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APPLICATI�"' FOR CONSTRUCT� �N PERMIT � <br /> TO BE COMPLETED IN BLACK INK—PLEASE PRINT <br /> BI;�LDIHG DEPARTMENT HEATING SYSTEM: J GAS J ELECTRIC J —� <br /> 259-8810 <br /> DEMOUTION COMBINATION i BUILDING MECHANICAL ;PLUMBING SIGN <br /> �pOWNER IdAI�RDGRE55/7 / CIiV ZIP PHONE rf <br /> .� �/�cnl d�/y /o �'�/N�7 `c%r. � J���d �r/- 77/' .1'/� I <br /> TENANT MAiL ACDRES CITY ZIP GHONE <br /> ARCHITECiOfiCES�GtiEfl MAILADDRE55 CITV ZIP PHONE I <br /> GENERAL CONTRACTON n�1AiL AU�q/ESJ� C�tt ZtP PHONE STATE LiCENSE r� �I <br /> '�l/l/V�A 7 /, l/ncr� C�R� ��o�c' /�'���i.C'LiR.y'�/rl �.r�J �a6 l�J 7�7� <br /> MECNAN CAL LONTqAL OP MAIL ADORESY CITY V IIP PNpNE STATE LICENSE t <br /> PWIdBINGGONTRACTOfl MqILqDDFE55 CITV ZIP PrqNE SUTELICENSE• <br /> CONTRPCT�`I�AFWOiMt �1,� <br /> � v( <br /> O <br /> DESC/R1I�BE WORK AND SOUARE�i O/OTAGE INYOL � �pNT T PERSON AND PHONE NO <br /> —NJ�� .�Z�L /7fi� //� �.+� / /„/ n � - 7� <br /> / <br /> � '� � 4 �. J <br /> I HE�iE9V CERTIFY THAT I HAVE FEAD AND EXAMINED THIS <br /> rqoros/eoy��5[�F BUILDING APP' ICATION AND KNOW THE SAME TO BE TRUE AND CORRECT.ALL <br /> -"" P� PRO JISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br /> LEGALDESCRIPTIONOFPROPERTV�SHOWNBELOWORATTACHTWOCOPIES� WORK WILL 9E COMPLETED WI7H WHETHER SPECIFlED HEREIN OR <br /> iai etocK 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 THE <br /> PERFORA7ANCE OF CONSTRUCTION.THAT I AM AUTHORIZED BY THE <br /> OWNER OF THIS PROPER7Y TO PERFORM THE WORK FOR WHICH <br /> �ARCELTA%i0.NI1M9ER APPLICATION IS MADE AND I COMPLV WITH THE STATE <br /> CONTFiACTORS � W 78.27 RC W AND 296.20�WAC. <br /> LONSTRUGTIONLOANLENpER.ADDPE55.TELEPNONENUMBER <br /> , I'7�✓.�a/. �' % f� <br /> PROJECTADDRES /� � / ,mvmm�r oac <br /> � <br /> �'�6` LVr'�'�; �',��' arvoos�.erssuc�rvsF��o <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FI%TURE OR ITEM FEE N0. TYPE OF EOUIPMENT PEE <br /> WATER CLOSET(TOILET� A�C—A�HNDLG UNITS—H.P. <br /> BA7HTUB i FORCE�AIR SYSTEMS—B.T.U. M E.A. <br /> LAVATORY(WASH BASIN) UNIT HEATERS—B.T.U. M <br /> _ SHOWER CLOTHES DRYERS <br /> _ KITCHEN SINK 8 DISP VENTILATION FAN <br /> _ DISHWASHER RANGE HOOD � <br /> LAUNDRVTRAY WATEA HEATER <br /> CLOTHES WASHER WOODSTOVE <br /> URINAL � METAL FIP.LPLACE(WOOD BURNING) <br /> DRINKING fOUNTAIN ; FIREPLACE INSERT � <br /> FLOOR DRAIN HEAT PUMP � <br /> BACKFLOW PREVENTERS GAS PIPING <br /> ROOF DRAINS—RAINLEADERS � EXHAUST FAN �— <br /> SINK(SEPVICE—BAR,ETQ) <br /> i <br /> i <br /> � <br /> SUB TOTAL $ � SUB TOTAL $ � <br /> PERtd1T $ FERMIT 5 <br /> TOTAL FEE $ TOTAL FEE $ � <br /> FOR OFFICE USE ONLY: <br /> �pONTSETBALN REARSETBACK SIDESETOAGK PLANCHELKNUMA F[[ REGEIPTNO. <br /> /-� O/ <br /> usezoNE �oinaeq VACANT6ITE FEES VALUATION FEE <br /> L� VES I] NO OUILDING �[// <br /> iVPfOiLpNS7. NOAFSTORIES oCCucAFCv NOaowFWtGUN'.�5 '--� / ���� <br /> cnauv pLUMBM� i <br /> � <br /> SIZE OF BLDG. —�— <br /> FIqESPRINNLEPSRE00 9q5EMENT MECHANICAL <br /> ❑ YES i NO <br /> � <br /> OCCUPANCY LOA� fIRE AIAqM REOD HEIGM7 LiMIiAT10N �DDITIONAL PLAN CHECK � <br /> �EnSON OTHER i <br /> STA7E oUILDING SURCHARGE i ' - � <br /> INiANEBV PLANSAPPROVEOBV CIiYOFEVERETT PUI3LICWORK$ � <br /> LOCAL SALES <br /> o�,rr TAl(CODE IS 3105 TOTAI <br />