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APPLICATIC�1 FOR CONSTRUCT�N PERMIT � <br /> TO BE COMPLETED IN BLACK INK—PLEASE PRINT <br /> HEATING SYSTEM: ❑GAS ❑ELECTRIC U <br /> BUILDING DEPARTMENT <br /> 259-8810 <br /> C 1 DEMOLITION ❑ COMBINATION ❑ BUILDING I 1 MECHANICAL ']PLUMBING ❑ SIGN <br /> �ON?!ER �/// MAILADDRE55 SI/��/�`i � f,1TY 2iP PNONE <br /> YJ� A'1 I I R ! �Z I {N�J��"G/ �`�- �C`�'�'�T Z�, PNONE <br /> �NµT ✓ y].��/M�A,ILADDRE5I5L��/ <br /> �}'�p �y Jy/L� SC!/Wt_ � GIiY 21P PHONE <br /> ARCMITECTORDESIGNER M�ILADDRE55 <br /> 1 �.y ��i� STATE UCENSE t <br /> W�Rp1i..Zl�.lA�ilX9�� M�I�/ l{) ' �WI 1U�0�V(. J �7��Z�1: —1���1 �_ �R/ �(//GSOC365A� <br /> MEGHNIICALCONTRACTOR MAILADDRESS <br /> CITV 21P PNONE STRiELICENSEt <br /> ��n. Z�p PMONB ST�iEL10ENSEa <br /> PIUMBINGCONTRACTOR MAILADDRESS <br /> CONTRACT PRICE OF WORK� �Z�OOO� � <br /> DESLNIBE WORK AND SW�RE FOOT�GE INVOLVED CO ACT PERSOf ANO PMONE N _ 7/ <br /> O V <br /> $��t/Td6Zi0�2 ��-��i�b lll/fLL �G?OCA77d,tJ <br /> 4' (� I�JT ��vic�c�(J� �✓�T I HEREBY CERTIFY fHAT I HAVE READ AND EXAMINED THIS <br /> PROPOSED USE OF BUILDING APPLICATION AND KNOJJ THE SAME TO BE TRUE AND CORRECT.ALl <br /> ��� /�/,(�(�i PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS NPE OF <br /> LEGRLDESCRIPTIOf{OFPROPERiY�SHOWNBELOWORATT�GNIWOCCPlES� NOT 7HELGRAN NG OF AD ERMITJDOES NOT PRIESUME TO GIOVE <br /> �ors rO78q b'���e�ocK� oF q� dF ���� AUTfIORITY TO VIOLATE OR CANCEL THE PHOVISIONS OF ANY <br /> K/Jp�y��VS Z.7Zl �,U���QQ��✓G ' OTNER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br /> PERFORMANCE OF CONSTRUCTION.THAT I AM AUTHORIZED BY?HE <br /> OWNER Of THIS PROPERTY TO PEFFORM THE WORK FOR WHICH <br /> APPLICATION IS MADE AND I COMPLY WITH 7HE STATE <br /> PANCELTA%I.D.NUMBER CONTRACTORS LAW 1B.27 RCW AND 296200 WAC. <br /> COHSTRUCTION LO�N IENDER,RDORE55.TELEFHONE NUMBEII � � <br /> HeiunE ueiE <br /> PpOJECT ADDflESS _ � <br /> a�z� m � ' . ��,.e�=��Eu,k��=E�o <br /> PLUMBING MECHANICAL <br /> Np, TYPE OF FlI(TURE OR ITEM FEE NO. TYPE OF E�UIPMENT <br /> FEE <br /> WATER CLOSET(TOILET) NC—NHNDLG 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 <br /> � CLOTHES DRVERS <br /> KITCHEN SINK&DISP � VENTILATION FAN � <br /> DISHWASHER � RANGE HOOD <br /> LAUNDRYTRAY ; WATERHEATER <br /> CLOTHES WASHER � WOOD STOVE ' <br /> URINAL METAL FIREPLACE(WOOD BURNING� ' <br /> DRINKING FOUNTAIN � FIREPLACE INSERT � <br /> FLOOR DRAIN HEAT PUMP ' <br /> BACKFLOW PREVENTERS ; GAS PIPING <br /> ROOF OFiAINS—RAINLEADERS � EXHAUST FAN — <br /> SINK(SERVICE—BAR.ETC.) <br /> � <br /> � <br /> SUB TOTAL $ SUB TOTAL S <br /> PERMIT $ PERMIT S � <br /> — TOTALFEE 5 TOTALFEE 3 ' <br /> FOR OFFICE USE ONLY: Receiareo. <br /> FRONT SETBACN FERR SETBAGN SIOE SETBACK PLAN CMECM.NUMBEP FEE <br /> _ ,���� 3 27 ,28 0000 <br /> USE 20N� � LOi AREA �j <br /> VqGANTSITE FEES VALUATION FEE <br /> � C YES �N� BUILDING r'f O� ' _ Z✓ ' O <br /> iYPE 0f CONSi. NOAF STORIES OCCUo�utr NC W bMu��+cuNi*5 <br /> � snwv PLUMBMG ' <br /> 1 Z � � <br /> SRE 01'BIDG FlRE SPRINNLERS REO'D BASEMENT MECHANICAL <br /> r'JCIZ� C7 T.I. N� �XYES ❑ NO ; <br /> ADDITIONPL PLAN CHECK � <br /> OCCUPRNGVLOAO FIREAURMRE00 HE1GHTlIMITFTION i <br /> I Q OTHER � <br /> FEASON � � <br /> STATE BUILDING SURCHARGE <br /> � <br /> MTAKEB� PUNSPi!PR VEUBV CITYOFEVERETT PUBUCWJRK$ —T- <br /> 3�1�°!3 LOCAL SALES '��/� <br /> DAIE J/V� TAX CODE IS 3105 TOTAL �(lv <br />