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APPLICATIO�I FOR COMSTRUCT.JN PERMIT <br /> TO BE COMPLETED IN BLACK INK—PLEASE PRINT ��r��sr <br /> BUILDING DEPAFTMENT HEATING SYSTEM: C.l GAS ❑ELECTRIC ❑ <br /> 259•8810 <br /> X DEMOLITIQN COMBINATION ' BUILDING !MECHANICAL PLUMBING � SIGN <br /> OWNER M�IIL ADDRE55 GITY ZIP PNOHE <br /> Go�n_,.i SmuAa2� �de;1,�s �731 IAJk7�.(d�€ �N� �/ uX 9l3?a I �-�kr� <br /> TEN�NT M,11L ADDPESS CITY ZIP � PHDNE <br /> ARCMITECTORDESIGNER MAIL�DDRE55 CITV ZIP PHONE <br /> GENERALCONTPACTOR MRI�pODRE55 /� � CITY ZIP PNONE STATEUCENSE� <br /> -¢� v.� �-�i.� i� <br /> v <br /> MECMAN�CALCONTRACTOfl MMLADDRES—5 T� CITY 21P PMONE STATEUCENSEI <br /> PLUMBINGCONTP�C70R M�ILA�DRESS CITY 21P PHONE STAfEIICENS@t <br /> CUSS OF WORK <br /> I I NEW ��. ! ADDITION �� �� ALTERATION � I REPAIR x DEMOLITION � WOODSTOVE/FRPL INSERT � BUILDING RELOCATION <br /> CONTAGT PEFSON AND PMOHF NO}.�.���,� �yp� �yw�,., <br /> CONTRACi PRICE OF WONK UA{.•b L. �JY{'n .rC.�J"�iW <br /> DESCRIBE WORK AND SOU�RE FOOTA9L INVOLVED <br /> PROPOSE�USEOF6UILOING i HEREBY CERTIFY THAT I HAVE READ /,nD EXAMINEO THIS <br /> APPLICATION AND KNOV!THE SAME TO BE TRUE AND GORRECT.ALL <br /> LEGALDESGRIPTIONOFPROPERi�'ISNOWNBELOWORATTr1CHFpURCOPIEF� PROVISIONSOFIAWSANDORDINANCESGO'lERNINGTHISTVPEOF <br /> � WORK WILL BE COMPLETED WITH WHETHEP SPEqFIEO HEREIN OR <br /> �oT l Z e�ocK �p�_ on NOT. THE GRANTINti OF A PERMIT DOES NOT PRESU�AE TG GIVE <br /> AUTHORITV TO VIOLATE OR CANCEL THE PRUVISIONS '�F ANV <br /> OTHER STATE OR LOCAI LAW REGULATING CONSTRUCTION OR THE <br /> PERFORMANCE OF CONSTRUCTION.THAT I AM AUTHORIZED 8V THE <br /> OWNER OF THIS PROPERTV TO PERFORM TF1E WORK FOR WHICH <br /> APPIICATION IS MADE A�JD I COMPLV WITH THE STATE <br /> � D CONTRACTORS LAW 1827 RCW ANO 296.200 WAC. <br /> PROJELTADDNESS /���� y � Sic iun I Dei[ -` ?� <br /> /L'721 ��,�{/ /�[�? �^(�f/Q�� �j/� utveusmcssucrnsreo ' <br /> PLUMBIN6 MECMANICAL <br /> NO. TYPE OF'FU(TURE OR I7EM FEE NO. TYPE OF EOUIPMENT FEE <br /> WATER CLOSET(TOILET) � A��fvHNDLG UNITS—H.P. <br /> BATHTUB ; FORCED AIR SYSi�EMS—B.T.U. A7 E.A. <br /> LAVATORY(WASH BASIN) � UNIT HEATERS—D.T.U. IA � <br /> SHOWER CLOTHESDRYERS I <br /> KITCNEN SiNK 8 DISP ; VENTILATION FAN I <br /> DISHWASHER � RANGE HOOD � I <br /> LAUNDRYTHAY ; WATER HEATER ' <br /> CLOTHES WASHER —� WOOD STOVE � <br /> URINAL METAL FIREPLAGE 8 CHIMNEY � <br /> DRINKING FOUNTAIN � FIREPLACE INSERT ; <br /> —�_ <br /> FLOOR DRAIN HEAT PUMP � <br /> BACKFLOW PREVENTERS ; GAS PIPING ; <br /> ROGF DRAINS—RAINLEADERS � EXHAUST FAN � <br /> SINK(SERVICE—BAR,ETC.) ; <br /> T <br /> 1 1 <br /> 1 1 <br /> I 1 1 <br /> SUB TOTAL $ ; SUB TOTAL 5 ' <br /> PERMIT $ � PERMIT 5 <br /> TOTAL FEE $ ' TOTAL FEE $ � <br /> FCrH OFFICE USE ONLY: ' <br /> FRONTSETBRLN REARSETB�CK SIOESETBACN PLANCHECKIlUMBEP fEE RECEiPTNO. <br /> >/ <br /> USEZONE �oTnaen VACRNTSITE FEES VALUATION FEE <br /> BUILOING � I' <br /> lYPEOfLONiS.ALLUWABLE lYPEOfCONSTACNAL Otcu�eNa xOaoxRluvcuNnS <br /> 09�n � pLUM81NG ' <br /> T <br />� SIZEOFBLDG. NO,OFSTOPIES BASEMENT MECNANICAL <br /> i <br /> OCCUPANCYIORD FIRESPRNKLERSflEOD NEIGMTLIMITATION ADDITIONALPLANCHECN <br /> i <br /> SPRINKLER ' <br /> R[RSON FOR SPRINKLERS —T <br /> STATE BUILDING SURCHARGE i <br /> INTAKEBV PLINSAPPROVEDBY CITYOFEVERETT PUBLICWORKS � <br /> LOCAL SALES <br /> TAX COOE IS 3105 TOTAL � <br />