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APPLICATI�^1 FOR CONSTRUCT'�N PERMIT � <br /> ' � �� TO BE COMPLETED IN BLACK INK-PLEASE PRINT <br /> BUILDING DEPARTMENT HEATING SYSTEM: ❑GAS U ELECTRIC ❑ _ <br /> 259-8810 <br /> I-7 DEMOLITION ❑ COMBINATION ❑ BUILDING C 1 MECHANICAL ❑ PLUMBING I� SIGN <br /> OWNEP MNLFDDRESS CiTY ZIP PHONe <br /> d��r��c 32v- I�S�� � si.,�yt-he ,� ' Juu� v�t, yfx:er�- 933 v3�4 <br /> T N / CGA1 MqILA�DRE55 CITY ZIP PHONE <br /> t J /(/ <br /> S C. ��F�X 37 • Zn ' �v9�3 <br /> A,R�CyM�ITECTOR�ESIGNER IAAILAUD ESS - ITV ZIP PHONE Z <br /> ///I- fL!'Lf+� /gl'�I9� � c�nG /�i;,v/� .�}l/� C�J �e'��L' .�' � - � <br /> GENERAL NTRACTOR IdAILAODPESS CITY 21P HONE STATELICFNSFn <br /> MECHANICALCONTRFCTOR MAILADDRESS CITY ZIP PHONE STATELICENSEb <br /> PLUMBINGCONTRFCTOR MAILAD�FE55 CITY ZIP PHONE STATEUCENSEV <br /> ONiflACTPPICEOFWORK ryU <br /> S`1��.C�� . <br /> OESCRIBE WORN AND SOUARE FOOTFGE INVOLVED CONTACT PEFSON AND PHONE NO. <br /> � '�� . � - �� �s 2�9,3/�l <br /> Z I HEREBV CERT(FY THAT I HAVE READ AND EXAMINED TFIIS <br /> PR OSED USE OF BJIL[IING APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT.ALL <br /> � r �.K� !v� PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br /> LEGALUESCRIPiION PRO RTV�SHOWNBEIOWORATfAGMiVJOCOPIES� WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br /> NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br /> �or �ocH oF AUTHORITV TO VIOLAT� OR CANCEL THE PROVISIONS OF ANY <br /> i� �. OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br /> V yv�y PERFORh7ANCE OF CONSTRUCTION.THAT I AM AUTHORIZED BY THE <br /> ��� r�,W OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br /> � � � APPLICATION IS MADE AND I COMPLY WITFI THE STATE <br /> PARCELTA%ID.NUMBER �7�['j2 � �� �+� <br /> Sl7�� ' � '' UO) — IOu'� CONTR 5 LAW 18.27 RC 296.200 WAC. <br /> CONSTRUCTION LOAN LENOEF.ADDRESS,TEIEPHONE ROMBER <br /> �`-� �9�� <br /> ' PROJECT ADDRE He on�e <br /> crtr ousrvess ucv+se rvo. <br /> PLUMBING • MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM FEE N0. TYPE OF E�UIPMENT FEE <br /> . WATER CLOSET(TOILET) � A/C—AIHNDLG UNITS—H.P. I <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 /> KITCHEN SINK 8 DI5P � VENTILATION FAN <br /> DISHWASHER � RANGE HOOD T— <br /> LAUNDRY TRAY ; WATER HEATER ' <br /> CLOTH�SWASHER � WOODSTOVE i <br /> URINAL ; METAL FIREPLACE(WOOD BURNING) � <br /> DRINKING FOUNTAIN � FIREPLACE INSERT ; <br /> FLOOR DRAIN � HEAT PUMP � <br /> BACKFLOW PREVENTERS � GAS PIPING ; <br /> ROOF DRAINS—RAINLEADERS � EXHAUST FAN � <br /> SINK(SERVICE—BAH,ETC.) ; <br /> � I <br /> - � � <br /> � � <br /> � � <br /> � SUB TOTAL 5 ; S118 TOTAL $ ' � <br /> PEFMIT 5 � PERMIT $ <br /> TOTAL FEE $ ; TOTAL FEE $ � <br /> FOR OFFICE USE ONLY: �35 7�' ��� �3L'SG--`'� � <br /> FRONT SETBFCN REAq SETBACK SIOE SETB�CK PLAN CME 1! h BER �FEE RECEIPT NO <br /> � � 3G�'�=9�' Os% .3 <br /> USE 20NF LOT AREA VACANT SITE / FEES VALUATION FEE <br /> � ❑ YES /-1 P10 BUILDING - � -'1 ' i Q <br /> iYPEOFLONST. NO.OFSTORIES OCNv+rvtv xOCiowFuixGuxrtS //, 2 � <br /> �l� � cnouv A. pLUMBING ��J�C��✓ ��.J(,��� i.JC� . <br /> �SIZE OF�LUG 4 FIRE SPPINNLERS REO'D BASEMENT MECHANICAL i <br /> n ��- Y�LJ ❑ YES }� NO ; <br /> � OCCUPANCV LOAD FIaE AIARM REO'D HEIGNT LIldR�TION AODITIONAL PLAN CHECK �;� � <br /> y I � <br /> �, IIO (G>C7 �J � � OTHER � <br /> � REASON ��p�_.�� �.y <br /> AI{�%�'} ��wTv,/rl�i �w{NIf�� S7ATEBUILDINGSURCHARGE i`�� <br /> '�, INTAKE BY �� �Py}�A;6�PR �Lq� CITY OF EVfRETT PUOLIC WORKS i <br /> ° LOCAL SALES <br /> �i DATE JM � � TAX COUE IS 3105 TOTAL ��/�3U �,U <br /> 7�r1� _ �: F�Mir <br />