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APPLICATIO� FOR CONSTRUCTI �`N PERMIT <br /> TO BE COMPLETED IN BLACK INK—PLEASE PRINT � <br /> BUILDING DEPARTMENT HEATING SYSTEM: ❑GAS ❑ELECTRIC ❑ <br /> 259-8810 <br /> ❑ DEMOUTION ❑ COMBINATION �(BUILDING ❑MECHANICAL ❑PLUMBING ❑ SIGN I <br /> 0 <br /> LITY ZIP PHONE <br /> F� <br /> TENANT MRILADDRESS ITF jiP FHONE <br /> /11 sOi�s.IL q�wry^7/L QLO�.. SssSli Z SY-G t�t f/ <br /> ARCHITECTORDESIGNEF MFI�ADDFES$ CITV IIP PHONE M <br /> � ' a„ . <br /> GENERALLONTRqCTOF MAILADDRE55 CITY Z�p �, PHQ A <br /> �� n � /y' � STATE IICEHSE I <br /> .Y <br /> MECHANICALCONTRAGTOR MAI�ApDRE55 � v�� <br /> ��Tr ZIP PHONC STATE UCENSE� <br /> PIUMBINGCONTRqCTOR MAILADORESS pTY ZIP PMONE <br /> SUTE LICENSE 1 <br /> CONTPRCT PFILE QF WpRN <br /> � <br /> OESCRIBE WORK AN�SOUARE FOOiAGE INVOWED CONTA Eq p E��Q <br /> � e� <br /> �.e.ir.E /o'G " .�tt_ <br /> e� C s I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br /> ROPOSEDUSEOFBUILOING APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT.ALL <br /> PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br /> LEWIDESCRIPTIONOFPROPERiV�SMOWNBELOWORATTACNTWOCOPIE3� WORK WILL BE COMPLETED WITH WHETHER SPECIFIEU HEREIN OR <br /> �or g�p�K oF NOT. THE GRANTING OF A PEqM1T DOES NOT PRESUME TO GIVE <br /> AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANV <br /> OTHER STATE OR LOCAL LAW REGULATING CONSTfiUCTION OR THE <br /> PERFORMANCF OF CONSTRUCTION.THAT I AM AUTHORIZED BY THE <br /> OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br /> PpRCELTA%L�.NUMBEP APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> CONTRACTORS LAW 1827 RCW AND 296.200 WAC. <br /> GONSTRUCTIONIOANLENDEP.ADDRESS,TELEPHONENUMBER <br /> � ' y <br /> PROJECT ADDRESS • <br /> �aa �F o.,E <br /> im �:.a�=��Ess�,�E�s�� <br /> PLUMBING MECHANICAL <br /> N0. TYPE OF FIXTURE OR ITEM FEE NO. TYPE OF EOUIPMENT FEE <br /> WATER CLOSET(TOILET) A/C--A/HNDLG UNITS-H.P. <br /> BATHTUB ; FORCED AIR SYSTEMS-B.T.U. M E.A. � <br /> LAVATORY(WASH BASIN) � UNIT HEATERS-B.T.U. 61 � — <br /> SHOWER � CLOTHES DRYERS <br /> KITCHEN SINK 8 DISP ; VENTILATION FAN � � <br /> DISHWASHER � RANGE HOOD � ' <br /> LAUNDRY TRAY ' WATER HEA1tq - <br /> CLOTHES WASHER WOOD STOVE <br /> URINAL � ' <br /> METAL fIREPLACE(W000 BUfiNING) � <br /> DRINKING FOUNTAIN FIREPLACE�NSER? <br /> FLOOR DRAIN � NEAT PUMP � �— <br /> BACKFLOW PREVENTERS ; GAS PIPING � <br /> ROOF DRAINS-RAINIEADERS EXHAUST FAN � <br /> SINK(SERVICE-BAR,ETC.) � � <br /> i_ <br /> i � <br /> i �-- <br /> i <br /> i <br /> � I <br /> SUB TOTAL 5 � SUB TOTAL $ � <br /> PERMI"f $ PERMIT $ ; <br /> TOTALFEE $ TOTALFEE $ � <br /> FOR OFFICE USE ONLY: <br /> FRONiSETB�CK REARSET9RCK SIDESETBACN PLANCHECK 'UM�Eq FEE FECEIPTNO. <br /> USEZONE LpTAREA VACANTSITE EES /C VALUATION FEE <br /> ❑ VES �l NO BUILOING <br /> 7YfE0FLON5T. NO.OFSi07lES IXtuaaricv rvawo-AYwYGuxus � <br /> �pm�� PWMBING i <br /> SIZEOfBIDG. FIRESPRiNNLER5RE0'0 BASEMENT � <br /> ❑ YES ['� N� MECHANICAL i <br /> OCCUPAIJCYLOnJ FIREALARMNEOD HEIGHiIIMITATION ADDITIONALPLANCHECK <br /> REnSON OTHER ' <br /> i <br /> STATE�UILDING SURCHARGE � <br /> INT4kEBY PLANSAPPROVEOBY CITYUFEVERETT PU�LICWORKS � <br /> LOCAL SALES <br /> onrF TAX CODE IS 3105 Tora� <br /> I <br />