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APPLICATIC' 1 FOR CONSTRUCT' 1N PERMIT �✓� <br />TO BE COMPLETED IN BLACK INK—PLEASE PRINT <br />- _ -- _ - <br />I HFATWG SYSTEM: �GAS J ELECTRIC J__ <br />BUILDING DEPARTMENT - ----- — <br />259-8810 <br />DEMOLITION COMBINATION XBUILDING MECHANICAL �PLUMBING SIGN <br />nwnrn eunnnnn[ss — _—arv zm --- - r��orr-- <br />LT�ECr_�uS G LeWe.Zl!Jy�� �vEt�err_ 9�zo3 __ zG��-�oo�, — <br />n��mrt um�nooness cnv �i� ���or,� <br />.�nry�nec oa o�sieNu� nun. nnonrsti �,i. ----Tir -- r��or.� .. <br />��J <br />_—_ — <br />r .�a�ir.orviranao� rnn�inunness � �=nv ;��� m�onr srnreucrr+se. � <br />C�TtEv L6ES�s2oot� 2loW -z3'] PL.St�I �{z:�----�gQ310-- ---`'�f5-'7s�3 �Ecc-�c'�iz/�i��___ <br />rA[crNN�CnICONiRnCiOn MNlnn0�iE55 c�t� IiP ru0vf s1NEl�r[v5E• <br />�RUMIIINGCONLR�CLOR M�II. <br />CONiRALI PqICE Oi WORN <br />DLSCPIOE WORN �ND SOU�RE IOOi�G[ MVOIVEG <br />rnovoseo use oF eu�ioiw; <br />lCG4L DESpCRIPTiON OF PROPERiV ISNOWN OE10� <br />i0t—l� BIOCN Of <br />PARCEL TRM I D Nl1Al0ER <br />GONGIRUG110N LOAN <br />TELEPNONENUTABCR <br />OF PIXTURE OR <br />LWATORV (WASH Bp51Nl/1i <br />SHOWEH // <br />HITCHEN SINH 8 DISP � <br />DISHWASHEF <br />�AUNDRVTRAV <br />CLOTHES WASHER .� <br />URINAL <br />DRINkING FOUNiAIN _ <br />FLOOF URAIN <br />BACNPLOW PREVENTLAS <br />ROOF DR��INS--RAINLEADE <br />SINK ISERViCE—BAR. ETC.1 <br />❑LV Z�� P�IONL STNEUCCNSE/ <br />���EN S --- <br />i HEREBV C[RTIFY THAT I HlNE READ AND EXAMINED THIS <br />�PPLICATION AND HNOW THE SAIAE TO BE TRUE AND CORRECT. ALL <br />PROVISIONS OF I.AWS AND ORDIIJANCEg GOVERNING THIS 1"YP[ UF <br />WOi7K 141LL �E COMPLET[D WITH WHETH[R SPECIFIED HEREIN OR <br />NOT. THE GRANTING OF A PERMIT DOES NOT PRESIIME TO GIVE <br />AUTNORITV TU VIOLATE f�R f,ANCEL THE PROVISIONS OF ANV <br />OTHER STATf OR LOCAL LAW REGULATING CONSTRUCTION OR iHE <br />PF.FFORA1Ah..E OF CONSTRUCTION. THAT I AM AUTHORIZED BV THE <br />OWNER OF TI{IS PROPEF�V TO PERFORM THE WORK FOR WHICH <br />�1PPLICATION IS MADE AND I COMPLV WITH THE STATE <br />CONTRACTORS LAW 1827 RCW AND 296.?JO WAC <br />^i <br />/xI{ '_/ / /f/L� — ii.�� �Z`%� <br />' l . .-,.= - _ _ _—l� — _ <br />U� r.l. __ <br />MECHANICAL <br />N0. TYPE OF EOUIPMENT � FEE <br />A C—A HNDLG UNITS—HP. <br />2 FORC[D AIR SYSTEMS—B.T.U. A7 E.A. � <br />�fS _UNITHEATENS—B.T.U. M __ <br />9 CLOTHES DRVERS S!�'G i . <br />V�NTILATION PAN <br />RANGENOOD � <br />WATER HEATEfl � <br />_ �WOODSTOVE <br />META�FIREPLACE(WOOD <br />, DT FIREPLACE INSERT <br />SUBTOTAL 5 �ZU <br />PERMIT 5 <br />TOTALFEE $ , <br />FOR OFFICE USE ONLY: <br />r�iorusemnrv aenes��nnck <br />,�� Zpr <br />u5f iONP l01 P9F. <br />R- Z �62 <br />n i n—� ri^r � no nr sio�ues <br />��Z7(,�� SFy �"'".srmYMIERSREOD <br />_S� _��_4ac /tl� <br />CtC'J�ANCvIOnI� IINI'AI��IAliE0f1 <br />Hfr150N <br />smr srrancK <br />—i <br />VRGANISRC. —�--- <br />�VES NO <br />�.� _ - <br />�••� � <br />AnSENPNr • / <br />YES V NO <br />REiG�Q 14u��1u;N <br />.. _ . <br />�u�in.�nr rinasm'r'r.ovinw CITYOFEVERETT <br />�.J I� LOCAL SALES <br />��,�,� z�/G,�, TAX CODE IS 3105 <br />SUB TOTAL 5 / L G�; <br />PERMIT $ � <br />�'�nrvUtl[rcriild9Ut rfl <br />�� ) �n///) �'�� %-�J <br />oui�oiNc _ 1�15�(¢�0 - --_1�1—i-��� <br />rwMoiHc �2�� _ <br />MECHANICAL __ _ �CI ; � <br />ADDITIONAL PLAN CHECN �2 <br />01HER . 11�L'�L) _—_ — ��/ � � <br />— T.. <br />STATE �UILOMG SUqC11ANGF. _ __�7 �C <br />Pl10LIG WOHKS ��� ;�� <br />10TAL /7'7// ; Q!� <br />