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APPLICATIOI��OR CONSTRUCTIC�1 PERMIT � <br /> TO BE COMPLETED IN BLACK INK—PLEASE PRINT �,✓—�,�,> <br /> �7--- <br /> BUILDING DEPARTMENT HEATING SYSTEM: GAS ❑ELECTRIC ❑ <br /> 259-6810 <br /> DEMOLITION COMBINATION BUILDING XMECHANICAL PLUMBING SIGN <br /> OWNER 1 9DPE55 dTV ZIP PNONE <br /> Do►.> V�A�.►,7s- ���1 ) P�PflR13,��R`1 A 6201 - o <br /> TENANT M�AIL���DDRfFS CITY Z PMON � _O� <br /> ARCMIT�P`�AIItYR t�l S�1.F4', pPE55 yGITY ZIP NE <br /> GENER�LfANTpACTOR MAIIADDRE55 CIiY plP PHONE STqTELICENSE• <br /> MECN�YILqL CONTR�CTOR MAIL ADOPE CITV IIP P ON[ SiATE UGENSE t <br /> _LoD�S1"/�R e0 � �r�TM 5� L �lv � <br /> PLUMBING CONTRACTOR MAIL AD RE55 LITY ZIP PHON[ � STATE LIGEI:S[M <br /> CLASS OF WORK <br /> �*[o �174 KS� <br /> XNEW � ' ADDiTION � �� ALTERATION REPAIR , -�. DEMOLITION WOODSTOVE/FRPL INSEFiT BUILDING RELOCATION <br /> CONTRRCT PRIGE OF WORK <br /> �S I I p � �ONTRGT PEliSON RND PMONE NO. <br /> DESCRIBE WONK�NDSOURRE FOOTFGE�NVOW[D <br /> 1� � W <br /> PROPOSEDUSEOFBUiL01NG i HEREBY CERTIFY THAT I HAVE READ ANG EXAMWED THIS <br /> K�TRIL �1�11/EP� SIa(jQ APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECi ALL <br /> LEGRLDESCRIPTIONOFPROPEPTY�5110WNBELOWORATTACHFOIIPCOPIES� PROVISIONS�FLHWSANDORDINANCESGOVERNINGTHIS7YPEOF <br /> WORK WILL BE GOMPLETED WITH WHETHER SPECIFIED HEREIN OR <br /> ior a�ocK oF NUT. THE GRANTING OF A PERMIT DOES NOT PRES�IME TO GIVE <br /> ��p�r�- / ' AUTHORITY TO VIOLATE OR CANCEL THE PROVISIOWS OF ANY <br /> �"Z tL ��-1��$��� — OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br /> PEAFORMANCE OF CONSTfiUCTION. THAT I AM AUTHOR12ED BY THE <br /> _ OWNER OF THIS PROPEHTY TO PERFORM THE WORK FOR 4JHICH <br /> APPLICATION IS MADE AND I COMPIY WITH THE STATE <br /> CONTR TORS' W 78. 7 RCW AND 296.200 WAC. <br /> X ( � �� �z <br /> PROJECTADDRE55 A ` ; ,q+ii �E �prE <br /> I / ` IV nivPO[rt655UC[NSrNO <br /> PLUMBIN6 MECHANICAL <br /> NO. TVPE OF FIXTURE OR ITEM FEE N0. TYPE OF EOUIPMENT FEE <br /> WATER CLOSET(TOILET) A�C—AiHNDLG UNITS—HP. <br /> BATH7UB FORCED AIR SYSTEMS—�B.T.U.�M E.A. � <br /> LAVATORY(WASH BASIN) UNIT HEATERS—B.T.U. M <br /> SHOWER CL07HES DRYERS <br /> KITCHEN SINK 8 DISP VENTILATION FAN <br /> � DISHWASHER RANGC-HOOD <br /> LAUNDFiV TRAY ; WATER HEATER � <br /> _ CLOTHES WASHER � WOOD STOVE <br /> 'IRINAL ; METAL FIREPLACE 8 CHIMNEY <br /> ' DRINKING FOUNTAIN � FIREPLACE INSER7 <br /> FLOOR DRAIN HEAT PUMP —T— <br /> BACKFLOW PREVEMERS � GAS PIPING <br /> ROOF DRAINS—RAINL,:ADERS � EXHAUST FAN ; <br /> SINK(SERVICE—BAR,ETC.) <br /> � �� <br /> SU8 TOTAL $ ; SUB TOTAL $ d � <br /> PERMIT $ � PERMIT $ ; <br /> TOTAL FEE $ ' TOTAL FEE $ �— <br /> FOR OFFICE USE ONLY: <br /> FRONTSETBACK FEAPSETBACN SI�ESETBACK PLANCHECeNUTABER FEE RFCEIPTNO. <br /> 3.�:� � y <br /> usezone IOTAREA VACANTSITE FEES VALUATION FEE <br /> BUILDING � <br /> iVPL Of LONtS.AIlOWABIE ttPE 0F CONST Ar,7UAL OccuaeN[r xo ar mrtwxs Na�s <br /> �a0°P PLUMBING <br /> i <br /> SIZEOFBLDG. NO.OFSTORIES BASEMENT MECHANICAL � <br /> S' o° <br /> OCCUPRNCVLO�D FIRESPRNKLEf15REOD HEIGHTIIMIT�TION ADDITIONALPLANCHECK � <br /> i <br /> S�(iINKLER ' <br /> REASON FOR SPRINNLE'i5 i <br /> — �_ <br /> STATE BUILDING SURCHARGE � <br /> MTANEBV PLANSAPPPOYEOUV CITYOFEVERETT PUBUCWORKS <br /> LOCAL SALES <br /> J n TAR CODE IS 310d TOTAI 9 f;oo <br />