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APPLICATIOI FOR CONSTRUCTIrI PERMIT � <br /> TO BE COMPLETED IN BLACK INK—PLEASE PRINT <br /> BUILDING DEPARTMENT HFATING SYSTEM: 0 GAS O ELECTRIC 0 <br /> 259-8810 <br /> ❑ DEMOUTION [� COMBINATION j�BUILDING I I MECHANICAL f l PLUMBING i I SION <br /> OWNER MAI��OORESS CITY 21P PNONE <br /> _�od/N6 e.o. � J? o. ESeti 3�o� , /�s ob�-�?, S�cAA'G6 wir • 91i iy 3'/Z--�3?9 <br /> TENANT �iU0�RE55 diV IIP PNONE <br /> l�O(SiN6 � <br /> ARCN/IT�ECTORJESIGNER M�IUODRESS CITV IIP PHONE <br /> I>0 E/n1 G• <br /> OENERIILC �C ON MA�DDPESj CITV IIP PHONE STATEII�ENSE� <br /> aa1�n�1 • <br /> MECNANIC�ICONIR�CTOR MAILADDRE55 CITY IIP PNONE STATEIILENSE� <br /> PLUMBINO LONTR�:TOF MAIL�DORE55 CITV IIP PHONE STATE I�CENSE� <br /> f.ONTR�CT PRICE Q'WORK <br /> 80� 0 <br /> �ESCRIBE YIONN�ND 60U�PE FOOT�OE INVOWED CONTALT PERSON AND PHONE NO. <br /> Le�o,v�ti0 �s T�'µBo�e s�i 26 6�3sGS <br /> i HEREBV CERTIFY THAT I NAVE READ AND EXAMINED THIS <br /> PqpPOSEO U6E OF BI1R RINO APpLICATION ANO KNOW THE SAME TO BE TRUE AND CORRECT.ALL <br /> SM,yLc. r�t�-wS�' �«-1 V S PROVISIONS OF LAWS AND ORDINANCES OOVERNINO THIS TVPE OF <br /> lEOAlDESCRIPTIONOFPPOPERi`.��SNpWNBELOWORATTALNTWOCOPIE51 WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIPI OR <br /> �or o�oca or NOT. THE 6RANTINO OF A PEPMIT DOES NOT PHESUME TO GIVE <br /> AUTHORITV TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br /> OTHER STATE OR LOCAL LAW REQUUTIN6 CONSTRUCTION OR THE <br /> PERFORMANCE OP CONSTHUCTION.THAT I AM AUTHORIZED BV THE <br /> OWNER OF THIS PHOPERiV TO PERFORM THE WORN FOR WHICH <br /> - APPLICATION IS MADE AND I COMPLV WITH THE STATE � <br /> P�qCEI T�R I D NUMBEP CONTRACTORS LAW 1827 RCW ANO 296200 WAC. <br /> CIXiSTPUCT10N LOAN LEN�ER.�DDr7E59.TELEFNONE NUMBER <br /> r / ��..,.�• 1�i9�9 y <br /> ��QQ�ECT AD E{b/�� �/� enx�mni� o�rE <br /> J� �• {/Af/NO �(/. ����I CItYWBME{lLKEHSFMO <br /> /LUM�INO MECNANICAL <br /> N0. TY►E Or fIXTURE OII ITEM fEE N0. TVPE Of EOUIPMENT iE[ <br /> WATER CIOSET(TOILET) � !uC—NHNDLG UNITS—H.P. � <br /> BATHTUB ' FORCEDAIRSYSTEMS—B.T.U. M E.A. <br /> LAVATORV(ItiASH BASIN) � UNIT HEATERS—B.T.U. M <br /> SHOWER � CLOTHESDRYERS <br /> KITCHEN SINK 6 DISP VENTILATION FAN <br /> DISHWASHER � RANOE HOOD T <br /> LAUNDRY TRAV ; WATER HEATER ' <br /> ��� CLOTHES WASHER � WOOD STOVE I <br /> � URINAL METAL FIREPLACE(WOOD BURNING) ' . <br /> � DRINKINO fOUNTAIN I FIREPLACE INSERT ; <br /> � FLOOR ORAIN � HEAT PUMP <br /> BACKFLOW PREVENTERS ; GAS PIPING ; �� <br /> ROOF DRAINS—RAINLEADERS � E%HAUST FAN � <br /> SINK(SERVICE—BAR,ETC.) ; ' <br /> — � <br /> � <br /> � <br /> SUB TOTAL S SUB TOTAL 3 <br /> PEHMIT S � PEFMIT E <br /> TOTAL FEE S ' TOTAL FEE S � <br /> FOR OPFICE USE ONLY: <br /> FPONT SETBACR REAR SET9A7N SIDE SETBACN PLAN CNECN NIIMBEN FEE RECEIPT NO. <br /> / <br /> USE:ONE LOTANEA VALANTSITE FEES VALUATION FEE <br /> ❑ YES ❑ NO BUILDING ' i <br /> TYVEO�CN:St NOAFSTORIES rctunx[r FOdM�auNGdMn{ � <br /> ,�/,� G�_yM��r '____ ceao PLUMBING ; <br /> IV(/ :n/�(�!L �— <br /> SIZE OF BLDO. FIRE SPRINKLERb NEO'D P�SEMENT MECHANICAL � <br /> G YES ❑ NO � �/ <br /> OCCUPANCYl0.1D FIRE�LAPMREOD HEI6MTLIMITATION ADDITIONALPUNCNECK /v . "]") <br /> �� <br /> OTHER ' <br /> �EA50N � <br /> sTaie ouaowc sui�cr�nnc� � <br /> MTANEBY PlANS�P�ROVEOBv CITYOFEVERETT PUBUCWORKS � <br /> JM LOCAL SALES � <br /> oe =. � � 4. TAX COOE 18 3105 TOT�� 7; ' <br />