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APPLICATI�! FOR CONSTRUC'T'�N PERMIT � <br /> TO BE COMPLETED IN BLACK INK—PLEASE PRINT ��i�r.- <br /> �� <br /> HEATING SYSTEM: U GAS ❑ELECTRIC ❑ � <br /> BUILDING DEPARTNENT <br /> 259-8810 <br /> DEMOLITION COMBINATION BUILDING MECHANICAL ,�(PLUMBING SIGN <br /> OWNER MAILADDRESS qTV 21P PHONE <br /> Sk�T��a�� r-,��� ��«�.rr.r P c� Ro�- �a.c> ccF�.�r �..:�r ��a� �.�°r-��35y ' <br /> TENANT MAILADDRE55 CfTV ZIP PHONE <br /> ARCHITECTORDESIGNEfl MAIIADORE55 GITY zIP PNONE <br /> GENERRLCpNTRAGTOR MAILADDRE55 CRV ZIP PHONE STATELICENSER <br /> MEGHANIC�L CONTRRLTOR MML RDDRESS QTV LP PNONE STATE LICENSE� <br /> PIUMBIHG CONTRACTOR M�IL ADDRE55 CITY ZIP PNONE STRTE LICENS[Y <br /> ARTr PLL/hB��L!'� lC �l It��. 1�. Shc�NdM�IH- Wf - �1,��1%0 �6�`��3� /IP_TSP�-/,}3a� <br /> CLAS$OF WORK �—� <br /> ' NEW ADDITION :�(uLTERATION � REPAIR � DEMOLITION WOODSTOVE'FRPL INSERT BUILDING RELOCATION <br /> C �J CONTACT PERSON RND PHOJNF N0 / (� <br /> CONTRALT PRICE OF WOFK ` �,r �.C�I..( (_,Jr�I"{'� ��C tj � C L�� � <br /> r <br /> DESCRI E WORK AND SOUARE FOOiAGE INVOLVED <br /> L�,ti rNir c —ci �t <br /> Pao SEOUSEOFBUIIDING i HEREBY CERTIPY THAT I HAVE READ AND EXAMINED THIS <br /> 4-rl Z � APPL�CATION AND KNOW THE SAME TO BE TRUE AND CORRECT.ALl <br /> LEGAL DCSLPIPTIONOF PROP��RTY�SNOWNBLLOW ORARACHFWRCOPIES� PfiOVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br /> WORK INILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br /> tor BLOCK oF NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br /> AUTNORITV TO VIOLATE OR CANCEL THE PROVISIONS OF ANV <br /> OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br /> PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BV THE <br /> OWNER OF THIS PROPERTV TO PERFORM THE WORK FOR WHICH <br /> APPLICATION IS MADE AND � COMPLY WITH THE STATE <br /> CONTRACTORS LAW 7827 RCW AND 296200 WAC. <br /> X ��:_ �.�� �(a�ly � <br /> PROJECTR� E55 Sm�+mm�t -1� (�/"� � / o�rE <br /> l:/ 7� <br /> LIl V PaC�4[54 tIC{NSF NO <br /> PLUMB�NG MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM FEE NO. TYPE OF EQUIPMENT FEE <br /> � WATER CLOSFT(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. M <br /> SHOWER ' CIOTHES DRYERS <br /> KITCHEN SINK 8 DISP VENTILA710N FAN <br /> DISHWASHER RANGE HOOD <br /> LAUNDRYTRAY ; WATEA HEATER <br /> CLOTHES WASHER WOOD STOVE <br /> URINAL METAL FIREPLACE 8 CHIMNEY ! <br /> DRINKING FOUNTAIN � FIREPLACE INSERT ; <br /> FLOOR DRAIN HEAT PUMP <br /> BACKFLOW PREVENTERS ; GAS PIPING <br /> ROO�DRAINS—RAINLEADERS � EXHAUS7 FAN <br /> SINK(SERVICE—BAR,ETC.) ; <br /> � („i t r � r <br /> SUB TOTAL $ 5UB TOTAL $ ; u <br /> PERMIT $ '�J � PERMIT $ <br /> TOTAL FEE $ TOTAI FEE $ 'U <br /> FOR OFFICE USE ONLY: <br /> FRONTSETBACN REAPSETBACK SIOESEiBaCN PLANCHECKNUMBEfi � FEE RECEIPTNO. <br /> 3 �-' <br /> «,�y <br /> USE ZONE LOT AhEA vncnHT site � FEES VALUATION FEE <br /> BUILDING <br /> TYPEO�COMS.pIIOWABIE TYPEOfLONSi.AGTWL OttuwNtv NOorow[wxGUNi*5 — <br /> GRW° � PLUMBING ; �� <br /> 512E OF OLDG. NOAF 6�ORIES BASEMENT MECHANICAL �ti <br /> OGCUPANCVLOAD FlRESFW�NLERSiiEO'0 M[IGNTLIMIIAiION ADDITIONALPLANCNECK i <br /> i <br /> SPRINKLER <br /> ' REASON FOR SPRINKLERS �— <br /> STATE BUILDING SURCHARGE � <br /> INTANEBY PlANSAPPFOVEDBV CITYOFEVERETT PUBLICWORK$ � <br /> LOCAL SALES �� � <br /> TAX CODEIS 3105 TOTAL �7 ; C J <br />