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APPLICATIC ] FOR CONSTRUCT��N PERMIT �G��" <br /> TO BE COMPLETED IN BLACK INK—PLEASE PpINT �C <br /> BUILDING D�PARTMENT HEATING SYSTEM: ❑GAS ❑ELECTRIC J <br /> 259•8810 � 7L�^�r� `flE /�7�� 7j'�Fll �0// d <br /> „IJa,L�f� ���n�L+ i.� 9 ?S- i2�j' <br /> -, DEMOLITION ;_I COMBINATION BUILQING MECHANICAL PLUMBING xSIGN <br /> OWNER MAILFDDRE55 GT'I ZIP PNONP. <br /> BILL wN,� asa6 c.�v ,�E ���RErr 9��0� eZrB-5968 <br /> TE!JANT MARApDPE55 qTY =IP PMONE <br /> c�t�� e►�fi1�oS �S�?��) <br /> 'ARCMRECTORDESIGNER MAILADDRESS � CITV ZIP PHONE <br /> NMI�Nkc S/6N <br /> GENEF4�CONTRACTOR AIFIIADDRE55 LI;V ZIP PMONE STaTELICENSEI <br /> NA�ri,� si6i✓ i1sswEs�rqrE A�F�✓ :�rn� 9B�oq afd-o�Go �✓fifioscs3siL <br /> MECHIINIL4LCONTP�CTOR MRILADDRE55 GITY 21P PHONE $TFTELIGENSEI <br /> PLUMBING GONTR�CTOR MAII FDDRE55 GTv ZIp FHONE ST.iTE LIGENS[� <br /> CLASS OF WORN <br /> i NEW ❑ ADDITION �.� � ALiERATION REPAIR DEMOLITION WOODSTOVE/FRFLINSERT � BUILDINGRELOCATION <br /> ��D� �ONTAGT PTSp'NA'AND PH��NN `N'�I L� SI� a�a-o�co <br /> CONTRAG PRICE OF WORK 5 V�4 <br /> OESCRIBE WORK AND SOUARE FOOTAGE INv:LVED <br /> � y,y,�X ��3 �� <br /> NSl�}GG 0�/F flfL /L wrtLl ,S �J <br /> PROPOSEDUSEOFBUILDING i HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br /> ESTA[V�4V7��4 APPLICATION AND KNOW THE SAME TO BE TRUE ANO CORRECT.ALL <br /> IEGAI DESCRIPTION OF PROPERTY(SNOWN BELOW ORATTACH FOUR COPIE51 PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS 7YPE OF <br /> �or /q 1�20 eiocK LI oF R�(�('�[s /!J/(/f �r WORK WILL BE COMPLETED WITH WHETHEF SPECIFIED HEREIN OR <br /> � NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br /> AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANV <br /> 0 L. 2. L OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br /> PI (Q/ �� � 'O a// � 'w� PERFOFMANCE OF CONSTRUCTION.THAT I AM AUTHORI2ED BY THE <br /> / M1'� OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br /> APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> CONTRACTORS lAW 18.27 RCW AND 296200 WAC. <br /> T�r P�cE� �D � ,'s6a N-Ssl-o,9-o ons X ,,� ,. _ _ , <br /> PRQIECT AD�RE55 Smae*uaE DerE <br /> asa� �o�� ��,.a�.s��Fs���E„5�.,� <br /> PLUMBINC MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM FEE N0. TVPE OF EOUIPMENT PEE <br /> WATER CLOSET(TOILET) A/C—ArHNDLG UNITS—H.P. <br /> BATHTUO FORCED AIR SYSTEMS—B.T.U. M E.A. <br /> IAVATORY(WASH BASIN) � UNIT HEATERS—B.T U. M <br /> SHOWER CLOTHES DRYEAS —�— <br /> KITCHEN SINK&DISP VENTILATION FAN <br /> DISHWASHER � RANGE HOOD —� <br /> LAUNDRYTRAV � WATERHEATER <br /> CLOTHES WASHER WOODSTOVE � <br /> URINAL ; METAL FIREPLACE 8 JHIMMEY <br /> DRINKING FOUNTAIN � FIREPIACE INSEaT <br /> FLOOF DRAIN HEAT PUMP ?— <br /> BACKFLOW PREVENTERS ; GAS PIPING <br /> ROOF DRAINS--RAINLEPDERS EXHAUST FAN � <br /> SINK ISERVICE—BAR,ETC.) ; <br /> � <br /> � <br /> T— <br /> I <br /> SUBTOTAL $ SUBTOTAL 5 <br /> PERMIT $ PERf,�IT $ <br /> TOTAL FEE S TOTAI.FEE $ �— ' <br /> FOR OFFICE USE ONLY: <br /> FRONTSETBACK — REPRSETBACK //� / SIDESETBACK PIANCHEpKNpMBEy'7 FEE ,�n �� ✓ AECEIPT�� _,) <br /> � I fi�L�4 `1 (� <br /> USE20NE LOTAREA VAGFNTSITE FEES VALUATION FEE <br /> 3 euaoiNc ?Z � — <br /> iYPC01CONi5.Al_�pWABLC 1YPE0(CONS�.ALTUAL oaur�xCr HodowEuinGuxrts <br /> 4P0p� PLUM�ING '. <br /> SIZE OF Blf%G. NO.OP STORIES BASEMENT MECHAIJICAL ' <br /> OCCUP/.NCVLDAD FIRESPPNM1LEPSRFO'D NEIGHTI.IM�TATION ADDITIONALPLANCHECN � <br /> � <br /> _ SPflINKLER � <br /> REPSON FOR SPRINKiERS h� <br /> STATE OUILDIHG SURCHARGE / <br /> INTAKEBY PLANSAPPWOVEGBY CITYOFEVERETf PUOLICWORKS � <br /> LOCAL SALES <br /> �JM ll /C TAX CODE IS 3;05 TOTA� ��G' �`J L� <br />