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APPL:�ATIQ ' FOR CONSTRUCT' �1N PERII111T � <br /> TO BE COMPLETED IN BLACK INK—PLEASE PRINT <br /> BUILDING DEPARTMENT HEATING SYSTEM: ❑GAS (]ELECTRIC ❑ <br /> 259•8810 <br /> ❑ DEMOLITION ❑ COMBINATION ❑ BUILDING �IIECHANICAL ❑PLUMBING C� SIGN <br /> ��� MAIL�DDRE� � \ , CITY � �--.J I PC'VF -- <br /> /A/_ � H 'f �/�ZO/ <br /> v���,�.� 7 <br /> tEHMIT W�ILl1ppRE55 GTY ZIP %IONE <br /> /�RRZU. Lynl�tF ,a7�v Ce�.e�r �.l�E �'!�o! .�11F,/tETT <br /> ARLHITECTOqDE51GNEN M�IL�DORE55 GTY ZIP PNONE <br /> • <br /> GENERAICpNTq11CTON MAIL�DDRESS GITY ZIP PNONE STATELIC[NSEt <br /> mMEGHNi��/[j�.L/CO�`NT'A,A�GT�O/R M�IL DDRE 5 '/�y �}ITY�J� �JZI'P ,/ 'PN+O�N}E� MS1�AiE�/t+ICEN'5E1 <br /> MG•"w�qX/(�'/ � ��RE�X�`�J[O� .�ifFIT���L �nP��{' /GM Ni7�� 'Ilp"�1iI[ E�37aN0 <br /> GONTRAGT PflICE OF WOAK� ^ `I OD� <br /> Py <br /> DESCRIBEWOqKAND50UAREFO0U4EINVOLVED��� ^ �� WM T�ERSONANDPI/ONENO. <br /> /1•L.- _�s... ��.,t<-mw�rss�y � 7(�•33 I� <br /> Duc�t , ,Ds�'usF�t4,�t�lE <br /> �E ��, L.Z�'r i)/'[.LT S+'� ��GG�� I HEREBY CERTIFY THAT I HAVE READ AWD EXAMINED TNIS <br /> PPOPOSED USE OF nU0.DINC ��� !PPLICATION AND KNOW THE SAME TO PE TRUE AND CORRECT.ALL <br /> PROVISIONS OF LAWS AND ORDINANCES GOVERN�NG THIS TYPE OF <br /> lECN1L0E5CRIPTIONOFPROPERIY�SHOWNBELOWOPATTALNTWOCAPIES� WORK WILL BE COMPLETED WITH WHETHEH SPECIFIED HEREIN OR <br /> �ot otocK oF N07. 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 TNE <br /> PERFOHMANCE OF CONSTRUCTION.THAT I AM AUTHORIZED BY THE <br /> OWN[R OF THIS PqOPERTY TO PERFORM THE WORK FOR WHICH <br /> PRqLELTA%I.D.NUMBEfl APPLIr,ATiON IS MADE AND 1 COMPLY WI7H THE STA7E <br /> CONTFAC70 5 LAW 18.27 RCW AND 296.200 WAC. <br /> CONSTRVCTqN IOAN LENOER,ADD IE55.TELEPNONE NUMBER= � <br /> � <br /> wr.tt.=S nt • .n, ( s x �6►+u�.-/� , l�/7 <br /> PROJECT ADDRGSS p�r� <br /> �70o Cu44� J�4� . Slclst6 / �( � ������,��t���.g�81 -w <br /> PLUMBING MECHANICAL <br /> NO. TYPE CF flXTURE OR ITEM FE� NU. TYPE QF EOUIPMENT FEE <br /> WATER CLOSET(TOILET} A/C--A/HNDLG�`JITS—H.P. ; <br /> BATHTUB ' FORCED AIR SYSTEMS—B.T.U. M E.A. <br /> IAVATORY(WASH BASIN) , UNIT HEATERS—B.T.U. M ; <br /> SHOWER � CLOTHESDRYERS <br /> KITCHEN SINK 8 DISP � VENTILATION PAN <br /> DISHWASHER � RANGE HOOD �— <br /> LAUNDRV TflAY ; WATER HEATER � <br /> CLOTHES WASHER � WOODSTOVE <br /> URINAL ' METAL FIREPLACE�WOOD BURNING) �— <br /> DRINKING FOUNTAIN FIREPLACE INSERT — <br /> � <br /> FLOOR DRAIN HEAT PUMP � <br /> BACKFLOW PREVENTERS ; GAS PIPING � <br /> ROOF DRAINS—RAINLEADERS � [XHAIIST FAN , <br /> SINK(SERVICE—BAR.ETC.) � <br /> � <br /> � <br /> � <br /> � � <br /> � <br /> SUO TOTAL $ ' SUD TOTAL $ ,>,) � v� �. <br /> PERMIT $ � PERMIT $ i^ <br /> TOTAL F�E $ ' TOTAL FEE $ "' ��--� <br /> FOR OFFICE I�SE ONLY: <br /> FNONTSETOACK REARSEiBACK SIDESETBRCK VUNCHFGKNl1M0ER FEE REGEIPiNO. <br /> Z <br /> USE20NE IOTAAEA VqCANT51iE FEES VALUATION FEE <br /> ❑ res ❑ No ouaomc <br /> � <br /> � <br /> lYMOiCONSC NO.OFSTORiES ouuruqr xoaw.nuxcuxns <br /> �wa' PLUMBING � � <br /> S�ZEOFBIDG. FIRESf'RINKLEPSPE09 �ASEMENT —~— <br /> MECHANICAL � <br /> ❑ YES ❑ NO - <br /> — � <br /> occur,wcv two FIpC NAflM NEO'� NEIGHT LIMITATION ADDITIONAL PLAN CHGCK � <br /> O7!{[Fi <br /> REASON i <br /> STATL OUIl01NG SURCHARGE � <br /> INTAKEBV PlANSRPPROVE00Y CITYOFEVERETT PU�LICWOf7N5 i <br /> �.IM LOCAL SALES � <br /> onre lu�Zf�a� TAX CODE IS 3105 rorn� ; <br /> r ' -- <br />