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APPLICATIC�1 FOR CONSTRUCT"lN PERMIT � <br /> TO BE COMPLETED IN BLACK INK—PLEASE PRINT <br /> BUILDING DEPARTMENT HEATING SYSTEM: I.�GAS U ELECTRIC O —� <br /> 259•8810 <br /> ❑ DEMOLITION I J COMBINATION � BUILDING I I MECHANICAL � I PLUMBING f 1 SIGN <br /> OWNER M�ILAO�RESS �� CILY Zlp pNq�E —�--� <br /> �H,� c«s�„�,y �2�„� ��U-5 �., �.,s.�,� ,�� ��„��n lti% ,���� Pys-,?3 9� <br /> iEN�NT MMIAUDRE55 CIiV 21P P1qNE <br /> �N,�a /I4F, ���c .,75,7 s P �-l IJFs lAs��: /�o .F%c,eFn �/� .v ja. <br /> 11RCHITECT<MDE516 ER M�:IFDOP[SS CITV ZIP PNONE <br /> �• �tsa/M o2a// _ /o?/s� S `,f''lr�c,r'v�E Nr,. I�Oos <br /> OENCR CONTRACTpq M�IL��DRE55 CITY IIP PHONE ST�TE Uf,Eq'?� <br /> C7E/�( Ce•✓si, .�i�-S `�'D9 5�7.,�F ,Si,' �/�F'e',�T/,' �+�a %�ZO3 �r%EYxCcs-�9GrE-3 <br /> MECNANICQCONiR�CTOR MMLIIDDNE55 CITV IIP PIIONE gU�ELICENoE/ <br /> PIUMBINOCONTR�CTOH MAILII�DREfS ❑Iv 11P PIqNE £TATF.LILEhSE� <br /> CONTRAGT PRICE OF VlONN <br /> �S/S p. QC <br /> OEBCqIBE WOHK AND 90VARE FOOTAOE INVOtVED CON7�GT PERSON AND PIqNE <br /> /'/oD s,� "� . //�1✓s 7�s"'-a 35� <br /> �NnniT �iw�>,Pos�.lvc,�r_ /h,��i� ���0�d�c as�- S�o� <br /> i HEREBV CERTIFV THAT I HAVE READ AND E%AMINED TNIS <br /> PROPOSEOUSEOFBUIlDINO � AppLICATION AND KNOW THE SAME TO BE TRUE AND CORqECt ALL <br /> ��`iLE / F�. PROVISIONS OF LAWS AND OFlDINANCES GOVERNING THIS TVPE OF <br /> LEO�l0E6CRIPTqNOFPROPERTVISMOM�NBEL WORARACHTWOCOPIE51 WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br /> NOT. THE GRANTING OF A PERM�T OOES NOT PqESUME TO GIVE <br /> ior eiocK or AUiHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br /> O�l� ����5 OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br /> PEHFORMANCE OF CONSTRUCTION.THAT 1 AM AUTHOHIZED DV THE <br /> OWNEH OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br /> APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> PAPGEL TA%IA.NUMBER CONTRACTORS LAW 18.27 RCW AND 296.200 WAC. <br /> CONSTFUCTqNLWNLENOER,�DURESS,TELEVMONENUMBER. 4 , <br /> 'y �� Je9�t�c �- r/- `1� <br /> P110fJ'')ECT ADDRE89 /1A s���une w�e <br /> pL �� ( ryS�/\�Q � �` ��� LlivqU9Mf99l�CFMYNJ - <br /> PLUMlINO MECMANICA6 <br /> � N0. TYPE OF Fl%TURE OR ITEM FEE NO. TYPE OF EOUIPMENT FEE <br /> WATER CLOSET(TOILET) NC—A�HNDLG UNITS—H.P. � <br /> � BATHTUB ' FOFCED AIR SYSTEMS—B.T.U. M E.A. � <br /> UVATORY(WASH BASIN) � UNIT HEATERS—B.T.U. M ; <br /> SHOWER � CLOTHES DRVERS T— <br /> KITCHEN SINK 8 OISP ; VENTILl�TION fAN ; <br /> � DISHWASHER RANGE HOOD <br /> LAUNDFV TRA` ; WATER HEATER <br /> � CLOTHES WASHER i WOOD STOVE <br /> � URINAL METAL FIREPLACE(WOOD BURh iG) � <br /> DRINHING FOUNTAIN � FIREPLACE INSERT ; <br /> FLOOR DRAIN HEAT PUMP � <br /> BACKFLOW PqEVENTERS ; GAS PIPING <br /> ROOF DRAINS—RAINLEADERS E%HAUST FAN <br /> SINK(SERVICE—BAR,ETC.) ; � <br /> -- � <br /> — —' i i <br /> SUB TOTAL S ; SUB TOTAL S <br /> PERMIT S � PERMIT f <br /> TOTALFFE S TOTALFEE S ' <br /> FOR OFFICE USE ONLY: <br /> FPONT SETBACK RE�H SEiBl1CN SIDE SETB�CN PUN CHECR�N7UMOER LEE_�� �f, . REG�T.NO�D� <br /> V� / ��� U� <br /> USE 20NE LOT AREl1 V�CANT SITE FEES VALUATION fEE <br /> —� i.l VES fl NO BUILDINO i <br /> IYPFOfCONSf �'�OOFSTORIES ocaMM[r rppoWFuiNGUNi�s <br /> �� ' �R01j° d PLUMBING <br /> � <br /> i <br /> �95E BI�W '. FIRE6PRINKLERSNEOD B�SEMENT MECHRNICAL —� <br /> � ❑ YES 1�N0 –�- , <br /> /OCCOP�NGY LOAD FIRE AL�RM PF.O'D NEIGH7 LIMITRTION �'.DDITIONAL PUN CHECK � <br /> Cj�Q —� I S� ��p OiHER <br /> i <br /> nE�swi <br /> An..� �� $TATE BUILDING SURCHARGE ; �� <br /> •�►T <br /> MT�kEBY PlANS�PPROVEDBV CITYOFEVERETT PUBLICWOfiKS `� <br /> �M LOCAL SALES ' <br /> p,,,� � 9 TAX COUE IS 3105 ror�� � <br />