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APPLICATI�1 FOR CONSTRUCT�N PERMIT � <br /> TO BE COMPLETED IN BLACK INK—PLEASE PRINT <br /> BUILDING OEPARTMENT HEATING SYSTEM: J GAS J ELECTRIC > <br /> 259-8810 <br /> DEMOLITION i I COMDINATION i BUILOING I '�MECHANICAL i 1 PLUMBING i SIGN <br /> OWNEF/�� � IdA�IL�AD�DR(�/55 LITY � �J Z�P PHONE <br /> (i/Jl/'.I7f �C/i-vv—�_ �/S� �7"�(7 CfY��I 3 3�� y�?� <br /> T[NA4T���� �q��pppqES$ CITV TP PNONE <br /> / // <br /> i'�S <br /> ARGHITECTOP�ESIGNEfi MARADDRE55 CITY ZIP PMONE <br /> GLNERAI CONTRACTOq MFIL AUDRE55 CITY $IP PHONE $TFTE LICENSE Y <br /> MECHpNi��RA iOR��A MAi�AD�n��/� l CITY ZIP PHONE STATE L�CENSE� <br /> / <br /> ��C `J J� <br /> f'L111ABING CONTRRCTOR MAII ADDRE55 CITV $IP PHONE SiATE LICENSE M <br /> GONiFACT PRICE OF N�'OyR�✓, / / - � <br /> ��7 L/(l�� ( R�'O'z _! <br /> DESCRIBE WOFN ND SOUARE FOOTAGE INVOLVED CONTACT PERSON RNO PHONE NO. <br /> C/�/u^ <br /> I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS � <br /> aao�roseo use oF emioiNc APPLICATION AND KNOW THE SAME TO BE TRU[AND CORRECL ALL <br /> PROVISIONS OF LAN'S AND ORDINANCES GOVEFNING THIS TYPE OF <br /> LEGALOESCRIPTIONOFPROP[qtt�SHOWNBELOWORr1TTACHTWOWPIES� WORK WILL BE COMPLETED WITH WHETHER SPEGFIED HEREIN OR <br /> NOT. THE GRANTING CF A PERMIT DOES NOT FRESUME TO GIVE <br /> �or etceK oF qUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br /> OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br /> PERFORAIANCE OF CONSTRUCTION.THAT I AM AUTHORIZED BV THE <br /> OWN[R OF THIS PROPERTV TO PERFORM THE WORK fOR WHICM <br /> � APPLICATION IS MADE AND I COMPLV WITH TNE STATE <br /> PARCELTA%ID.NI/MUER <br /> CONTRACTORS LAW 1827 RCW AND 296200 WAC. <br /> GONSTRUGTIONLOANLEN�ER,ADDRESS.TELEPHONENUMBER <br /> � � . // �' 'JrJ' <br /> PROJECT Af;O /5$ /_/� / s nw unc �<.� <br /> oL !!' I�BtS..Ji <br /> �,�,�,�.�Fss,�«,�st�� <br /> I�LUMBING U ECHANICAL <br /> , NO. TVPE OF FI%TURE OR ITEM FEE NO. TYPE OF EOUIPMENT FEE <br /> WATER CLOSET(TUILET) � A�C—A'HNDLG UNITS—H.P. aSD <br /> BATHTUB (� FORCED Alfl SVSTEMS—B.T.U. M E.A. l—~— <br /> _ LAVATORV(WASIi BASIN) UNIT H[ATEFS—B.T.U. M <br /> SHOWER � CLOTHES DRVeFS � <br /> KITCHEN SINK 8 DISP � VENTILATION FAN � � <br /> DISHWASHER �" RANGEHOOD � <br /> LAUNDRY7RAY WATER HEATER ! <br /> CLOTHES WASHER WOODSTOVE ; <br /> URINAL METAL FIREPLACE(WOOD BURNING) ; <br /> DRINKING FOUNTAIN i fIREPLACE INSEflT i <br /> FLOOR DRAIN � HEAT PUMP ��— <br /> BACKFLOW PREVE-NTERS ; ,� GAS PIPING ' <br /> ROOF DRAINS—RAINLEADEFiS � EXHAUST FAIJ <br /> SINK(SEHVICE—BAq.ETC.) ; O�t6R t $ � 1rJ U Z ' <br /> � <br /> � <br /> —T <br /> SUB TOTAL $ SUB TOTAL $ <br /> PERMIT S � PERMIT $ <br /> TOTALFEE 5 TOTALFEE 5 <br /> FOR OFFICE USE ONLY: ��'7(rG <br /> FROYTSETBFCH REARSETBACK SIDESETBACK PLANCHEGKNUMBER FE[ PELEIPTNO <br /> L����'� <br /> USEZONE LCTAPEA VACANTSITE FEES VALUATION FEE <br /> i <br /> J YES . NO BUILDING i <br /> iVPEOFCONST NO.OFSTOFIES ottuv�Mn imormtTiUH4u4ns <br /> ceouv pWMBING � <br /> i <br /> SIZE OF BLDG. FlRE SPRINKLERS PEOV BASEMENT MECHANICAL � <br /> ���.-� YES 'l. NO <br /> OCCUPANCY LOAD FIRE ALFRM FEOD HEIGMT IIMITATION <br /> ADDITIONAL PLAN CHECK ; <br /> OiNER <br /> REASON � <br /> —� <br /> S1ATE BUILOING SURCHARGE i <br /> ' MTANEOY PLANSAPPpOVE�BY CITYOFEVERETT PUBLICWORK$ <br /> L�CAL SALES <br /> on,e TAY.CODE IS 3105 TOTAL <br />