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APPLICATIC'``! FOR CONSTRUCT"')N PERMIT � <br /> TO BE COMPLETED IN BLACK INK—PIEASE PRINT <br /> BUILDING DEPARTMENT �HEATING SYS7EM: J GAS ELECTRIC J <br /> 259-8870 <br /> '�DEMOLITION COMBINATION �BUILDING MECHANICAL [l PLUMBING I ; SIGN <br /> OWNEF IdAILADDRE55 CITV ZIP PNON[ <br /> Ch5�k9E SR��Yre94M+k. 247.o Go�-A`/ �~���� — <br /> iENRNT IdAILApDRESS QTV ZIG PHONE <br /> ��� 4'1Ac- 44tv�cETi tox.'iiqc�i. Sd4Tllls 48ro�( <br /> �RCHITEGTORDEiIGNER MMLhDDqESS � CIiV 21P PMONE <br /> "11tE o�F:l� tau�ARoRA�1vE 2a.t1 zt �vee 5�"�T�.� WA `� Sil�- 's29-rr�z, <br /> GENLFALCONiRtLTOF IANLADDRE55 GTV 7.IP PHONEauO�OJ SiATELIGENSE� <br /> (�PFti+ cc�,�n� P•o P�� �i2z°t gt���e wa 48�vq � u+4qe�c�K�Ko�W7 <br /> MEGM4MG�L COATFAC70H IAAIL AD�RE35 CRY ZIP PNONE STnTE UGENSE r <br /> To /�E vr�t�.w��vJp <br /> PWNAINGCONTIIACTOR IAAI�pDDPESS GTV ZIP PHONE SiATELICENSER <br /> Ta P�c t"Mz,w,. v <br /> ca+rana PA��E or woaK <br /> $d DOO°u <br /> DESCRIBEWOR4ANDSOU�REFOOTAGE�NVOWE� GONTAGTPERSOtJANOPHONE� �8�8a� <br /> W l�'c� '2ct C.. 20Co _ <br /> ��woR�� o�- z9�a S r- aF <br /> �C}Jt(Z/S'1� Oj—�'<<�= I � W�21�- I HEREBV CERT�FY THAT I HAVE READ AND EXAMINED THIS <br /> PROPOSFDUicOFBUIIDING APPLICATION AND KNOW THE SAME TO BE TFUE AND CORRECT. ALL <br /> PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br /> l[GALUESCRIo*;Ot101'Pi10PERTVISNOWNBELOIVORATTACHiWOCOPIES� WORK WILL BE COMPLETED WITH WNETHER SPEGFIED HEREIN OR <br /> NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br /> �ot =�ock oF AUTHGRITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br /> ��j ^�'p �L/9.� OTHER STATE OR LOCAL LAW REGUTATING CONSTRUCTION OR THE <br /> PEFFOR�IANCE OF CONSTRVCTION.THAT I AM AUTHORI2ED BY THE <br /> OWNER OF THIS PROPERTV TO PERFORM THE WORK FOR WHIGH <br /> APPLICATION IS MADE AND I COMPLV WITH THE STATE <br /> pnacei.tnx i o.raue+eeq CONTRACTOI S L 8.27 RCW AND 296200 WAC. <br /> CONSTN TION LO�N L[NDER.AODFE55.TEIEPMONE NUMBEF <br /> u�A .��z8' � ��+y 4Y <br /> ' PROJECTADD�`5,�� s�cu.. vrb2y 7J o.+e <br /> � Gilv�VSIN!G51�^_!rtti(NO <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM FEE NO. TVPE OF EOUIPMENT FEE <br /> WATEF CLOSET ITOILET) A/G—MHNDLG 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 /> T <br /> SHOWER CLOTHES DRYF(iS ' <br /> KI'fCHEN SINK&DISP VENTILATION FAN i <br /> DISHWASHER RANGE HOOD � <br /> L4UNDRY Tf1A1' ; WATER HEATER ' <br /> CLOTHES WASHER � 1NOOD STOVE � <br /> URINAL ' METAI FIREPLACE(WOOD BURNING) <br /> DRINKING FOUNTAIN I FIREPLACE INSERT I <br /> FLOOR DRAIN � HEAT PUMP <br /> BACKFLOW PREVENTERS GAS PIPING � <br /> ROOF DRAINS—RAMLEADEFc EXHAUST FAN <br /> SINK(SERVICL—BAR,ETC.) <br /> — � ' <br /> �— <br /> _ , � <br /> � _� <br /> SUB TOTAL 5 ; SUB TOTAL $ ' <br /> PERMIT $ � PERMIT $ <br /> TOTALFEE $ 'OTALFEE 5 <br /> FOR OFFICE USE ONLY: <br /> FRpNT SETBACK REAP SETBALK SIDE SEt6ACN PLAN H K NUMBEDR F[E �G./, FK51PT HO � <br /> C 2 � V <br /> usEzor+e �ornaen vncnNrsire FEES VALUATION FEE <br /> ❑ YES , : NO BUILDING �OOOO _������ <br /> TYPE Oi GONST N0.OF STORIES bcCVno��qcv uu ar�.iM6 NmS <br /> I I I — I ��' t— 1_ PLUMBING _ <br /> SIZE OF BL�G FIRE SPRINKLERS PEO'D BASEMENT MECHANICAL � <br /> 29�s y • '� YEs n YES :.:� N� � <br /> OCCl1PANGv LOAD FIRE RLARM RE00 NFIGNT LIMITATION ADOITIONAL PLAN LHECK i <br /> 3 S `(�CS on+Ea <br /> REASON <br /> f ����� , STATE BUIL�ING SURCHARGE '�.�� <br /> INTFKE9Y PLANSAP OVEDBY CITYOFEVERETT PUBLICWOflKS � <br /> �1h LOCAL SALES <br /> �,�,� 7AX COUE IS 3105 TO7AL ��� ;�-'� <br /> - 1D•5 <br />