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ppPLICATIC"- 1 FOR CONSTRUCT'"1N PERMIT �`� <br /> TO HE COMPLETED IN BLACK INK—PLEASE PRINT <br /> HEATING SYSTEM• GAS ❑ELECTRIC ❑ � <br /> BUILDING DEPARTMENT <br /> 259-8810 <br /> i 1 DEMOLITION C7 COMBINATION [i BUILDING �MECHANICAI oNE ❑PLUMBING ❑ SIGN <br /> OWNEH / MAllA0DRE55 y/f � GITY ZP' J 1 : _/ � C ) � " [J <br /> �((''�� �� 1 Z Y��� 1 � ���) � � 11� 'V� ���� ]IP I � � �P��E � � � 1 �1� <br /> TENANT MAII ADDRESS <br /> i <br /> ARCHITECT OR DES16NEH <br /> MAR AD�RESS ��tY Z� �� <br /> � Z�P pHpNE STATE UCENSE� <br /> GENERA6CONiPAG]OH PILAD�RE55 i' J� y � C'Ky L�,� \ � F7 r� � � 7 /'.\ <br /> � � / q .!�/ ,`� � 1 (JV!I 1�'` F t' 1 '"t' <br /> : �� �-- <br /> CITY 21P PHONE ' ST E IICENSE k� <br /> E MANiCRI CONTFACTOH � A�L AO�PE55 <br /> � �) a/��� � PHONE ST�TEI�LENSE� <br /> PWMBINGGONTRACTOF MAIIADURESS <br /> GRY 2IP <br /> CONiRACi FPICE OF WORK 2l �— <br /> L <br /> � CONTAGT PEPSON M1�PMONE NO. f �/ /� �� ! <br /> OESCFIBE WORN AND SOURHE FOOTiGE INVOLVEO _ <br /> n - 7�� L r - 4- � L �� <br /> � ' '�-' 1� ' "�^. '.� ' ` �_ <br /> i HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br /> FROPOSEDUSEOF BUILDING APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT.All <br /> PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br /> LEGALDESCRIPTIONOFPROPERiY�SHOWNBEIOWORATiPCHTWOCOPIES� WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br /> NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br /> �oi e�ocK oF AUTHORITV TO VIOLAT[ OR CANCEL TNE PROVISIONS OF ANY <br /> OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br /> PERFORMANCE OF CONSTRU TION.THAT I AM AUTHORIZED BY THE <br /> OWNER OF THIS PRO Y TO ERFORM THE WORK FOfi V'HICH <br /> APPLICATION I. ADE AND PLY WITH THE STA1E <br /> PFRCELTR%ID.NUMBER CONTRACTORS AW78.27RC 96.20WAC. <br /> � � 1 <br /> GONSTAUGTION LOAN LENDER.RODRE55.TELEPNONE NOMBER <br /> pAl <br /> S�GNa�UR[ <br /> pROJECT ADDRESS c�r.nusirvFss i�cF�se xo <br /> PI.UMBING MECHANICAL <br /> FEE N0. TYPE OF EOUIPMENT FEE <br /> Hp, TYPE OF PIXTURE OR ITEM q��AiHNDLG UNITS—H.P. ' <br /> WATER CLOSET(TOILET) FORCED AIR SYSTEMS—B.T.U. M E.A. ' <br /> BATHTUB � UNIT HEATERS—B.T.U. M ' <br /> LAVATORY(WASH f3ASIN) , CLOTNES DRYEFS I <br /> SHOWER VENTILATION FAN ' � <br /> KITCHEN SINK&DISP RANGE HOOD � <br /> DISHWASHER � � WATER HEATER , <br /> LAUNDRY TRAY � WOOD STOVE � <br /> CLOTHES WASHER , METAL FIREPLACE(WOOD BURNING) <br /> URINAL FIREPLACE INSERT <br /> DRINKING FOUNTAIN �, HEAT PUMP <br /> FLOOR DRAIN � GAS PIPING <br /> BACI(FLOW PFEVENTERS ' —�-- <br /> ROOF DRAIN�RAINLEADERS <br /> , EXHAUSTFAN � <br /> SINK(SEAVICE—BAR•ETC.) � <br /> � , <br /> � <br /> � <br /> I SUB TOTAL 8 � <br /> SUB TOTAL S � pERMIT 5 <br /> PERMIT � ' TOTAL FEE $ ' <br /> TOTAL FEE $ <br /> FOR OFFICE USE ONLY: FEE RECEIPT N0. <br /> p�AN CHELK NUMBER <br /> FRONTSETBFGK REFR>ETBPCK S'.JESETBACK C <br /> FEES VALUATION FEE <br /> USE ZONE LOT AFlEA VPCANi SIiE � <br /> ❑ YES ❑ NO sui�oiNc � <br /> � <br /> NO.OFSTORIES aavr,xcr xOmwrtu'wGwirs <br /> TvaE OF WN57 cauio PLUMBING <br /> SIZEOFBLOG. FIPESPFINKIERSREOD BA£EMENT �J�ECHANICAI � <br /> �-1 YES � NO ' <br /> nEiGr+T uMrznno!J ADDITIONAL PLAN CHECK ' <br /> OCCUPANC�IORD FlREQARMREOD � <br /> OTHEP � <br /> i <br /> REnSON STATE BUILDING SURCHAR�E � <br /> INTRKEBY RANSAPPFOVEO[3Y CITYOFEVERETT PUBLICWORKS � <br /> LOCAL SALES <br /> onre <br /> TAX CODEIS 3105 TOTAL <br /> � <br />