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�C r�p APPLICATIC'1 FOR CONSTRUCT"-�N PERMIT <br /> � TO BE COMPLETED IN BLACK INK—PLEASE PRINT <br /> HEATING SYSTEM: ❑GAS CI ELECTRIC ❑ <br /> BUILDING DEPARTMENT <br /> 259-8810 <br /> ❑ DEMOLITION ❑ COMBINATION O BUILDING ❑ MECHANICAL ❑ PLUMBING ❑ SIGN <br /> OWN ��.e ILRDOflESS CITY ZIP PHONE <br /> ��li�s .2L�V y 'Fy ��/ CC���-nfl�(��n G �'$U43 �Zb� 7�/ �6 b <br /> TE�ANT IAAILADDRESS ITY ZIP PHO F <br /> - „ ' fc`� �_ o o s¢7-Y� Z <br /> ARCHITECT DES NER rAILAD�RESS GITV ZIP HONE <br /> GLNERALCONTRACTOji C MAllAOD 55 PHONE STATELILENSEu <br /> T.e�e i��! f � �.�l,�v'r�-- c5�- ���075(o RU SH i= � <br /> MECHANICALCONTRACTOR MAILAO ESS CITY Z PHONE TATELICENSEA <br /> �3oFs c�l.e,��dy� /�� � inc�rnw .3C� �� �l�U��v� - <br /> PLUMBINGCONTRACTOR MRILADORE55 CITV ZIP PHONE STATEIICENSEP <br /> WFTRACi PRICE OF WOR�( <br /> � ryr� 1 <br /> SV VUv <br /> DESCRIBE OR AND SOUARE FOOTAGE INVOLVED C TACT RER50 � <br /> � <br /> �m,�l. � wu t�/ 5y� -yi�iz <br /> I HEREBY CERTIFY THAT I HAVE READ ANG EXAMINED THIS <br /> PPOPOSED e oF aoir+ APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT.ALL <br /> ! �C PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br /> LEGALDES RIPTIONOFPRO°ERiV�SHOW B OWORATTACHTWOCOPIES) WORK WILL BE COM�LETED WITH WHETHER SPECIFIED HEREIN OR <br /> NOT. Ti1E GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br /> �pT e�ocH oF AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br /> 07HER 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 I COMPLY WITH THE STATE <br /> PARCELTA%I.�.NUMBER CONTRACTORS LAW iB.27 RCW AND 296.200 WAC. <br /> CONSTFU T N LOAN LENOEo A�DRE55,TELEPHONE NU ABER X �� � � � � C��� <br /> L 1. <br /> Ll��'i <br /> PRW ADDRESS sicHaroaE <br /> . CITY BOSiNE55 LiLENSE N0. <br /> PLUMBING MECHANICAL <br /> NO. TVPE OF FIXTURE Ofl ITEM FEE NO. TYPE OF EQUIPMENT 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 ' CLOTHESDRI'ERS <br /> � KITCHEN SINK 8 DISP � VENTILATION FAN � <br /> DISHWASHER � RANGE HOOD ' <br /> � LAUNDRY TRAY ; WATER HEATEfi <br /> CLOTHES WASHER � WOOD STOVE ' <br /> � METAL FIREPLACE(WOOD BURNING, ' <br /> URINAL � � <br /> DflINKING FOUNTAIN � FIREPLACE INSERT <br /> FLOOR DRAIN � HEAT PUMP ' <br /> BACKFLOW PREVENTERS ; GAS PIPING � <br /> ROOF DRAINS—RAINLEADERS � EXHAUST FAN _ ' <br /> SINK(SERVICE—BAR.ETC.) � �— <br /> � <br /> i <br /> � <br /> i <br /> SUBTOTAL 5 ' :iUBTOTAL , � <br /> PERMIT $ � PERMIT S � <br /> � TOTAL FEE $ ' TOTAL FEE $ ' <br /> FOR OFFICE USE ONLY: Aeceirr No. <br /> FRONT SETBACK flEAli SETBACK SIDE SETOACK PUN CHE K NJh1BER FEE <br /> � so.33 <br /> USE20NE LOTAREA VACANTSIIE FEES VALUATION FEE <br /> ❑ YES L� NO gU1LDING �� �7,TiV / �' —_ <br /> iYPEOFCONST. NO.OFSTORIES acCUoa'¢Y No0iV�4FLUNGUHrtS � <br />. � A ' / �:.°� PLUMBING _� _ � <br /> �V t5 � <br /> SIZEOFBLDG. FIRESPRINNLEF.SREO'D BASEMENT MECHANI:AL 1— <br /> I?D� T.I. Y�S ❑ YE� .� r+o ; <br /> FIREALAFMREO'D HEIGHTLIlAITATION ADDiTIONALPLANCHECK _ ' _ <br /> OCCUPANCVLOAD �/�J � <br /> � /�-/ OTHER �__ <br /> REASON STATE BUILDING SURCHARGE ' � / <br /> INTPKE6V PLANSAP7ROVEOBY CITYOFEVERETT PUBLICW�RKS � <br /> �/wi LOCAL SALES � <br /> onre pZIl,'� <br /> TAX COOE IS 3105 rora� Z 27�?Jf <br />