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APPLICATIQ '! FOR CONSTRUCT' lN PERMIT � <br /> TO BE COMPLETED IN BLACK INK—PLEASE PRINT <br /> BUILDING DEPARTMENT I HEATING SVSTEM:�GAS U ELECTRIC 'J _____� <br /> 259-8810 �/' <br /> I DEMOUTION i l COMBINATION I I BUILDING i1V.MECHANICAL I I PLUMBING I : SIGN <br /> �ar,�s�,�o"l'�'orE� a3.c�� �c�'c�ntiS �v� �k �"ao3 355 -s�� <br /> TENANi �� MAILRDORESS CIiY ZiP PHONE <br /> � ` <br /> ARCHITECT��E{1S-,yIGNEF MAILADOPESS CITY ZIP PMONE <br /> � 1 l <br /> GENERALQ��TOR MNILApDRESS CITV ZIP PHONE STRTELICEN5EN <br /> � <br /> ME�HRNICAIGOZlTRFGTOR �1`ORESS ,,1I� �� � C�O�� f���O) PN� ��� STATELICEN�E��'� <br /> 1 ` � �\ \ 1 y' (1 V�n <br /> �: ;—� t_ ; 1 N <br /> PLUMBINGCONTqACT_OQP MRILADOF�E��SS(��/�/� 1 qTY ZIP PHONE STATEUCENSEp <br /> � �AYV\�G.. c�� •"\�-lN\�.ln���F \ <br /> C CT P OF WOR�/K'� <br /> C�v.� <br /> OESCRIBE WORK AND S�URRE FOOTAGE INVOLVED GONTNCi PERSON AND PHONE NO. <br />' Z� '�` i��l C �VL� <br /> W ' ` " I HEREBV CEFTIFY THAT I HAVE READ ATJD EXAMINED THIS <br /> v e F BUILDING APPLICATION AND KNOW THE SAME 1'O BE TRUE AND CORRECT.ALL <br /> PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TVPE OF <br /> LEGALDESGRIGtIONOGPROPERTV�SHOWNBELOWOfiATfACHTWOCOPIES) WOpK WILL BE COMPLETED WITH WHETHER SPEqFIED HEREIN OR <br /> NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br /> �or e�ocK oF AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br /> OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br /> PERFORMANCE OF CONSTRUCTION.ThAT I AM AUTHORIZED BY THE <br /> OWNER OF THIS PROPERTV TO PERFORM THt WORK FJR WHICH <br /> APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> PAPGEL TRX I.D.NUMBER CONTRACTORS LAW 18.27 RCW AND 296200 WAC. <br /> /-� a <br /> CONSTRUCTION LORN LENDER,ADDRESS,TEIEPMONE NUMBEfi ( �i� • � C� 1 '///n� <br /> � A i.\ � ll �� <br /> PROJ T D R SS ^1\ �—� ,L�J / <br /> �8� �`��� Y� CITVBUSINESSLiCEN5EN0. DAiE— <br /> PLUMBING MECHANICAL <br /> NO. TVPE OF PIXTURE OR ITEM FEE NO. TYPE OF EOUIPMENT FEE <br /> WATER CLOSET(TOILET) A/C—A/HNDLG UNITS—H.P. <br /> � BATHTUB FORCED AIR SYSTEMS—B.T.U. M E.A. <br /> LAVATORV(WASH BASIN) UNIT HEATERS—B.T.U. M <br /> SHOWER CLOTHES DRYERS <br /> KITCHEN SINF:8 DISP VENTILATION FAN <br /> DISHWASHER RANGE HOOD �— <br /> � IAUNDRY TRAY WATER HEATER ' <br /> CLOTHES WASHER NlOODSTOVE <br /> URINAL METAL FIREPLACE(WOOD BURNING) . <br /> DRINKING FOUNTAIN FIREPIACE INSERT <br /> PLOOR DRAIN HEAT PUMP _ � <br /> BACKFLOW PREVENTERS GAS PIPING <br /> ROOF DRAIN�RAINLEADERS EXHAUST FAN _ �_ <br /> SINK(SERVICE—BAR,ETC.) � _ � <br /> SUB TOTAL $ SUB TOTAL $ D I <br /> PERMIT $ PERMIT $ / <br /> � TOTAL FEE $ TOTAL FEE $ <br /> FOR OFFICE USE ONLY: <br /> FFONT SETBACH REAR SETBAGK SIDE SETBNCN PLAN C ECN N MBER FEE AECEIPT NO <br /> G/�S" <br /> usezor+e LOTAREF vneaNrsi�e FEES 4ALUATIUN FEE ��- � ��"��'�' � <br /> -1 VES .'^.. NO gUiL�iNG � � <br /> TYPEOFLONST. NO.OFSTOFIES OCCUPnxcv x0.orowEwNeuwiS i <br /> cnouP PLUMBING ' <br /> S2EOFBLDG. FIRESPRINNLEPSREO'D BASEMENT MECHAN!CAL <br /> ❑ YES �' NO — , <br /> OCCUFr1NCV LOAD FIRE FLARM REO'D HEIGMT LIMITATION ADDITIONA�PLAN CHECK - <br /> OTHER <br /> REn50N — <br /> STATE BUILDING SURCHHRGE I <br /> INiAKEBV PLAHSFPPHOVE�BY CITYOFEVERETT PUBLICWORK$ ' <br /> � �LOCAL SALES — <br /> onre TAX CODE IS 3105 ' TOTAL <br />