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- APPLICATIO" FOR CONSTRUCT�'�N PERMIT � <br /> TO BE COMPLETED IN BLACK INK—PLEASE PRINT <br /> BUILDING DEPARTMENT HEATING SYSTEM: ❑GAS ❑ELECTRIC U <br /> 259-8810 <br /> ❑ DEMOLITION 1 1 COMBINATION �d'BUILDING L 1 MECMANICAL [1 PLUM81Nf3 Ll SIGN <br /> OWNER MAILADDRESS �ITY =IP p�E <br /> THe BoEi,�� cc, p. o Bc•r ?�u� n,�S 6! -76, S�9 �GG, G.�� , 9,�z� � �6c -3a'67 <br /> TENANT M ILAUONESS ��Ty Z�p PIbNE <br /> SA�wic /rs or.�,aE',t <br /> ARCNITECTORDE5IONER M�II.ADDRESS CI1Y 21P ppppE --- <br /> TN-C 13oE��G co, <br /> OENE ��C�ONiRqGTOR M�IL�DDRESS CIiV 21P PMpryE 6T�tE LICENSE• <br /> �II IU �f,�.G I� . <br /> MECHANICQ��r1TRAGR7R M�IL�DORESfi GRY 21V PHONE 6UTE LIC2NSE� <br /> PLUMBIN�CONTP�CTOq M�IL�DORESS QTY 21P PHONE ST�TE LKENSE/ <br /> CONTIIACT PRICE OF WORK — <br /> DE9CRIBE Y/O�IN AND SqURF FOOT�OE MVOLVED CONT�CT VERSON AND PMONE N0. <br /> /2scoc.frE'f c�-Fecre-.r..�r r�c.¢,cc.� r-,co,n <br /> �oNkn.O I�sT¢'M/.SaR.>K I 3��-��G3 <br /> L�L��NG F��7 �� 2 Sa SF 1 � i HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br /> PROPOSED USE OF BURDINO APpLICATION AND KNOW THE SAME TO BE TRUE AND CORRECL ALL <br /> C'4`a�T�n'i� PROVISIONS OF LAWS AND OROINANCES QOVERNIN6 TMIS TVPE OF <br /> IEOALDEFCRiPTqNOFPROPERTY�6NOYMBELOWORATUCMTWOCOPIES� WORK WILL BE COMPLETED WITH WHETHER ^aPECIFIED HEREIN OR <br /> ior �ocK oc NOT. THE GHANTINO OF A PERMIT DOES NOT PqESUME TO GIVE <br /> AUTNORITV TO VIOLATE OR CANCEL THE PROVISION3 OF ANV <br /> OTHER STATE OR LOCAL LAW RE�UUTINO CUNSTRUCTION OR THE <br /> PERFORMANCE OF CONSTRUCTION.THAT I AM AUTHOHIZED BY THE <br /> OWNER Of THIS PROPERTV TO PEHFORM THE WORK FOR WHICH <br /> APPLICAiION IS MADE AND I COMPLV WITH THE STATE <br /> P�RCEL T�Jf I.D.NUMBER CONTRACTOHS LAW 1827 RCW AND 296.200 WAC. <br /> CONSTRUCTION LWN LENDER,AOOflESB,TELEPIIp1E NUMBER <br /> PROJECT ADDNESS/f ,/�/� I/ sYoruivae � ' /� ' '"�"' - � G�6 �9? <br /> 3�� �/ VqS�NO /W • 'I�` Li�vBU9ME98l�LiNSEN[t Wlf <br /> ��M� MECHANICAL <br /> NO. TYPE OP FlXTUIIE OR REM FEE NO. TYPE OF EOUIPMENT FEE <br /> WATER CLOSET(TOILET) � A/C—NHNDIG UNITS—H.P. , <br /> BATHTUB FORCED AIR SVSTEMS—B.T.U. M E.A. �— <br /> LAVATOHV(WASH BASIN) � UNIT HEATERS—B.TU. M ; <br /> SHOWER � CLOTHESDRYERS � <br /> KITCHEN SINK 8 DISP � ; VENTILATION FAN � <br /> DISHWASHER � RANGE HOOD � <br /> LAUNDRYTRAY ; WATER NEATER � <br /> CLOTHES WASHER � WOODSTOVE ; <br /> URINAL � METAL FIqEPLACE(WOOD BURNING) � <br /> DRINKINO FOUNTAIN � FIREPLACE INSEHT ; <br /> FLOOR DRAIN � HEAT F'UMP � <br /> BACKFLOW PHEVENT'cRS ; 6AS PIPINO � <br /> ROOF DRAINS—flAINLEADEHS � E%HAUS i�FAN i <br /> SINK(SERVICE—BAR,ETC.) ; � <br /> � <br /> � , <br /> � <br /> � <br /> � , <br /> SUB TOTAL S SUB TOTAL S �__ <br /> PERMIT S � PERMIY S ; <br /> TOTALFEE E ' TOTALFEE S ' <br /> FOR OFFICE USE ONLY: <br /> FNONTBETB�CN RE�R6ETBACN SIDESETBACN P�ANLNECRNUMPER FEE RECEIP7N0. <br /> � <br /> �^�(��� <br /> usezone LOT�RE� V�C�NTSITE F[f.8 VALUATION FEE <br /> ❑ VES 17 NO BUILOINO l/ �JS—' D <br /> lYPfOlCONSi. �.OFSTOqIES ua�Ncr NoaOW[uMGUMne — � <br /> �{S1(� ,AI�OtKAC °� PLUMBINO <br /> SIiE OF BL00. FIRE SFRINNlEFS REdO B�SEMENT A1c�M1NICAL i <br /> G� sp,fr• FS � �ES � No -.— _ . <br /> OCCUPANCYLO�D FIREW�RMREO'D MEIOHTLIMIT�TION ADDITICMIALPUIICHECK �C� i c <br /> z ✓� OTHER � <br /> REASON � <br /> 7 O/�O STATE BUIlDINO SURCHAROE ��� ��,'� <br /> INT�IfEBV PlANSAP UVEDBV CITYOFEVERETT PUBLICWOHNS ' <br /> �/M LOCAL SALES ' <br /> o�ie/ � �� q� TAI(CODE IS 3105 TOTAL inn� I JJ <br />