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APPLICATIC—f FO�R CONSTRUC7`�N PERMIT � <br /> TO BE COMPLETED IN BLACK INK—PLEASE PRINT <br /> HEATING SYSTEM: U GAS U ELECTRIC Cl � <br /> BUILDING DEPARTMENT <br /> 259•8810 <br /> ❑ DEMOLITIOP� I ] COMBINATION I ', BUILDING f 1 MECHANICAL ❑PLUhABING �SIGN <br /> OWN'R RIAILAODRE55 LITY 21P PHONE _ <br /> ,�I ; ., �.�lri� l�'ll L � �� �' I (�i'Y c'' [-�/r FF`l� l/�/� ry!:�)�Ii � �'"�i_ r���ly <br /> �ENPNT MAIL hDDRE55 GITV ZIP PNONE <br /> `���,51-KsP�lk� �bll��s(oIR�) AU��t,�� � u,�i. HSaCiI d-���-3U55 <br /> `�r- GITY 2�P PNONE <br /> GENERAI.CONTRACTOR/ MpI]LAQ00REV55 � CITV / Z,IP1 PHONE IS-TATELICENSE� -�^ j`y�d_ <br /> M�MANICAICO�R 1TIlR�I I ilA17DDRhMYVYW AL^ ��/ XWitIIX �I�JV�. �VI� S��PHO��S� S//OTELI C�Er'IO 1 � _ <br /> FI.UMB�NGCONTIiALTOR MAILADDRE55 CITY Z!p PMONE STATEIICENSE� <br /> CONTRACT PRIC OF WOFK <br /> �„ �� .i <br /> OESCRIBE WORK'AND SOUARE FOOUGE INVOLVED � CONTACT PERSON AND PMONE NO. �C I C� S <br /> —� �� x ,o�� �n 1 � ce CQ � I 5� � 5Ga-8'�3� <br /> I HFREBY CERTIFI' THAT I HAVE READ AND EXAMINED THIS <br /> PROPOSEO USEOF uaoiyG L , APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT.ALL <br /> I�� PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE 0� <br /> LEGpLDESCPIPTIONOFPROPERiV�SHJNTlBELOWORATTACMIWOGOPIES) WORK WILL BE COMPLETED 4VITH WHcTHER SPECIFIED HERFIN OR <br /> � � �/� ���-� ���.p��-}� NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TU GIVE <br /> �o*—/—+� BLOCK�— oF �-W-ty�+-- AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS CF ANY <br /> OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br /> PERFORMANCE OF CONSTRUCTION.THAT I AM AUTHORIZED BY THE <br /> OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br /> APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> PAACEITA%ID.NWABER t'?nl ��I/_�j , /1O� _O�Q� CONTRACTURSLAW18.2�C�N0296.200WAC. <br /> -��`-� y�yir 1' v <br /> G- <br /> CO4STRUCTION LOAN LENO[F,AO�RESS,TELEPHONE NUMBEF „���j j/// <br /> � �� f'_ � ' ��f��/ !. <br /> PROJECT ADDRESS � f I �' D ���p smv�ruoKc t., �"�T��� o^'E — <br /> n� /�.� nrrau�i�i txsErro <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF fIXTURE OR R"cM FEE NO. TYPE OF EQUIPMENT FEE <br /> WATER CLOSET(TOILET� !+!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 ' CLOTHES DRYERS � <br /> KITCHEN SINK 8 DISP � � VENTILATION FAN <br /> DISHWASHER � RANGE HOOD ' <br /> LAUNDRY TRAY ; WATER HEATER ` <br /> CLOTHES WASHER � WOOD STOVE ' <br /> URINAL ' METAL FIREPLACE(WOOD BURNING) ' <br /> ' �'IREPLACEINSERT � <br /> DRINKING FOUNTAIN ' — <br /> FLOOR DRAIN �— HEAT PUMP � __ <br /> BACKfLOW PREVENTERS GAS PIPING — <br /> ROOF DRAINS--fiAINLEADERS � EXHAUST FAN ;__ <br /> SINK(SERVICE—BAR,ETC.) � <br /> � — <br /> � � <br /> SU6 TOTAL S ' SUB TOTAL S ' <br /> PERM�T 8 PEAMIT $ <br /> TOTAL FEE S TOTAL FEE 5 <br /> FOR OFFICE USE ONLY: <br /> � FRONTSEiBAGK " ACN SIDESETBACK PIAII�ECKtlUMi ER FE[ ��'� � AECEIPTpO�o�� � <br /> Yl <br /> o�a �r� <br /> usezori� iotaAen VACANTSITE FEES VAIUATION FEE <br /> _� ❑ YES ❑ NO BUILDIYG -�`�' � <br /> NPEOfCONSi. NOAFSTORIES OCcuveNCv NOaow[IUH,Uous � <br /> cnouv PLU6IBIRG � <br /> SIZEOPBLDG. FlRESPRINKlER5RE0'D BASEMENT MECHANICAL � <br /> ❑ YES ❑ NO <br /> OCCUPANCVLORD FIREAIARMPEOD NEIGNiLIMITAT�ON <br /> AODITIONAL PIAN CHECK <br /> OTHER � <br /> REASON �SZ� <br /> STATE�UII.DING SURCHARGE <br /> INTRKEBY PLANSAPPROVEDBY CITYOFEVERETT PUOLICWORKS � <br /> JM LOCAL SRLES � <br /> OATE Iz/3/93 TAX CODE IS 31U5 TOTAL I � <br />