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APPLICATIO�: FOR CONSTRUCT►)N PERMIT <br /> TO BE COMPLETED IN BLACK INK-PLEASE PRINT � <br /> HEATING SYSTEM: ❑GAS ❑ELECTRIC ❑ <br /> BUILDING DEPARTMENT <br /> 259-8810 <br /> !- DEMOLITION ❑ COMBINATION ❑ BUILDING ❑ MECHANICAL I-1 PLUMBING ❑ SIGN <br /> OWNER M1�AILAOOFE55 CIN IIP PHONE <br /> r1R�2K ih t���� �z�- g�C�D� 4,►9y c�crz�('i , °rsz�� /2��) �se -2�3o _ <br /> TENFNT MAILADORE55 CITY 21P PNONE <br /> ARCHITECTORDESIGNER NAI�A��RESS CITY ZIP PHONE <br /> GENERALCONiRACTOR h1A1LADDRE55 CITV ZIP PMONE STqTELICEYSEt <br /> MECHJA'N�IGA�CON�TR�ACiO�R NAI�AODRE55 CITV ZIP PNONE STATEUCENSE• <br /> PLUMBING CONTR�RCT R MAIL A�DRESS CITV 21P PNONE STATE IICENSE• <br /> CONTRAGi PRIGE OF\40NK <br /> DESCRIBE WORK RND SOUARE FOOTAGE INVOWED CUNTACT PERSON FND PHONE N0. <br /> /IUST/tLL tr� z./.L�� � <br /> I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br /> PPOPOSED U O�W II�C11NG APPLICATION AND KNOW THE SAME 70 BE TRUE AND CORRECT.ALL <br /> �/�✓� PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br /> LEGA�DESCNIPTIONOPPROPERTV�SHOWNBELOWORATTACNTWOCOPIES� WORK WILL BE COMPLETED WITH WHETHER SPEC�FIED HEREIN OR <br /> NOT. THE GRANTING Of A PERMIT DOES NOT PRESUMF TO GIVE <br /> ior BLOCK oF AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br /> OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br /> -- PEflFORMANCE OF CONSTRUC`ION.THAT I AM AUTHORIZED BY THE <br /> OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br /> APPL�CATION IS MADE AND I COMPLY WITf1 THE STATE <br /> PARCELTA%ID.NUNBER CONTRACTORS W1827RCWAND296.200 C. <br /> CONSTPUCTION LORN LENDER.AODRESS,TELEPHONE NUMBER <br /> xy�..z � � ,«,> �� ,- 9� <br /> PROJECTAD RESS sarumnE o"�� _ <br /> aa� �,o�� ��,.a�s���ss,��E�sE� <br /> PLUMBING MECHANICAL <br /> N0. TYPE OF FIXTURE OR ITEM FEE N0. TYPE OF EQUIPMENT FEE <br /> WATER CLOSET(TOILET) � A/C—A/HNDLG UNITS—H.P. � <br /> BATHTUB ; FORCEDAIflSYSTEMS—B.T.U. M E.A. ; <br /> LAVATOHY(WASH BASIN) � UNIT HEATERS—B.T.U. M � <br /> SHOWER ' CLOTHESDRYERS ' <br /> KITCHEN SINK 8 DISP ; VENTILATION FAN � <br /> DISHWASHER RANGE HOOD <br /> UIUNDRY TRAY ; WATER HEATER <br /> CLOTHES WASHER WOOD STOVE � <br /> URINAL METAL FIREPLACE(WOOD BURNING) ' <br /> DRINKING FOUNTAIN FIREPLACE INSERT � <br /> FLOOR DRAIN HEAI�PUMP ' <br /> BACKFLOW PREVENTERS ; GAS PIPING � <br /> ROOF DRAINS—RAINLEADERS � EXHAUST FAN ' <br /> SINK(SERVICE—BAR,ETC.) ' � <br /> � ' — <br /> � ' <br /> � ' <br /> � <br /> � <br /> SUB TOTAL $ ; SUB l'OTAL $ � <br /> PERMIT $ � PEFAIIT $ � <br /> TOTALFEE $ ' TOTALFEE $ ' <br /> FOR OFFICE USE ONLY: <br /> FRONT SETBRCK RERR SE7BAGN S�DE SE7BACK PLAN CNECK NOMBER FEE RECEIPT NO. <br /> USE20NE LOTAREA VACANTSITE FEES VALUATION FEE <br /> G YES ❑ NO BUILDING ' <br /> iYPEOiCDNST. NO.OFSTORIES oa�n�Ntv xoaowFuiNGmr�S � <br /> t3wv pLUMBING � <br /> i <br /> SIZEOFBLW. FIFESPRINKLERSREO'U BR:iEMENT MECHANICAL � <br /> i.-" YES i' NO — <br /> OCLIIPANCYLUAD FlREALFRMREO'D HEIGNTLIMITATION ADDITIONALPLANCHECK � <br /> OTHER i <br /> —T <br /> REASON � <br /> STATE BUILOING SURCHARGE � <br /> INTANEBV PLRNSAPPROVEDBV CITYOFEVERETT PUBIiCWORKS � <br /> LOCAL SALES �- <br /> •�TE TAX f,ODE IS 3105 TOTAL � <br />