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APPLICATIC"�1 FOR CONSTR�ICT'�N PERMIT � <br /> TO BE COMPLETED IN BLACK INK—PLEASE PRINT <br /> HEATING SYSTEM: J GAS J ELECTRIC _I <br /> BUILDING DEPARTMENT <br /> 259-8870 <br /> DEMOUTION � COMBINATION i BUILDING �MECHANICAL ;-: PLUMBING i:l SIGN <br /> OWNER MAILFODPE55 GiY ZiP PHONE _(J . C�( <br /> L Na��" l�t D .�9 �/) ln/l�vnUrL .4 /� t! C1D1" ti/GflY� I✓.4 �-I�'o70<, - U-:/-�v- ' <br /> iErypryT'--� MARADORE55 GiV ZIP PNONE <br /> Lci .�—���.rlij 35�S C l h�/ A�ie r�/� r�/a�_�',7dc.. — <br /> ARGHITECTOFDES^N[' MPILADDRE55 CIT' ZIP P��ONE <br /> GENEFIALLONTRAGTOE MAILADDRE55 CRV ZIP PHONE STATELIGENSEY <br /> MECHANI�ALCONTPlu,TOP MFILADDRESS C'TV ZIP PNONE9�G'I��STATELIGENSEt <br /> ' � rc �cm� - , t" � . r. � � i <br /> LUMBING LONiPACTOR MAI ADDRESS LITV .iP PMONE STAtE UCENSE r <br /> CONTRAGT Pf110E OP WOHN <br /> DESGRIB�ORNANDSOUAREFOOTFGE OLVED GONTACT RSON NDPNjjN NO. � <br /> ` r� a - - <br /> a 35 1�cad,s <br />� I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br /> PHOPOSEDUSEOFBUILDIN6 APPLICATIUN AND KNOW THE SAME 70 BE TRUE AND CORRECT.ALL <br /> PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br /> IEGAUESCPi�710NOFPROPERTYISHOWN!IELOWORRTTACMTWOCOPIESI WORK WILL BC COMPLETED WITH VJHETHEfl SFECIFI[D HEflEIN OR <br /> NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br /> ior-- o�ocK ov AUTHORITY TO VIOLATE OR CANCEI_ THE PROVISIONS OF ANY <br /> OTHEfi STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br /> — PERFORAIANCE OF CONSTFUCiION. THAT I AM AUTHORIZED BY THE <br /> OWNER OF THIS PFOPERTY TO PERFORM THE WORK FOR WHICN <br /> APPLICATION IS MADE AND I COMPLV WITN THE STATE <br /> rnacei uK i o.n�uMeeR CONTRACTORS LAW 1827 RCW AND 296200 WAC. <br /> GGNSTRUCTIONLOAYLEN�ER.A��RESS.TELEPNONENUMBER r— � � /�� �� <br /> �� oa+c <br /> PROJECTADDRESS �^� '��� <br /> Ov �ss�� <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM FEE N0. TYPE OF EOUIPMENT FEE <br /> WATER CLOSET�TOILET� � _ A�C—A,HNDLG UNITS—H.P. � <br /> BATHTUB � FORCED AIR S'(STEMS—B.T.U. M E.A. _i_ <br /> LAVATORV(WASH BASIN) UNIT HE�TERS—B.T.U. M <br /> SHOWER ' CLOTHESDRYERS ' <br /> r VENTILATION FAN � <br /> KITCHEN SINK 8 DIuP —f— <br /> DISHWASHER � RANGE HOOD <br /> LAUNDRYTRAY ; WATER HEATER <br /> CLOTHES WASHER � WOOU STOVE <br /> URINAL � METAL FIREPLACE(WOOD BURNING) --� <br /> URINKING FOUNTAIN i FIREPLACE MSERT i <br /> FLOOR DRAIN � HEAT PUMP ' <br /> BACKFLOW PREVENTERS ; GAS PIPING . � <br /> T <br /> ROOF DRAINS—RAINLEADERS � EXHAUST FAN <br /> SINK�SERVICE—BAR.ETC.) I <br /> � <br /> � � <br /> SUB TOTAL $ ; SUB TOTAL S <br /> PERMIT $ �— PEFMIT S <br /> TOTAL FEE S TOTAL FEE $ <br /> FOR QFFICE USE ONLY: <br /> FRONTSEiBACH REAPSETBAGK SIOESETBALK PLANCME;MIjU1dBEF FEE. n�� RLCEIPTNO. <br /> s.l J �<d -.-, <br /> UE420NE LOTAflEA VACANiSITE FEES VALUATION FEE <br /> ❑ VES ❑ NO BUILDING ' <br /> iVPEOtCON51. NO.OFSTORiES Octo��btr uoarowfuiR6usrt5 � <br /> cao.�v PLUMBING <br /> SIZEOfBLUG. FIRESPRINKLERSREO'D BASEMENT �dECHANICAL � <br /> t-: YES �_: NO � <br /> pCCOPMILY LOAO FlRE AIAPM flEO� HEIGNT LIMITRTION AODITIONAL PIAN CHECK i_ <br /> _ � <br /> � <br /> OTNER � �_v � � � `>'� <br /> REASON <br /> S7ATE BUIL�ING SURCHARGE <br /> i <br /> INinREOY PLANSFP OVEOOY CITYOFEVERETT PUBLICWORKS <br /> d� LOCAISALES <br /> ppTE y ��� q�� TAX COUE IS 3105 TOTAL <br />