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APPLICATIQ � 1 FOR CONSTRUCT' 1N PEROVIiT j,� <br /> TO BE COMPLETED IN BLACK INK—FLEASE PRINT �� <br /> HEATING SYSTEM: i,]GAS ❑ELECTRIC U <br /> BUILDING DEPARTMEWT - -� <br /> 259•8810 <br /> i : DEMOLITION ��COMBINATION I ! BUILDING ❑ MECHANICAL ❑PLUMBING SIGM <br /> OWNER IAAILADORESS GITV 21P PMONE <br /> �,SiF'oit7i�L,/f�er Qo��ox �z�> ��z,rr/- g�szo� z.s�-v.��-� <br /> iE� IA4ILAODPESS GITY ZIP PHONc' <br /> �r.Au�y �S/�D/' C'i/i�= S�C'oiao.h� <br /> FRL/HJIiECTORDESIGNER MA'.LAODRE55 /C�Ii�Y� 21P �µ PI/CNE <br /> fcl.V/_-D/-2/_ ['O �/•-�!_ ol�CJUTI..'�r„ <br /> GENER/ALCONTRACTOB MAILADDRESS GITV ZIP PHONE STATELICENSEO <br /> �y��ilr•L�f�L./q/Z% <br /> MECNANICAL C011TPA i0F MAI!.RD�RES$ dTV Zlp PNONE STATF.LICENSE tl <br /> PLUMOINGCONTRAGTON MAILADDRESS ��n' 21P PNONE ST�TELICENSEI <br /> CONTRACL PRIGE OF WORN <br /> � I $ OBO <br /> DESCRIBE WORK AND SOUARE fOOiAG[INVOIVED CONT T VERSON 4Nf]PHONE NO. <br /> 1=:.�,.s�� itoo�h �o� b2a�-�-y s(to � �/wr�� .?s y �Y�s;� <br /> i HEREBY CERTIFV THAT I HAVE READ AND EXAMINED THI� <br /> PROPOSED USEOf B1/1101NG APPLICATION AND KNOW THE SAME 10 BE TRUE AND CORPECT. ALL <br /> �/�/�j,-� S/�OP PROVISIONS OF LAWS AND ORDINANCES GOVERNING I H15 TYPE OF <br /> LECALUESCflIPTIONOFPROPEFTV�SHONTlBELOWORRTTALMTWOLOPIES� WORK WILL BE COMPLE7ED WITH WHETHER SFcCIFIED H[REItJ O� <br /> NOT. THE GRANTING OF A PERMIT DOES Nf i PRESUME TO GIV� <br /> iot o�ocK oF AUTHORITY TO VIOIATE OR CANCEL TH= PROVISIONS OF ANY <br /> OTHER STATE OR LOCAL LAW REGULATIN�CONSTRUCTIO�UR TH[ <br /> — PERFORMANCE OF CONSTHUCTION.THAT I AM AUTHORIZEJ BY TH[ <br /> OWNER OF THIS PROPERTV TO PERFJRM THE WORK FOR WHICH <br /> APPLICATION IS MADE AND I .:OMPLV WITH THE Sir1T[ <br /> Pnace�inx i o,Hun+aea CONTRACTORS LAW 7827 RCW ANO 296200 WAC <br /> CONSTRUQ�ONL04NLENDER,AD�RESS.TfLEPNONENUMBEp <br /> x C��'„�.� .�/�s�ll � —� y � _ <br /> PROJECT ADD-7IiFS3 / G soauwr+c --m�c <br /> /� � ,f�J� (�U��/ � r.nrm;siNr;r�.uc�rvsevo - <br /> PLUMBING MECHANICAL <br /> N0. TYPE OF FIXTURE OR IiEM FEE NO. TYPE OF EOUIPMENT FEE <br /> WATER CLOSET(TOILET) A'C—ArHNDLG UNITS—H.P. <br /> BATHTUB ; FORCED AIR SYSTEMS—B.T.U. M E.A. <br /> LAVATORY(WASH EASItJ) UNIT HEATERS—B.T.U. M <br /> —� <br /> SHOWER ' CLOTHES DRYERS � <br /> KITCHEN SINK 8 DISP � ��ENTILATION P�N ; <br /> DISHWASHER RANGE HOOD <br /> LAUNDRYTRAY WATER HEATER ; <br /> � CL(1THE5 WASHER WOOD STOVE i <br /> UFINAL METAL FIREPLACE(WOOD BURNING) � <br /> DRINKING FOUNTAIN � FIREPLACE INSER' <br /> FLOOR DRAIN HEAT PUMP <br /> BACKFLOW PREVENTERS ; GAS PIPING ; <br /> ROOF DRAINS—RAINLEADERS EXHAUST FAN <br /> SINK�SERVICE--BAR,ETC.� ; ' <br /> �— � <br /> — — — � � <br /> — ' —T-- <br /> SUB TOTAL 5 SUB TOTAL 5 ' <br /> PERMIT S PERMIT $ <br /> TOTAL FEE $ TOTAL FEE S � <br /> FOR OFFICE USE ONLY: <br /> FPONT SETBAGN REAti SETpACK SiOG 5[T�ACK PLANC��UMBER O f�� n ��l HE(/�py� /�� <br /> 3 � � �`� <br /> USEZONE LOTAREA VACnNT51TL FEC-S VALUATION FEE <br /> �. I YES '—' NV BUILDINO �.�S �(�j � _ .��� <br /> t1PE0FCONSi NO.OFSTO @S or:una�cr �„o�ewn�n�eun�.x —}-- � <br /> � — I �� � '�T'I. �j� I � PLUMBING �_ <br /> � • <br /> SIZEO�]F�L�G FIRESPRINK�ERSFEOU �ASEIdE1JT �� MECHANICAL � <br /> �I"I�L I�I. �-'i xYES `1 NO �— <br /> ADDITIONAL PLAN CHECH ' <br /> OCCUPANGYIOAU FIRERLARIdRWD HEIGHTIIMITATION i <br /> 2Z y�j ' <br /> OTHER � <br /> PE450N /� �— <br /> �j�(J��J�,.E�i rj S7ATE BUILDING SUHCHARGE ''CD <br /> INiFNEBV PLANSAPPPOVEDBY CIiYOFEVERETT PUBLICWORKS <br /> LOCAL SALES —/f �—/ <br /> ppT� y '�� TAX CODE IS 3105 TOTAL Y', i /�5 <br /> 6, �. p �c <br />