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APPLICdTIC� l FOR CONSTRUCT"lN PERMIT � <br /> TO BE COMPLETEO IN BLACK INK—PLEASE PRINT <br /> BUILDING DEPARTMENT HEATING SYSTEM: ]GAS ❑ELECTRIC J —� <br /> 259-8810 �niP.v� �M Pf��'�'1E��� <br /> ' DEMOLITION i J COMBINATION i BUILDING �MECHANICAL !7 PLUMBING I i SIGN <br /> OWNEP MAILpDORESS GiY ZIP PHONE <br /> -��P� � ,v <br /> TENANi MAILADDRESS CiTV ZiP PHONE <br /> �RCNIiECTORDESIGNER MAILADORESS qTY 2iP PNONE <br /> _..7! YKfivlA�u <br /> GENEFALCONiRFG/0R MAILA�DFE55 GTV 21P FIIONE STATELICENSEs <br /> C-�`� C�a��oN �cc u���n�� �- v,�.�uE ry� <br /> MECMANICALCONTRPCTOR MAILADORESS CIiV 21P PNONE STATEIICENSEI <br /> �Uh�,�cFE�+ �T �,ryirr �,�a� Ir�u E �M,'_'rraE � Fw e ruC��CTr �:yl ps2-3//�/ �t�C�C'Fi552i.�] <br /> PWMDINGCONiRACiO� MnILADDRESS CITV IIP p110N[ STATEIICENSEe <br /> C NiP CT PqICE OF WORK <br /> Q� <br /> OESCRIBE WORK AND SOUARE FOOTAGE INVOLVED <br /> GONiACT PERSON AND PMONE NO ��� 7`q���/ <br /> (�a C <br /> INS'(ALL " Ej(F(RtXaT � <br /> "t' -�v` � w�K� I HEREBV CERTIFY THAT I HAVE READ AND EXAMINED THIS <br /> PROPOSED USE OF BUIL�ING APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECL ALL <br /> _Orr�Cl ��F�Cr PROVISIONS OF LAWS AND ORDMANCES GOVERNING THIS TVPE OF <br /> �ecA�oescaianoNOFrAorFarv�snowr+ec�owoaattncNnvocoPies� WORK WILL BE COMPLETED WITH WHETHER SPEGFlED HEREIN OF <br /> NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br /> ior e�ocK oF AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br /> OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br /> PERFORMANCE Of CONSTRUCTION.THAT I AM AUTHORI2E0 BY THE <br /> OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br /> APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> PqRCEI.TRX I D NUMBER CONTRACTORS LAW 18.27 RC�V AND 296200 WAC. <br /> GONSTRUCTIO LOA ENDER.AOD SS,TELEPNONE NUM9Efl <br /> /�Z� _�� �'�r� �/�jT ' � � �-- /Z �� <br /> PROJECTADDRESS � smNs�n�� � oere � <br /> CIIV O1191N[55lILCN$f N'J <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM FEE NO. TYPE OF E�UIPMENT FEE <br /> WATER CLOSET(TOILET) AiC—A�HNDLG UNITS—H.P. ; <br /> BATHTUB ; FORCEU AIR SYSTEMS—B.T.U. M E.A. <br /> LAVATORV(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 ; 'NATER HEATER <br /> CLOTHES WASHER WOODSTOVE <br /> �� - - URINAL METAL FIREPLACE(WOOD BURNING) <br /> DRINKING FOUNTAIN FIREPLACE INSERT ; <br /> FLOOR DRAIN HEAT PUMP <br /> BACKFLOW PREVENTERS ; GAS PIPING <br /> ROOF DRAINS—RAINLEADERS � 3 EXHAUST FAN � <br /> SINK(SERVICE—BAR.ETCJ � <br /> � , <br /> � ; <br /> � ; <br /> SUB TOTAL 5 ; SUB TOTAL 5 <br /> PERMIT $ PERMIT $ I <br /> TOTAL FEE $ TOTAL FEE $ <br /> FOR OFFICE USE QNLY: <br /> FROMSETBALK flEANSETB�CH SIUESETBACK PLANCH[ NIIMg�i FEE REGEIPTNO. <br /> f f� <br /> usezorve LOTAREA VACANTSITE FEES VALUATION FEE <br /> �- <br />� � ! YES . � NO BUi�DMG I <br /> TYPE Of CON57 NO.OF STOR�ES p«uo�y�r uo w owuuncuxas — <br /> tnniv PLUMBING <br /> —r— <br /> SIZEOFBLDG. FIFESPRRlKLEFS(iE0'0 BASEMENT MECHANICAL 13� — <br /> i=. YES �.- NO — <br /> OCCUPANLV lOAO fIRE ALARM REOD NEIGNTLIMITAiION AD�IT�ONAL PLAN CMECK � <br /> OTHER � <br /> REASON —� <br /> STATE Bl11LDING SURCHARGE <br /> INiAKEBV PLANSAPPFOVEOBV CITYOFEVERETT PUBLICWOHK$ <br /> LOCAL SALES <br /> on,e TA%COUE IS 3105 rorn� I <br />