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APPLICATIC'"7 FOR CONSTRUCT'-1N PERMIT � <br /> TO BE COMPLETED IN BLACK INK—PLEASE PRIN7' <br /> BUILDING DEPARTMENT HEATiNG SYSTEM: ;J GAS ❑ELECTRIC J 1 <br /> 259-8810 <br /> DEMOLITION COMBINATION � BUILDING MECHANICAL PLUMBING I SIGN <br /> OWN[F IAAi�ADDRE55 �IiY ZIP !.• PHONE <br /> � Ea�„�,J r? r;ven.�lE/� �a� tv2z (zcY�2� z- ys&Q Nof-c <br /> ,E���, w; . �r.,,�,' �2Z�j �•/T A�� r�C?E? �S�-C�l /�o(�I3s ti yn;n !-%�..,c <br /> IAAILApDqE55 GRY ZiP PNOH[ <br /> �9�� 5����w�nls. zr aFr KovTA�c C..-z« SsZo i (zo b)z5 2. 9,o 0 <br /> ARClaTECTORDE5IGNER M41LqDDFE55 GTv 21F PMONE <br /> GENERALCONTqq�TOR MAILAO�RESS `��.3 / __��C�Y C�iy TIP PMONE STATELIC[NSEY <br /> ._� <br /> �,l. S1c;s�ecdS�,n� C sb C N..k'ilico S&a7r 7va-vSVN ALSi,E���q9pg <br /> IdECHANIGAL CONTqqCTOR MNL ADDFESS CITY pIP PHONE STATE LICENSE x <br /> PLUMBING CONTRACTOP MAIL ADDFESS CITV 21P PHONE $TATE IICENSE Y <br /> CONTRApT PRIGE OF WORK <br /> �� � ax�,o0 <br /> �DESCRIBE WORK AND SOUARE POOTAGE INVOLVED NiACT PERSON�ND PHONE NO. <br /> (�aio sf �+ d/�. / 7�Y sj �� c P � G:cS _ctct��c� Zy�'�` ?'�v <br /> n¢/hOACI sTJ�K �JFt.��e.� J �f�tm�Il nCW CS'�oO SG^n I.\J O�T C'JY�I �"S L ' / I C�l� <br /> —� J <br /> ^ i HEREBY CERTIFV THAT I HAVE READ AND EXAMINED THIS <br /> aaoroseo use or euaoinc APPLICATION AND KNOW THE SAME TO BE TRUE AND COPRECT. ALL <br /> Sel'J' S �: +� Fo . . �r PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br /> �iecn�oescaianor+oFraorEarvisHo�Nee�owoaarrncHrnocoviEs� WORK WILL BE COMPLETED WI7H WHETHER SPEGFIEO HEREIN OR <br /> �ot��8����BIOCK�y� oF �'f oF �.<+�-H' NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GNE <br /> AUTHORITY TO VIOLATE OR CANCEL TIiE PR��VISIONS OF ANV <br /> /.cy.c,l (' F sa- Add '�+' �'o E✓c.�-ft'� Uol 3 OTHER STATE OR LOCAL LAW REGULATING CONS i RUCTION Ofl THE <br /> PERFORMANCE OF CONSTRUCTION.THAT I AM AUT�iOR12ED BV THE <br /> � (�j�,J I �49� � OWNER OF THIS PROPERTV TO PERFORM THE WJRK FOR WHICH <br /> APPLICATION IS MADE AND I COMPLY WITH TV1E STATE <br /> PARCELI�XID NUMBER <br /> � y39o'x,�aa,7 BOl o y `, � �5- CJ CONTRACTORS LAW 18.27 fiCW AND 296.200 WAC. <br /> GONSTRUCTION IOAN LENDER,ADDFE 5.TELEPNONE NUMBEP ' <br /> � �-�- gy <br /> � PROJECT ADDRESS sc.s�unr � ��rE <br /> O ci.v ouswtss i¢i.a«rn � <br /> PLUMBING MECHANICAL <br /> N0. TYPE OF FIXTURE OR ITEM FEE NO. TVPE OF EOUIPMENT FEE <br /> WATER CLOSET(TOILET) NC—A�HNDLG UNITS—H.P. <br /> BATHTUB FORCED AIR SYSTEMS—B.T.U. M E.A. � <br /> LAVATORY(WASH BAS�N) UNIT HEATERS—B.T.U. M <br /> SHOWEfi CLOTHES DRYERS � <br /> KITCHEN SINK 8 DISP i VENTILATION FAN <br /> DISHWASHER RANGE HOOD <br /> LAUNDRY TRAV ; WATER HEATER <br /> CIOTHES WASHER � WOODSTOVE <br /> URINAL � METAL FIREPLACE(WOOD BURNING) <br /> DRINKING FOUNTAIN FIFiEPLACE INSERT <br /> FLOOR DflAIN HEAT PUMP <br /> BACKFLOW PREVENTERS GAS PIPING � <br /> ROOF DRAINS—RAINLEADERS � EXHAUST FAN <br /> SINK(SERVICE—BAR,ETC.) � �— <br /> � __ , <br /> � ; <br /> � ' <br /> -�— <br /> SUB TOTAL $ SUB TOTAL $ <br /> PERId1T 5 PERMIT $ <br /> TOTAL FEE $ IOTAL FEE $ �— <br /> FOR OFFICE USE ONLY: <br /> FRONi TBACN REAFSETBACH SIDESETBAGK PLANCHECK� '!A q FE[ RECEIPTNO <br /> o' ��"`' o ' ,�' ��o oi. os i��5�y� <br /> USE ZONE LOT AREA VACANT SITE FEES VALUATION FEE <br /> G� I f YES �NO BUILDING 9G�'� � ��� i U;� <br /> 1YPEOiCON51 NOAFSTpqIES otcuvxycv VaO�OwtwxLUNnS <br /> � <br /> � g'� �Z �r PLUMBING � <br /> �� <br /> Si7 F BLDG flRE SPRINNLERS REO'D BA EMENT y � <br /> 'I �Fr ND .�i YES /� NO MECHANICAL i <br /> �F�m2��r C}�A1g�N � <br /> OCCOPqNCY LOAD FlRE Al4RM PEOD HEIGHT L�MITAiION ADDITIONAL PLAN CHECK i <br /> •2 ND � , <br /> OiHElV <br /> R@ASON <br /> STATE BUILDING SURCHARG[ � ��� <br /> INTAKE6Y PLANSAopROV[OBY CI7YOFEVERETT PUOLICWORKS <br /> �,Mn LOCAL SALES ' <br /> onTe � �(�/j � TAX CODE IS 3105 TO7AL ; I , - , <br /> ( ;�. <br />