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APPLICATIC l FOR CONSTRUCT`�N PERMIT � <br /> TO BE COMPLETED IN BLACK INK—PLEASE PRINT <br /> BUILDING DEPARTMENT HEATING SYSTEM: J GAS ❑ELECTRIC J <br /> 259-8810 <br /> ❑ DEh70LITI0N ❑ COMBINATION C 1 BUILDING ❑ MECHANICAL ❑ PLUMBING ❑ SIGN <br /> OWNER I.IAILA�DRESS CITV n Z/I�P PMONE <br /> cr ICl{ 1�t✓tleamin'f" l r��ii� f�u✓i ' Yl) !SOY 371v.3 ' St�+��� y���y <br /> TE y[T) �I MAILAD ESS — CITY — Z�p PHONE <br /> C>' � s <br /> AFCHITECTORDESIGNEF MAILA�DiiESS LITY ZIP PNONE <br /> GENERALCONTRACTOR h1�ILnDDRE55 CITY ZIP PHONE STATELICENSEq <br /> MECHANICALGONTRACTOR IdAILAD�RE55 qTV ZIP PHONE STATELIGENSEN <br /> Smr1J� F'r� Cisf�»,< S�S/9 Sn C)r�l��.[ 7a�. IJA. 98f/. U7�'�o% 7 �VITTH�< 1 �/ Or <br /> PLUMBINGCONTPACT IAAILAO�RESS CITV 21P PHONE STATELICENSEY <br /> CONTRACT PRICE OF WORH � <br /> OESCRIBE LVORK AND SOUARE FOOTAGE IN1�OLVED CONTACT PEFSON AND PHONE NO <br /> �GII4�lC)( "1' � fC YI (rS ,�/yy�s!)/� � ��'�p��� <br /> �2z � <br /> I HEREBY CERTIFY THAT I HAVE READ AND EXAh11NED THIS <br /> PROPOSEO USE OF�UILDING APPLICATION AND KNUW THE SAME TO BE TRUE AND CORRECT.ALL <br /> - PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br /> LEGALDESCRIP110NOFPROPERTV�SNOWNBELOWORATTACHTWOCOPIES) WORK WILL BE COMPLETEG WITH WHEThER SPECIFIED HEREIN OR <br /> NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br /> wT e�ocK oF AUTHORITY TO VIOLATE OR CANCEL TNB PROVISIONS OF ANY <br /> OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br /> PERFORh1ANCE OF CONSTRUCTION.THAT I AM AUTHORI2ED BY THF. <br /> OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br /> APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> PARCELTAX I.D.NIIMBER CONTRACTORS LAW 18.27 RCW AND 296200 WAC. <br /> CONSTPUCTION LOAN LENDER,ADOf7ESS,TELEPHONE NUMBER � <br /> PROJECT ADDRESS �D -�j"y`� <br /> sicrv tua onrE <br /> ', �/�f/9 �vr� � t r e — � cnv iHEss�icEHseuo � <br /> i PLUMBING CHANICAL <br /> �, N0. TYPE OF FIXTURE OR ITEM FEE N0. TYPE OF EOUIPMENT FEE <br /> �NATER CLOSET(TOILET) � A/C—AIHNDLG 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 /> �— <br /> SHOWER ' CLOTHES DRYERS � <br /> KITCHEN SINK 8 DISP ; VENTILATION FAN ; <br /> DISHWASHER � RANGE HOOD �— <br /> LAUNDRY TRAY � WATER HEATER ' <br /> CLOTHES WASHER � WOOD STOVE � <br /> URINAL ' METAL FIREPLACE(WOOD BURNING) � <br /> DRINKING FOUNTAIN I FIREPLACE INSEflT . I <br /> FLOOR�RAIN � HEAT PUMP � <br /> BACKFLUW PREVENTERS ; GAS PIPING ; <br /> FOOF DRAINS—RAINLEADERS � EXHAUST FAN � <br /> SINK(SERVICE—BAR,ETC.) ; <br /> � <br /> i � <br /> � � <br /> ' � <br /> � � <br /> SUB TOTAL $ ; SUB TOTAL $ ' , <br /> PERMIT $ � PERMIT $ � <br /> ----�— <br /> TOTAL FEE $ ; TOTAL FE= S ; <br /> FOR OFFICE USE ONLY: <br /> FflONTSETBACK PE�RSETBACH SI�ESETBACK PLANCHECRNUMBER FEE FiE�P NO. <br /> / i <br /> USE 20NE LOi AREP YACANT SITE FEES VALUATION FEE <br /> ❑ YES ❑ NO BUILDING i <br /> SVPEOFWIlSi. NO.OFSTORIES oc[urxnCv r+OA�owFluNGUNrtS � <br /> �rrf�N .Z L4p� �. PLUMBING ' <br /> 11E <br /> SIZEOFBLDG. fIFESPR�IN/KLEP5RE0'D BASEMENT MECHANICAL <br /> q,�J �C ✓F, 1�� ❑ YES 3�CN0 , <br /> l <br /> OCCUPANCYLOAD FIREALAFMREO'D HEIGHTLI ITATION ADDITIONAL°LANCHECK � <br /> i <br /> I�ol� Y�� �� 2 ��cwr�� .er�_ �p�v ' .SO <br /> REASON <br /> A.pv-� f� �D������ S7ATE BUILDING SURCHARGE i <br /> /l!Z <br /> INTAKEBY PLANSAPPROVEDOV CITYOFEVERETT PUBLICWORN$ � <br /> JM LOCAL SALES , <br /> DATE �� �i TAX CODE IS 3105 TOTAL � <br />