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APPI_CCATIQ'� FOR CONSTRUCT' 1N PERMIT <br /> TO BE COMPLETED IN BLACK INK—PLEASE PRINT � <br /> BUILDING DEPARTMENT HEATING SYSTEM: [J GAS O ELECTRIC ❑ <br /> 259-8810 <br /> f 1 DEMOLITION ! J COMBINATION f 1 BUILDING ❑MECHANICAL ❑PLUMBING r i SIGN <br /> OWNER M�II qDDFESS CITY ZIP PMONE <br /> �vFR�TT ��} •�'D�sT �h73o octi,r � e�T'f 9�2e>3 339' y-2Z� <br /> TEN T \ MAI ADDRE55 LITY � ZIP PHONE <br /> ��Jl,( �o��,�n , <br /> APCHiTECTORDE5IGNE MAILA�DRE55 CITY ZIP PHONE <br /> �rJ L6v 142c�___, ?'�c,Ts 2`12f'� 'j R�WA� AuE F���q 0'T�J ZS A-6� <br /> GENERpL CON RpCTOR MFIL AODRESS dTV 21P PHONE STATE LICENSE Y <br /> ��s�'� F1 o V1 u 4 (D tc.l� �#' RAN�P 7y�7' <br /> MECHANICALCONTRACTOq MAILADORESS I ��� <br /> C17Y 21P PHON[� SUTELICENSEb <br /> PWMBINGGONTRACTOR MAILpUDRE55 CITY ZIP PNONE <br /> STATE LICENSE t <br /> CONTRACT PRICE OF WOFK � � � <br /> OESCPIBE WORN AND SOUANE FOOTAGE INVOLVEO CONTACT PEFSON AND PMONE NO. — <br /> c- 6 `�I�oD RASS <br /> Lm�+a roN l�cbFt o 25 —(o <br /> �eT�a�� G�SS i HERFBY CERTIFY THAT I HAVE READ AND EXAMINED TNIS <br /> PROPOSED USE OF BUIL�ING APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECL ALL <br /> — � I S nROVISIONS OF LAWS AND ORDINANCES GOVERNING THI$TYPL OF <br /> LEGALOESCRIPfIONOFPROPENTV�SNOWNBELOWORFTiACHTWOCOPIE51 WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br /> �or g�p�K oF NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br /> AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br /> OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR TH[ <br /> PEAFORMANCE OF CONSTRUCTION. THAT I AM AUTHORI2ED BY 7HE <br /> OWNER OF THIS PROPERTY TO PERFORM THE WORK FOF WHICH <br /> vaAce�rnxio.NUMeea APPLICATION IS ADE ND I COMPLY WITH THE STATE <br /> CONTRACTORS LA iB2 W AND 296200 WAC. � <br /> GONSTRIICT10N LOAN LENOER.AODRE55,TELEPNONE NUMBER � <br /> PROJECT ADDRESS /�� ('y� �/� ���� l <br /> �� 1"��/�LMlI� sicHn.un[ o�.E _ <br /> LItV OIISINC55lILENSE NO <br /> PLUMBING MECHANICAL <br /> N0. TYPE OF FIXTURE OR ITEM FEE NO. TVPE OF E�UIPMENT FEE <br /> WATER CLOSET(TOILET) FVC—A/HNDLG UNITS—H.P. <br /> BATHTUB FORCED AIR SYSTEMS—B.T.U. M E.A. � <br /> LAVATOfiV(WASH BASIN) UNIT HEATERS—B.T.U. M � <br /> SHOWER � CLOTHES DfiYERS �� <br /> KITCHEN SINK 8 DISP ; VENtI!ATION FAN <br /> DISHWASHER � RANUc HOOD �-- <br /> LAUNDRY TRAY ; WATER HEATER <br /> CLOTHES WASHER WOODSTOVE <br /> URINAL ' METAL FIREPLACE(WOOD BURNING) <br /> DRINKING FOUNTAIN ' FIREPLACE INSERT <br /> _ FLOOR ORAIN � HEAT PUMP —�— <br /> BACKFLOW PREVENTERS ' GAS PIPING -" <br /> ROOF DRAINS—RAINLEADERS � EXHAUST FAN -- <br /> SINK(SERVICE—BAR,ETC.) � - <br /> � T— <br /> SUB TOTAL $ ' SUB TOTAL S <br />� PERMIT $ � PERMIT $ <br /> TOTALfEE $ ' TOTALFEE 5 - <br /> FOR OFFICE USE ONLY: <br /> FRONTSETBACN REARSEiBACK SIDESETBACK PLANCHEC NUMBER PEE RECEIPTNO. <br /> � �S � b� 5�9 <br /> USE20NE LOTAPEA VACpNiSITE FEES VALUATION FEE <br />' C' i. YES �NO BWLDIIJG � <br /> TYPE OF LDNST. NO.OF STURIES � � - . � <br /> acwR�icv xoorow[wxcuxrts <br /> �A i 1 cuour -- <br /> /V / .F� .�� PLUMBING ' <br /> �_ � <br /> 52E OF BLDG. FlRE SPRINHLERS REO'D BASEMENT � -- <br /> � IdECHANICAL � <br /> �:i YES xi'NO _ <br /> OCcurqNC,r Lono Flae n�nqM qEOD eEiGHi uMRFnoN ADDITIONAL PLAN CHECK <br /> U �� � <br /> REnSON �• OTHER � <br />� <br /> STATEBUILDINGSURCHARGE • � , <br /> MTAKEBY PLqNSAPPROVE08Y CIiYOFEVERETT PUBLICWORKS <br /> �J LOCAL SALES <br /> oATe �z TAX CODE IS 3105 TOTAL <br /> , , <br />