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APPLICATIC' 1 FOR CONSTRUCT" 1N PERMI�' �� <br /> TO BE COMPLETED IN BLACK INK—PLEASE PRINT <br /> BUILDING DEPARTMENT HEATING SYSTEM: ']GAS ❑ELECTRIC ❑ <br /> 259-8610 <br /> � DEMOLITION f] COMBINATION I i BUILDING C2 MECHANICAL L�PLUMBING " SIGN <br /> OW/4-Ep MAIL ADDRESS GTY 21P PNONE <br /> SU ,P �7' I�Dul�/v /-��..-/toi���y���SL��� `� <br /> TENANT Id0.1L ADORE55 dTY ZIP PNONE <br /> c -`r� <br /> AACHITECTORDESIGIEB MAILAD�RESS pTV 21P PHONE <br /> GEkERAL LONiRACTOR MAIL ADDiiESS pTY 21P PMONE STATE UCENSE' <br /> MECNANICAL CUNTRACTOR Mt.IL ADDRE55 CITV 21P PHONE STATE I�CENSE� <br /> FlU BIN CONTRACTOR MqILAUDAESE ITY IIP PHONE STA'ELICENSE� <br /> lin;-fj • �l+ � �76Z � /4/lt C G/ /3oT�r��i pL.Urri�!.L/6 ! �-F <br /> CUNTRA PRI pF W <br /> ��� <br /> � DESCRI� 1VORKANDSOURREFOOTAGEINVOLVE� CONTALTPERSONANOPNONENO. <br /> `� �� <br /> i HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br /> aaoPoseousepcspi�ING AppLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT.ALL <br /> �3�� �'—� PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE (!F <br /> . LEGA�OESCBIPTIONOFPROPEfliY�5N01YNBELOWORATfALHTWOCOPIES� WORK WILL BE COMPLEiED WITH WHETHER SPECIFiED HEREIN O� <br /> . iaT B��K oF NOT. THE GRANTING Of A PERMIT DOES NOT PRESUME TO GIV[ <br /> AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANV <br /> OTHER STATE OR LOCAL LAW AEGULATIN^u CONSTRUCTION OR THE <br /> PERFORMANCE OF CONSTRUCTION.THAT I AM AUTHO'�IZCD BY TH[ <br /> OWNER OF THIS PROPERTY TO PERFOfiM THE WORK FOF WIiICH <br /> rnace�rnzio.NUMeea APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> CONTRACT lAW 18.27 RCW AND 296.200 WAC. <br /> GONSTRUC710NLOANlENOEF.ADORESS.TELEPHONENUMBEP .�_� <br /> PRO ECT ADDRESS X �L — ��� <br /> / -7 smrveiune ouc <br /> /� / ,C��J l, cirreusn�rssuccr�scno <br /> PLU BING �— MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM FEE N0. TYPE OF EOUIPMENT FEE <br /> , WATER CLOSET(TOILET) � AiC—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 CLOTHESDRYfRS � ' �•1 <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 /> DRINKING FOUNTAIN ; FIREPLACE INSERT ' <br /> FLOOR DRAIN � HEAT PUMP , <br /> BACKFLOW PREVENTERS GAS PIPING � <br /> _ ROOF ORAINS—RAINLEADERS EXHAUST FAN , <br /> SINK(SERVICE—BAF,ETC.) , <br /> � � <br /> � � <br /> � <br /> SUB TOTAL $ / SUB TOTAL $ 1 <br /> PERMIT $ �O , PERMIT y <br /> TOTAL FEE S � TOTAL FEE S —~— <br /> FOR OFFICE USE ONLY: <br /> FRONTSETBRCK PEARSETBACR SIDESETBACK PLANCMECKNUMBER FEE flELEIPThO <br /> � J�CJ <br /> usezone �otnaEn VACANTSIIE FEES VALUATION FEE <br /> ❑ YES ❑ NO BUILDING <br /> TYPEOFCONSi. NO.OFSTORIES acu�<rtr hOMmttumGuxns <br /> �p��'� PLUMBING i <br /> SIZEOFBLDG. FlRESPRINNLERSREQ� BASEMENT MECHANICAL i � <br /> r_� ves ❑ No — <br /> OCCUPANCYLOAO FIREALAPMREOD NEIGHTIIMITATION ADDITIONALPLANCHECK � <br /> OTHER i <br /> REASON � <br /> STATE BUILOING SURCHARGE i <br /> '�NTANEBV PLANSFPPROVEDBV CITYOFEVERETT PUBLIGWORKS <br /> LOCAL SALES <br /> onre TAX COOE IS 3105 TOTAL <br />