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� <br />APPLICATIC�`1 FOR CONSTRUCT"'1N PERMIT � <br />TO BE COMPLETED IN BLACK INK—PLEASE PRINT <br />� - - - - <br />__ - <br />I_ HEATING SVSTEM: J GAS J ELECTRIC J_ __ __ __ <br />BUILDING DEPARTMENT <br />259-8810 ` / <br />DEMOLITION COMAINATION BUILDING _ X MECHANICAL PLUMBING SIGN <br />. <br />o�•rtina �.ini�nnn��t.as n•r � -- zn ��utt,e <br />_�rsx�+t_C4nts._---,3�o�_1tn �9�� —'�shi-. y�.ol — <br />n r�n��r rrnn noor�t ss � mrv �ir wwr�e <br />�,,�.� c�tic. ����a�si�s�s���— _ qa�l <br />n1iCMtlECTOROESiCNEP �.���L4UDRFtiS cliv i�r rNONE <br />GCNfHlllf.ONifiAC10R AIAiI��Dnf55 (:iiv i��' �MUNE SiRi[LiCCNSE� <br />NElN4NiCAlCONifiACtOf1 M�il�0�OF5!i G1Y Tn P��0�1E titAiELILENSEi <br />Smi}h �{r� S N��9�S ars.ler.rc�Tt��o�na�y.(u�-° }Jl3 /a9(a`l �rniti�eS131ep_t <br />PWMBiNGCONiRAL10P M41LAO�R[SS Clfv 7��' 1'110NE ETQEUCENSEI <br />LONiRACi PRICE OF WORN <br />_1��Z <br />OFSCRIBE WORK R �D SOUM�E FGn1AGE INVOIVW <br />3� <br />US& OF <br />l E WL OESCRIPLION OF PROFENiv ISNOWN OFLOW ON �TTACN TWO LOPIGS� <br />ior etxK — or — <br />PRRCELT�%ID NWAB[R <br />LONSTRUC110N LOAN LENOER AO�RE55. TftEPMONE Nl1MBER <br />TVPE OF FIXTURE OR ITEM <br />WATEFi CLOSET (TOILET� <br />BATHTUB <br />LAVATORVIWASH BASIN) <br />SNOWFr <br />KITCHEN SINK 8 DISP <br />DISHWASHER <br />LAUNDFYTRAY <br />CLOTHES WASHER <br />URINAL <br />DRINKING FOUNTAIN <br />FLOOR DRAIN <br />BACKFLOW PREVENTERS <br />SUBTOTAL <br />— PERMIT <br />— TOTAL FEE <br />FOR OFFICE USE ONLY: <br />�R(SNiti[19ACM RE�RSROACK <br />nSf JON[ �Ot ARE� <br />nPl N caNsl <br />.� <br />��ri or oina <br />� s ci irm,cv �o+n <br />RI n fll� <br />q�:r�� N/+l <br />,������ �� <br />riee srawyri.Ens neoo <br />LINE /�L�n�[OD <br />CONiFGi PEH50�I Aqp P��ONE NO <br />—f�rL _.�ls�x harrl �1�_3J.oQL¢_�1 — <br />I HEREBY CERTIFY TI1AT I HAVE RFAD AND EXAMINED THIS <br />APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT, ALL <br />PROVISIONS OF LAWS AND ORDINANCES GOVERNING THI$ TVPE OF <br />WORK WILL BE COMPLETED W17H WFIETHER SPECIFIED HEHEIN OR <br />NOT. TNE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br />AUTHOP�TY TO VIOIATE OR (:ANCEL THE PROVISIONS OF ANY <br />OTHER S7��TE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br />PERFORAIANCE OF CONSTRUCTION. THAT I Ahl AUTHORIZED BV THE <br />OWNER OF THIS PROPERTV TO PEFFORM THE WURK FOR WNICH <br />APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />CONTRACTORS LAW 1827 RCW AND 296200 WAC. <br />ME <br />NO. <br />0 <br />tl <br />AfilUHl <br />TYPE OF EQUIPMEN <br />A�C—A HNDLG UNITS—H.P <br />FORCED AIR SYSTEMS—B T.0 <br />UNIT HEATEFS—B.T.U. M <br />CLOTHESDRVEFS <br />V[NTILATION FAN <br />RANGE HOOD <br />WATER HEATER <br />WOOD S?OVE <br />METAL FIREPLACE IWOOD BU <br />FIREPLACE INSERT <br />HEATPUMP <br />GAS PIPING <br />J, i <br />O�D�JSErenCN rtnNCutGNNu/�/f <br />' 6 <br />vncnN* siTE FEES <br />vEs N� uuaoiNc <br />�,•.�,.�.,�.:,,,, ------------ <br />/y rw��eiNc <br />�J�. .[7 -- <br />PnsE�.ieNi IA[CNANICAL <br />VES 'XNO --� <br />NEiGNr �ibninrio�� AD�ITIONAL PLAN CNECN <br />— ___ OiHFR '�in�.q ^,,.� �_ . <br />SrnrE eui o suncr+nnc� <br />vinns�rr�+�vEne. CITYOFEVERETT r�umicwo�Ks <br />� M LOCALSALES <br />���,r G��l��f�� <br />TAX COOE IS 3105 rora� <br />i �- � �,'�-� `�--- <br />E A. <br />SUB TOTAL $ <br />PEFMIT S <br />TOiAL FEE 5 <br />�,� . � � i. , l .� � � �" , � <br />rEi n[cFlrrNo <br />��, � '-' S <br />VALUATION FEE <br />-- --- .— <br />— --- 7 .� �' - <br />/ <br />/ <br />i��N <br />-- -�—T <br />