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�.� — <br /> APPLICATIC'1 FOR CONSTRUCY' lN PERMIT � <br /> TO BE COMPLETcD IN BLACK IN!<—pLEASE PRINT <br /> ��� <br /> HEA�ING SYSTEId' �GAS ❑ELECTRIC J _ ., <br /> BUILDING DEPARTMENT <br /> 259-8810 <br /> DEMOLITION � COMBINATION BUILCiNG �:MECHANICAL ❑PLUMBING xSiGN <br /> � PHptJE <br /> pVlNER MA�LA0�9E55 GRY � ZIP �� `�� <br /> �l / � � fC �(„a�(�U <br /> r/�'�evfr o l cTL.aKt �r�, r ( l� ��� <br /> SatL /.3[-`.� V✓.2^ � �° crtv z�v vHa+E <br /> �ENANT MRILAD�E55 � �� <br /> �c�f� /?BSwa�ooT,o ��S'c; cnFF c;�a- u,—. F�lii9 .11�U 47� -c.N•, 7 _ <br /> pqpHREGT OR DESiGNER MA�L RODRESS <br /> Clii� PNONE <br /> ✓�K �dL��� r�'/Pr O-l� �]�T�oiT Ml `�21� ��/,�� � '� PMUNE C t, STRTELIG[NSEt <br /> IENERALCONTRACTOR MRU :C�RE55 <br /> CITY Z�P <br /> ,u,rc-F'�'�wv�� /YJc�� 9P77� �«-o??�! S/J'JP.6rFi0u73�_-- <br /> f����' -��'r /iC✓ /�=�� �� PHONE STRTE LICENSE� <br /> MEGHANIGRLCOHTRAGTOR M4ILNUDflE55 <br /> CRY Z�P <br /> PLUMBINGCONTRACTOF MMLADDNESS <br /> Cm, Z�P pHpryE 6iAiE LICENSE� <br /> ppNTRACTPRIGEOFYIORK p <br /> /v000 <br /> CONT�CT PEHSOB AND PHONE NO `` �C' <br /> �Es�PIBE M�ORY.RND SOUARE F TA6E INVOL�ED __ <br /> Y��,r, i�1 fir�'tin/T �Ic/ r Ai�D -�n/sTne <br /> c'< c -O Z� -- <br /> /'A/J!" I[{O:i L✓/V;/f! T'' l+/ .L1P dY'.a1'�N .t� ' . <br /> �N� �,Fr� y�(� __ i HEREBV GERTIFV THAT I HAVE READ AND E%AIdINED THIS <br /> PPOPOSED USE OF BU�L�ING APPLIGATION AND KNOW THE SAME TO BE TRUE AND CORRECT. Al I. <br /> PROVISIONS OF LAWS AND ORDINANGES GOVERNING THIS TVPE Gf <br /> LEGALDESGFIVTqNOFPROPERTYISMOMM9ELOWORAttACHTWOCOPIES� WORK WILL BE COMPLETED WITH WHETHEP SPECIFlED HEREIN O�, <br /> NOT. THE GRANTING OF A PERMIT DOE5 NUT PRESUTAE TO GNF <br /> LOT— BLOCK oF — AUTHORITY TO VIOLATE OR CANCEL TNE PROVISIONS OF PhJ'i <br /> OTHER STATE OR LOCAI LAW REGULATING CONSTRUCTION OR Tt;[ <br /> PERFOfiMANCE OF CONSTRUCTION.THAT I AM AUTHOR17_ED BV TN[ <br /> OWNER 0� THIS PROPERTV TO PERFORM THC WORK FOR WHICH <br /> APPLICATION IS MADE AND I COMPLY WITH THE S�iAT[ <br /> VARCEL TA%10.NUMBER CONTRACTOR5 LAW 1827 RCW AND 2%200 WAC. <br />� y%73 - � � 9 - coi •�o3o <br /> CONSTRUCTION LOAN LEN�ER,AUDRESS.TELEPHONF NJMBER � �—����� <br /> X o�'f <br /> SO �*unr _ _ . <br /> PROJECT ADOAESS cu.nusv�ssncrHsr no <br />, � (�O CD � � _ <br />� PLUMB�NG MECM�NICAL <br /> FEE NO. TYPE OFEOUIPMENT FEE <br /> Np, TYPE OF FlXTURE OR�TEM _ <br /> WATER CLOSET�TOILET) � A�C—A�HNDLG UNITS—H.P. <br /> FORCED AIR SYSTEMS—B.T.U. M E.A. <br /> BATHTUB ' <br /> LAVATORY('NASH BASIN) � _ UNIT HEATERS—B.T.U. M __ <br /> CLOTHES DRYcRS - - <br /> SHOWER � VENTILATION FAN - - <br /> KITCHEN SINK 8 DISP RANGE HOOD -�-- <br /> DISHWASHER WATER HEATER --- <br /> LAUNDRY TRAY � WOOD STOVE -- - <br /> CLOTHES WASHER METAL FIREFLAGE�WOOD BURNING) _ . - <br /> URINAL FIREPLACE INSE(iT -- � <br /> DRINKING FOUNTAIN � HEAT PUMP --- <br /> FLOOFi DRAIN GAS PIPING — <br /> BACKFLOW PREVENTERS EXFiAUST FAN � <br /> ROOF DRAINS—RAINLEADERS � ' <br /> SINK(SERVICE—BAR.ETC.) ' � <br /> �� <br /> � <br /> � <br /> � i <br /> SUBTOTAL 8 I <br /> SUB TOTAL $ � pERM1T S � <br /> PERMIT $ TOTAI FEE $ I <br /> TOTAL FEE S <br /> FOR OFFICE USE ONLY: RECEiPT N <br /> SIOESETBACK PLANCHFC Nl11AeER FEE ^ ,Y � <br /> FRON15F.iBALK REARSETBh ,� // � �� <br /> �/ i <br /> VALUATION FEE <br /> LOT nREF VACANT SITE <br /> FEES —��� <br /> USEZONE ,'�� `(E$ �' N� BUILDING �� C <br /> 'J NO OF STORIES aCtu��Na Na m ewEUMs Unns <br /> TVPE Of GONSi cxouo PLUMBING <br /> S�ZEOFBLOG. FIRESPNINKIERSflEO'U BASEUENT MECHANICAL � � <br /> �; YES :-' NO � <br /> HEIGHT uMiTAT1oN ADDITIONAL PLAN GHECK ' � <br /> OGCUPANGY IOAD FIFE ALARM REO'D i ' <br /> O7HER �r--�/—� <br /> REnSON STATE BUILDING SURCHARG[ CL <br /> INTAKEBY PLANSA �DBV CITYOFEVERETT PUBLICWOPK$ T <br /> LOCALSAIES ' <br /> DRTE /O _ <br /> TAX COUE IS 3105 rorn� <br />