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APPLICATiQ�1 FOR CONSTRUCT,'.�N PERMIT � <br /> i -;,�; � TO BE COMPLETED IN BLACK INK—PLEASE PRINT `��E,r <br /> �J_"" <br /> _ _...... <br /> BUILDING DEPARTMENT � HEATING SYSTEM: ❑GAS ❑ELECTRIC O <br /> 259-8810 , . � f <br /> .. Ctl'�c.a�,�v�/��G2r�f�i.�o� �GG.L��i� n d»xnd� y�1�2�� <br /> i DEMCLITION I I COMBINATiON I I BOILDING I I MECHANIGAL Cl PLUMBING I I SIGN <br /> OLYN[fl MAIL AODfiESS CITV ZIP <br /> PHONE <br /> l3c %/!/li[ mnsa T�- a�t�r/ O � 1 A �o� +� �a �dieo <br /> 7[NANT MAILADDRESS CITY ZIP PHONL <br /> �r+.ax 1�I,asrExs 2q � 't P.oc.i��c. SLv r� i� e ft ,��A 9a'a qo <br /> ARCIIITLCTONDCSIGNCR MAILADORESS qry Z�p PH�'�' <br /> GLIJGULGONTf1�GTOB MMLADDAE55 GITY ZIP PHONE STATEUCENSEII <br /> Jo{�o. �a�,.�a�s 'c. a 'Z� �1 a '�`c Sa /3 /� �.h� ,o1a 9d-� 2G 7�s -3G/J' <br /> MLGpM�IGAL CONiRACTOR MAIL AODRESS P O �� CITY ZIP PMONE STRTE LIGENSE I <br /> I'lL�te.c:.ceC F�rc Pr I-e !-� ri.c /SH3 U�u .Q ♦�� .� Cl�A ��0� 1 �I'3 SG�"I Ap�p,✓FP - /9�il.id <br /> VIUMOR�GGONiRACTOH MqILADDNESS GTV � ZIP PHONE <br /> STATE LICENSE I <br /> C1A550F WORK <br /> ! ' NEW I I ADDITION I�f ALTERATION I I REPAIR f I DEMOLITION I 1 WOODSTOVE/FRPL INSERT f 1 BUILDING RELOCATION <br /> CANTACT PERSON AND PHONE NO. <br /> GONiMGTPRICBOFWORK MAe�t S�wN t�.g3 -� S'7 <br /> OESC01�[WORH AND SOUARE FOOTAGE INVOIVED <br /> R�J I`.IL' Eh f�I'. S(=21 N.1[L�2. SYSTFsH <br /> rnoroseouseoFouaowc J^ � I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br /> L!'CI L Q� APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT.ALL <br /> L@GALDESGNIPTIONOFP OPERTY�SHJWNOELOWOHATTACHFWPCOPIES) PROVISIONSOFLAWSANDORDINANCESGOVERNINGTHISTYPEOF <br /> �or WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br /> OLOCK _ OF NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br /> AUTHORITY TO VIOLATE Ofl CANCEL THE PROVISIONS OF ANY <br /> OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br /> PERFORMANCE OF CONSTRUCTION.THAT I AM AUTHORIZED BY THE <br /> ' - OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br /> APPLICATION IS MADE AND � COMPLY WITH THE S7ATE <br /> CONTRACTORS LAW 78.27 RCW AND 29G.200 WAC. <br /> '��I I "] �aG 1 F 1 L e��/ X ' „�f�,.�yZ� <br /> PROJLCT�DDHE55 bN'.NniUnE p��� <br /> r,rtr nus�Hrss t¢rusr uo <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FI7(TURE OR ITEM FEE NO. TYPE OF EOUIPMENT FEE <br /> WATER CLOSET(TOILET) � A/C—A/HNDLG UNITS—H.P. <br /> BATHTUB � FORCED AIR SYSTEMS—B.T.U. M E.A. <br /> LAVATORY(WASH BASIN) � UNIT HEATERS—B.T.U. M ; <br /> SHOWER � CLOTHES DRYERS � <br /> KITCH[N SINK 8 DISP ' VENTILATION FAN � <br /> DISIiW�SHER —�— RANGE HOOD —�— <br /> LAUNDRV TRAY ' WATER HEATER � <br /> CIOTHES WASHER WOOD STOVE <br /> URINAL � METAI FIREPLACE&CHIMN[V <br /> _ DRINKING FOUNTAIN � FIREPLACE INSERT ' <br /> _ FLOOR DRAIN � HEAT PUMP <br /> BACKFLOW PREVENTERS ' GAS PIPING <br /> ROOF DRAINS—RAINL[ADERS � EXHAUS7 FAN � ; <br /> _ <br /> SINK(SERVICE—�AR, ETC.) � <br /> i � <br /> i <br /> i <br /> i <br /> _ SU�TOTAL 5 ; SUD TOTAL $ � <br /> PERMIT $ � PERMIT $ ; <br /> TOTAL FEE $ ' TOTAL FEG $ � <br /> FOR OFFICE USE ONLY: <br /> FRONT SETO�GN HL�R SET�qCK SIDE 5[TOACK PLAN CHE K NUMBER FEE PECEIPT NO. <br /> � l^ 2 �3 � ;��� ��q� ��, <br /> usezoNe LOTAP[A VACANTSITE FEES VALUATION FEE <br /> �WLDING J <br /> IVP[01 GONIS.ALLOWAOIE 7YPE Of CONS7.ALiUAI pcur�xcy Im ur vxuurW�mnb <br /> LpW� FLUM�ING � � <br /> i <br /> SIZ[OF y�DG, NO.OF STORIES �— <br /> BASEMENT MECHANIGAL ' <br /> OGGUPANGYLOAD FIflESPqHNlER5RE0'D HEIGHTLIMITATION ADDITiONALPI.NNCHECK � <br /> SPRINKLLR � — <br /> RGASONFORSPRINKLERS yC �_ <br /> STA7E OUILDING SURCHARGE ; <br /> iNiAK��r r�nNsnrraov�oav CITYOFEVERETT PUOLICWORKS <br /> LOCAL SALES ' — <br /> � .� r TAX COOE IS 3105 rora� ,��' � - <br />