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AF�PLICATIC -1 FOR CONSTRUCT" lh1 PERM17' �� <br /> TO BE COMPLETED IN BLACK INK—PLEASE PRINT �+'� <br /> BUILDING DEPARTtdENT HEATING SYSTEM: J GAS _1 ELECTRIC CJ l <br /> 259-8610 <br /> �LDEMOLITION i� COMBINATION �_i BUILDING f7MECHANICAL PLUMBING ' SIGN <br /> r— <br /> Ol\'NEP IdARApDR[SS CITY 21P P��p!;E <br /> Gt1�� v� �VL�—L'-1"f" "'�2> L-�EiNIOK-� EVt£l"' GJi yP/_ul LJ�- 'S�j <br /> tENANT MAILADDRE55 CITV ZIP PHO1�E <br /> SAMe <br /> ARCHITEGTORDESIGNER lARILADDRE55 CITY Z1P PHONE <br /> SAr�r <br /> GLNERALCONTRALTOR MAILAPJRE55 CITV 2IP PMOHE STATELICENSE� <br /> ��lr- B�IwF�� Ir ic- /sr,�l <br /> 61ECHA41CAl GONiRACTUR MRIL ADDRE55 � � CITY ZIP PNONE STATE IICENSE� � <br /> PLUNBINGGONIAAGiON MAILADDRE55 CITY 21P PNONE STAiELICENSE� <br /> �ONTRALT PRICE OF WORN�� _ <br /> � <br /> OLSCRI�E�M1'ORK AND SOUARE FOOTAGE INVOLVED CONiAGT PERSON AND PuONE NO <br /> �u /�4!f - �59-8898 <br /> Deinv�mm�� ��- • s <br /> dwM�N�K f (�o�D �ikucivk�, <br /> I NEREAV CERTIFY THAT I HAVE READ AND EXAMINED THIS <br /> raoaoseousEOFBuaDir+� APPLICATICN AND KNOW THE SAME'!O BE TRUE ANCI CORRECT.ALL <br /> J�YSGfG GIA �� PROVISi0N5 OF LAWS AND ORDINAIJCES GOVERNIP:.G THIS TYPE OF <br /> LEGALDESC9IPTIONOFPROPE Y�SHOWNBELOIYORATfACHiWOGOPIES) WORK 'NILL BE COMPLETED WITH'NHETHER SPEciPIFD HEHEIN OR <br /> NOT. THE GRANTING OF A PERMIT DOES NOT P'iESUME TO GIV[ <br /> ior eiaK oF AUTHORITY TO VIOLATE OR CANCEL THE PRO`JISIONS OF ANV <br /> ui'= 1���='ril %s� D Gi' LOT �17� � ri.CLV�- OTHER STATE OR LOCAL LAW REGULATWG CONSTRUCTIO�:OR THE <br /> PERFORMANCE OF CONSTRUCTION. THAT I AM 4UTHORIZED BY THE <br /> OVlNkR OF THIS PROPERTY TC PERFOAM THE 1VORK FOF WHICH <br /> V� �Li\ID� '�i- ' ''� APPIICATION IS MAOE ANU I COMPLV WITH THE STATE <br /> ❑AP.:EL TAY I DJIU618ER CO�TRACTORS LAW 18.27 RCW AND 296200�'VAC. <br /> CONSTRUCtION LOd'I L[tIDER.ADUHE55,IELEFMONE NU1.�3ER <br /> X ��,�.� __�/�_r�3 <br /> PROJECT ADDRGSS I / ,, {� �"•"""'°� p41 <br /> yU WL1J `IV UF G'Ivnu5JCS511CO5ENo <br /> PLUMBING MECHANICAL <br /> IJO. TYPE OF FIXTURE OF ITEM PEE NO. TYPE OF EOi11PMEIJT FEE <br /> WATER CLOSET(TOILET) A,C—A�HNDLG UNITS—H.P. <br /> �ATHTUB FORCED AIR SYSTEMS—B.T.U. M E A. � <br /> LAVATORY(WASH BASIN� i UNIT HEATERS—B.T.U. M ; <br /> SHOWER CLOTHES DRYERS �— <br /> KITCHEN SINK 8 DISP - VENTILA710N FAN ' <br /> � <br /> r— <br /> DISHWASHER � RANGF.HOOD � <br /> LAUNDRYTHAY WATER H[ATER <br /> CLOTHES WASHER i WOOD STOVE i <br /> URINAL ' �7ETAL FIREPLACE(WOOD BURNING� <br /> DFiINKING FOUNTAIN � FIREPLAC[INSERT <br /> FLOOR DRAIN HEAT PUIdP <br /> BACKFLOV!PREVENTERS ; GAS PiPING <br /> ROOF DRAINS—RAINI.EADERS � EXIIAUST FAN <br /> SINK(SERVICE-2AR,GTC.) ; <br /> i <br /> SUB TCTAL S SUB TOTAL S <br /> PERMIT 5 T PERMIT 5 <br /> TOTALFEE S TOTALFE[ 5 <br /> FOR UFFICE USE ONLY: <br /> FR01lTSE1SACK flEARSETBACK uIDE5Ci0FCK PLANCIICCKY.UtdAER FEG RECEiPINO. <br /> � � l�i <br /> L'_ - <br /> 16[20NE �OTRFEA �ACANTSRE FEC-S VAWATION FEE <br /> ;] YES �7 NO pUll DING � <br /> t�'�f Of CON57. NO.OF STORIES P'cunµ�v �,d fEONTwH.nNrS — -- -�—— — <br /> ;xeuv pLUMBING <br /> :eZEOFBLD�. FIPESPRINNlERSREOD BASEM[Ni MC-CHANICAL � <br /> f-1 YES Ci NO - <br /> OCGUPANCY LOAD FIPE�LARM REOD NEIGNT LIAAI!ATION ADDITIONAI PLAN CHECK _ <br /> � <br /> _ _ OTHER <br /> — __—�— <br /> ��[nSON <br /> STA7E BUILDING SURCHARGE <br /> ir�,reecv r=�nruarrnoveonv CITYOFEVERETT nueucwor�Ks <br /> LOCAL SALES <br /> �„r� TAX CODE IS 3105 roTa� � <br />