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APPLICATIO�FOR CONSTRUCTI�1 PERMIT <br /> TO BE COMPLETED IN BLACK INK—PLEASE PRINT �Sr <br /> BUILDING DEPARTMENT HEATING SYSTEM: y�GAS ❑ELECTRIC ❑ <br /> 259-8810 <br /> J DEMOLITION ❑ COMBINATION ❑ BUILDING i7 MECHANICAL jf PLUMBING LI SIGN <br /> O�E� / ^ MAILADORE55\ /� dTY ZIP PHONE <br /> f— . r„�,.�.s- i n ,� <br /> ��ix.rxi/ iii�o�o--r Ll <br /> TENANT MAILFODRESS �IiY 21P PNONE <br /> ARCNttECTORUE5IGNER MAILADDRESS CITY ZIP PNONE <br /> GENERAL fANTRACTOR MAIL pDDRE55 CITV ZIP PHONE STpTE UCENSE• <br />( MEGHRNICPLWNTRRCiOR MAILAO�RE55 CITV ZIP PNONE STATELICENSE� <br /> PLUM ING C RA OR p MAI�ApB11@SS w n ' n �� C�TY ZIP PNONE S1ATE LICENSE t <br /> � �� <br /> �[/��K/l Q�.J <br /> CONTPACT PNIGE OF WORK <br /> DESLRIBE WORN AND SOUAPE fpOTAGE INVOWED CONTACT PERSON AND PHONE N0. <br /> I 11EREBY CERTIFY 7HAT I HAVE READ AND EXAMINED THIS r <br /> PPOPOSEOUSE unoiNc APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT.ALL <br /> PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br /> LEGALDESCRIPTIONOFPROPERtt�SHOWNBELOWORATTACHTV✓OCOPIES� WOAK WILL BE COMPLETED WITH WHETHER SPECIFIED HEliEIN O(i <br /> ioT eiocK oF NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br /> AUTHORITV TO VIOLATE OR CANCEL THE PPOVISIONS OF ANV <br /> OTHER STATE OR LOCAL LAW REGULATING CONSTtiUCTION OR THE <br /> PERFOR�4ANCE OF CONSTRUCTION.THAT I AM AUTHORIZED BY THE <br /> OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br /> PARCELTAXI�.NOMBER APPLICATION I5 MADE AND I COMPLY WITH THE STATE <br /> CONTRACTORS LAW 7827 RCW AND 296200 WAC. <br /> CONSTRULTION LOAN LEN�ER,ADORE55,TELEPNONE NUMBER <br /> X <br /> PROJEC�9��SS � s�H�ruAE o�ic _ <br /> O«f n*r eus�rvcss.�cer+sc r+o <br /> PLUMBING MECHANICAL <br /> ' N0. TYPE OF FIX RE OR�TEM FEE NO. TYPE OP EOUIPMENT FEE <br /> WATER CLOSET(TOILET) � AIC—A/HNDLG UNITS—H.P. ; <br /> BATHTUB ; FORCED AIR SYSTEMS—B.T.U. M E.A. <br /> LAVATORV(WASH BASIN) i UNIT HEATERS—B.T.U. M � <br /> SHOWER ' CLOTHESDRYEflS � <br /> KITCHEN SINK&DISP ; VENTIIATION FAN ' <br /> DISHWASHER RANGE HOOD �— <br /> LAUNDRY TRAY ; WATER HEATER � <br /> CLOTHES WASHER WOOD STOVE ; <br /> URINAL ; METAL FIREPLACE(W000 BURNING) � <br /> DRINKING FOUNTAIN � FIREPLACE INSERT ; <br /> FLOOR DRAIN � H[AT PUMP <br /> � BACKFIOW PREVENTERS ; GAS PIPING <br /> ROOF D9AINS—RAINLEAD[RS � EKHAUST FAN <br /> SINK VICE—BAR,ETC.) ; <br />, <br /> � ' <br /> � ; <br /> x � � <br /> SUB TOTAL $ � Sl1B TOTAL $ ' <br /> PERMIT $ � / PERMIT $ � <br /> TOTAI FEE $ ; ' TOTAL FEE $ <br /> FOR OFFICE USE ONLY: <br /> FPONT SET9AGN REAF SETBACK SIDE SETBACK PLAN CHECN N 1 P FEE RECEIPT NO. <br /> a� �I <br />, us[zoNe �or naen VACANT SITE FEES VALUATION FEE <br /> ❑ YES ❑ NO BUILOING i <br /> 1YPEOFCONSi. NO.OFSTORIES oc[uveNt� HOMDxEtoxGUNrtS <br /> �"°0o pLUM81NG � <br /> i <br /> i <br /> SREOFOLDG. FIRESPRINKLEHSREO'U BASEMENT �— <br /> MECMANICAL � <br /> ❑ YES C] NO ' <br /> � <br /> OCCUPANf.YLOAD FIFEALARMRE00 HEIGHTLIMIT�TION ADDITIONALPLANCHECK � <br /> � <br /> OTHER � <br /> REASON ' <br /> STA7C-DUILDING SURCHARGE i � <br /> INiAI(EBY P�.ANSAPPROVEOBY CITYOFEVERETT PUBLICINORNS � <br /> LOCAL SALES <br /> o�,e TAX CODE IS 3105 TOTAL I <br />■■� <br />