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APPLICATIC l FOR CON$�'RUCT'�1N PERMIT � <br /> TO BE COMPLETED IN k:_ACK INK—PLEASE PRINT <br /> BUILDING DEPARTMENT HEATIIdG SYSTEM: ❑GAS ❑ELECTRIC ❑ _ <br /> 259-8810 <br /> ❑ DEMOLITION G COMBINATION ❑ BUILDING ❑MECHANICAL ❑PLUMBING ❑ SIGN <br /> ONT! M IL�DDRE55 CI ZIP � PHONE <br /> ac,� jL ��,�z i .�.��_'�? /.��cor-� 9��v / <br /> TEN�NT M�ILADURE55 GIT� ZIP PHONE <br /> APCNITcGT OR�ESKNEP MMl ADDRE55 CITY ZIP pHONE <br /> GENERALCONTR�GTOR M�ILADDNE55 CIiV ZIP PHONC STRiEUCENSE� <br /> MECH�NI CONTR�CTOP M�ILADDRE55 UTY ZIP PMONE STRTELICENSEI <br /> �:� �i� <br /> PLUMBIOGC �LTOR MAILA�DRE55 Q1V ZIP PNONE STRELICENSE• <br /> CONTR�CT VRICt OF WORK <br /> DESCPIBE WORN ANJ$OIqRE FOOT�GE INVOLVED GONTAC7 PERSON FND PHONE NO. <br /> i HEREBY CERTIFY THAT I HAVE READ AND E%AMINEG THIS <br /> PROPOSED USE OF ILDING /'�' APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRF.CT.ALl <br /> �Q.k� D'!'f7 C.Q PROVISIONS OF LAWS AND ORDINANCFS GOVERNING THIS 7YPE OF <br /> LEGRLDESLRIPTqNOFPqOPERtt(SMOWNBELOWORATTACMTWOCOPIES) WORK WILL BE COMPLETED WITh WHETHER SPECIFIED HEREIN OR <br /> ior e�ocrc oF NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br /> AUTHORITY TO VIOLAiE OR CANCEL THE PROVISIOPJS OF ANV <br /> OTHER STATE OR LOCAL LAW REGULATIIJG CONSTRUCTION OR THE <br /> PERFORMANCE OF CONSTRUCTION.THAT 1 AM AUTHORIZED BY THE <br /> OWNER OF THIS PROPERTV TO PERFORM THE WORK FOR WHICH <br /> APPi,ICATION IS MADE AND I COMPLY WITH THE STATE <br /> PRRCEL TA%I.D.NUMBER CONTRACTORS LAW 1827 RCW AND 296200 WAC. <br /> CONSTRUCTIdILO�NLENDER.ADDRESS.TELEPMONENUMBER <br /> x ��/' <br /> PROJECT ADDRESS /. , sie��rune o��e <br /> r <br /> (/L/ arr eusw�ss ucsHsc uo <br /> PLUMBINfi ` MECMANICAL <br /> N0. TYPE OF flXTURE OR ITEM FEE NO. TYPE OF EOUIPMENT FEE <br /> WATER CLOSET(TO�LET) A/C—NHNDLG UNITS—H.P. � <br /> BATHTUB ; FORCEO AIR SVSTEMS—B.T.U. M E.A. <br /> LAVATORV(WASH BASIN) � UNIT HEATERS—B.T.U. M ; <br /> SHOWER � CLOTHES DRYERS � <br /> KITCHEN SINK 6 DISP VENTILATION FAN � <br /> DISHWASHER RANGE HOOD <br /> LAUNDRY TRAY WATER HEATER <br /> CLOTHES WASHER WOODSTOVE <br /> URINAL METAL FIREPLACE(WOOD BURIJING) <br /> DRINKING FOUNTAIN � FIREPLACE INSERT <br /> FLOOR DRAIN � HEAT PUMP �— <br /> BACKFLOW PREVENTERS ; GAS PIPING ; <br /> ROOF DRA�NS—RAINLEADERS EXHAUST FAN <br /> SINK(SERVICE—BAR,ETC.) ; � <br /> � <br /> � <br /> � <br /> � <br /> SUBTOTAL $ SUBTOTAL $ <br /> PERMIT $ PERMIT $ <br /> TOTAL FEE $ IUTAL FEE $ � <br /> FOR OFFICE USE ONLY: <br /> FPONTSETBr1CK qERRSETBACN SIDESETBACK PLANCHEC NUMBEP FEE RECEIPTNO. <br /> 5 <br /> USE IONE l0T RREA VACRNT SITE FEES VALUATION FEE <br /> ❑ YES � NO BUILDING ' <br /> TYFEOFLONSi. NO.OFSTORiES octureqcr xoorpw[¢wcUurts � <br /> G9W� pLUMBING <br /> SREOFBLIXS. FIRESPRINKLERSREO'0 B�5[MENT MECHANICAL <br /> ❑ YES u NO <br /> OCCOPANCY LOAD FIRE RURM REOD HEIGHT UMITATION ADDITIONAL PLAN CHECK ZD ' <br /> --� <br /> OTHER D� <br /> REASON ' � <br /> � <br /> I E'�U N STATE BUILDING SURCHARGE i <br /> INTRREBV PUN..yY¢w0Vf80Y CITYOFEVERETT PUBLICYlORKS � <br /> �M LOCIIL SALES ' <br /> oprE q ��,� . TAII CODE IS 3105 TOTAL Cj� I -- <br />