ � � ' *J CONTRACTOflS LAW 18.27 RCW AND 29G2U0'NAC <br /> f,��N,1RUCilONIOANIEHpFR I?DN�'S TFIFPHJNENIIMBFP / <br /> PROJE�TADDRESS -- ---- -----�- - -�;���.��j� -" _�� �� -. £�.�1_3 . . <br /> / ./ p n�•i <br /> G7� � �Q 8 /!� / L S�" .n iciNrss --i.-,i;—_'_ __"__ — ..._ <br /> PLUMBING MECHANICAL <br /> N0. TYPE OF FIXTURE OR ITEM FEE N0. TYPE OF EOUIPM°NT FEE <br /> _s _ WATER CLOSET(TOIL[TI ' '_ _ _ _� q�C-A�HNDLG UNITS-H P. <br /> .Z, BATHlU9 / ' FORCEUAIRSVSTEMS-B.T,LL M E.A � <br /> LAVATORV(WASY BASIN� /;� �_ UNIT HFATERS-B T.U. M -1- <br /> .� _ _ .__. _ _ <br /> r/a' SHOWER _ / CLOTHES DRVER� —� <br /> J KITCHEPI SINK 8 DIS�__ VENTILATION FAN <br /> [115HWASHER /__ _ / RANGEHOOD T <br /> __ �'✓ IAUNDFV TP.AY 1 WATER HE.4TER -� ! - <br /> CLO7HE5 WASHER � WOOD STOVE ' <br /> _�y! URINAL � _� METAL FIREPLACE�WOOD BUHNING) / �' y�- <br /> GRINKING FOUNTAIN r FIREPLACE INSERT <br /> _ l' FLOOR DF.41N ,i:`• HEAT PUMF <br /> �F-:' BACM:�LOW PREVENTEfiS / GAS PIPING <br /> t(r FOOF DRAINS-RAWLEADERS _ � Q E%NAUST FAN /�/� <br /> SI�.K(SEFVICE-BAR.ETC.1 ; � <br /> - -- -- - � <br /> -' --- ---�-- - — - <br /> . .- — - - -- -- -�-- <br /> SUB TQTAL 8 _ 7,__ ____ _______. SUB TOTAL 5 _ �i__ <br /> --- -_----- - PERMIi S � PERMIT ----- $ --�- <br /> - __ TOTAL FEE g _----- - -_-----_— TOTAL FE[ 5 ��-- -- <br /> FOR OFFICE USE ONLY: <br /> fRON15ET8ICN ilfRflti(1PRfK Sif1F5ElAAfY P1ANC11[CNNUMflER FEE !IF(f��'INn <br /> _?d'� �Lp � S� �/i.�Cv/ .33� l� ; 9�3�- <br /> usr zone ior nrai n vec�Nr srte� FEES VALUATION FEE <br /> � VES �. NO T- <br /> _�_ '_" �`��—_ B�IILC7WG /("! �_ . <br /> R7 4 / � 1' / 1 <br /> fVPFOifPN�� NOGFSLORiES i.�(r.� c x^miwt �r,!�n — - � �-'--- -- -✓-/�Q/- - _._- 1..L'�c.s�.V <br /> 2 !�_��__I PLUM�WG —_—__ 1 <br /> �.-N.. �� <br /> 9JFO�qttnl F y FIRESPPiNMlFR5PE0'D B�SEI.IFN* MECHANICAL <br /> l� fsf�_ aa _�t(o ves � ----- -- ---�—/, <br /> OCLUP�NCY l f1 FIRE AI�RM RE00 MFiGMI LiMiGiiON A��1110NAL PLAN CHECN � � � YL� <br /> � Q' �(�� �Q � /'�� <br /> --ly--' --�37_'- __._._ OTHER J!/ i <br /> fi[ASOH -- — _ <br /> STAIE BUILOMCi SURCHAHGF. � <br /> ir�rnkcer - ainr�senrr+ov�nt�. CITYOFEVERETT ��urti�ir.wonns----- �----��- - - - /�� _ <br /> �/� I LOCAL SALES <br /> o"'E 8/Tc�93 TAX COUE IS 3105 rorn� )2 71 � <br />