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APPLICATIC 1 FOR CONSTRUCT' lN RERMIT � <br /> TO BE COMPLETED IN BLACK INK—PLEASE PRINT <br /> HEATING SYSTEM: J GAS ❑ELcCTRIC -J <br /> BUILDING DEPARTMENT -- — <br /> 259-8810 <br /> D�MOLITION COMBINATION i BUILDING �I MECHANICAL �l PLUMBING !_ SIGN <br /> O�Cl.iEP IdAILA0DPE55 CITY ZIP PHONE <br /> ta�1MUNLTYI�.'�sti'6" 1133 164T� si' sW�'2CD�YNNtIZDD�i�7 �`FS-2�L <br /> T�yp��T IAAILP�DRE55 GTY PP PHOIiE <br /> �M�N►tY7�H1�stT�t05�Rf�W`�• �1T' �82�" � �7(31 _ <br /> A�'��ItECi R DESIGNEP IAAIL FD�FE55 LIiV ZiP PHOIlE <br /> � �}►/�J�c��N f�# l�l �. ��T: ��Y,e �Sllz- a23-8&U <br /> GENE�ONiFAGTOR IAAILAp�flE55 GITV ZIP ❑MONE STATELICEN'IE� <br /> T � 7 <br /> C CHANiCALWNTRACtOR MAILADOFESS CITV CiP PMONE STATELICENSF.I <br /> PLUMBING CONTRAGiOR IAAiL ADORESS CITV ZIP PHJNE STATE LICENSE a <br /> �ONiRA�FlYORN y� <br /> �.��G�/ <br /> vc--c-�— <br /> DESGFiBE W04i� ND SOU�RE FOOTAGE INVOIVED CONTACi PERSON ANO PHONE N0.�� 1 '� � � <br /> L <br /> `�Nt'�1t" IM��R�4�1% t�p-I lms F _ — <br /> �,�p��. .��y'� — �hlevs� � <br /> a���( '��'J� L, I HEREBY CERTIFV THAT I HAVE READ AND EXAI+IINED THIS <br /> aaowseo use oF ewicuic I .��/ APPLICATION AND KPlOW 7HE 3AME TO BE TRUE AND CORRECT.ALI. <br /> M/�L�'�(�'�� �tL��l�/ R70VISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br /> LEGA��ESCFIPTIONOFPROPERTv�SHOWNBELOY/ORATfACHTWOWPIES� WUFK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br /> NOT. THE GRANT!NG OP A PERMIT DOES NOT PRESUME TO GIVE <br /> io.— e�oc✓ oF AUTHORITY TO 'JIO�PTE OH CPNCEL THE PROVISIONS OF ANY <br /> OTHER STATE U9 LOCAL LAW REGULATINC CONSTRUCTION OR THE <br /> ------ PER��-ORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br /> OWNEFl OF ��HiS PROPERTY TO PERFORM THE WORK FOR WHICH <br /> APPLICATIOP� IS MAGE AND I COMPLY WITH THE STATE <br /> rnr.w�Tna i.o r+uMeea CONTflACTOFS LAW 18.27 PCW AND 296200 WAC. <br /> CC':STPUCTi0RL0/+NLEN�°N,ADORESS.TELEPHGNENU6I�ER � ��� �ryx�..�' <br /> 4 �' <br /> PPOJECT A DRES� sicwrune °"'E <br /> �c�✓ I� r KD. �� U��r, �143?!�— ��,.o���„�ss� ��„—�,,� <br /> PLUMBING MECHANV:AL <br /> NO. TYPE OF FI%TURE OR ITEM FE'e NO. TYPE OF EOUIPMENT rEE <br /> WA�ERCLOSET�TOILET) N(,A41NrLGUNITS—H.P. _ <br /> BATHTUB FORCED AIR S'fSTEMS—B.T.Ii. M E.A. _ <br /> LAVATORV(WASH BASIN) U�VIT HEATEAS—B.T.U. M __ <br /> SHOVJER CLOTHES DFYERS _ <br /> KITCHEN SINK 8 DISP VENTILATION FAN _ <br /> DISHWASHER fIANGE HOOD _ <br /> LAUNDRY TRAV 6VATER HEATER _. <br /> CLOTHES 1NASHER � 1YOOD STOVE '_ <br /> URINAL ; MET.4L FIREPLACE(WOOD BURNING) �_ <br /> DRINKING FOUNTAIN FIREPLACE INSERT ,T_ <br /> FLOOR DRAIN HEAT PUMP <br /> BACKFLOW PHEVEIJTERS GAS PIPING <br /> ROOF�RAINS—RAINLEADEflS EXHAUST FAN rt_ <br /> £INK(SERVICE—BAR,ETC.) � <br /> i <br /> i <br /> SUB TOTAL : SUB TOTAL 5 <br /> — i'e�iMIT S PERMIT S <br /> TOTALFEE 5 TOTALFEE 5 <br /> FOR OFPICE USE ONLY: <br /> NECE IPT NO <br /> Fli;]YtSETBAGK R[Af15E1p�CK SIDFSEi.^.AGK PLANC�jEfKGN���OER// �C/C/ ,� / � ////�J� <br /> � � ( 9 ✓ <br /> u:�i-i.ONE LOTA9EA VACANTSITE FEES VALUATION F� <br /> � YES .^: NO BUILOING �� `�i�`= � 'L�C./ <br /> „��i0it@bi. NO.OFSTOPIES au�Fu¢r uoarowau�mux'.is <br /> _� q � ^'Z N PLUh181NG <br /> L P <br /> �IF CF BL�G FIRE SPRINNLERS PEOD B EIAENT MECHANICAL <br /> I��G G . ��'�i ,I�> :�. VES /�NO — <br /> ADDITIONAL PLAN CHECK � <br /> O'l:.CUPANCYLORD F'TEAIAfihIREOD I MEIGHiLIMITATION �- <br /> N'� FA' I'I Y�h __ OTHER _ _ � <br /> r�— <br /> ie�nsoN <br /> STATE BUIL�ING SUFCHARGE ��XT <br /> [�Us'�1�,��� �� �`T�M�a _ -- — � <br /> ;�;:.: ;. v�nNsavaaoveo�v CITYOFEVERETT PUBLICWOHKS <br /> LOCAL SALES <br /> on,F <br /> 2�/,� �� TAX CODE IS 3105 TOTAL --� <br /> ,. <br />