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APPLICATIQ'� FOFi CO STRUCT' 1N P ��� <br /> TO BE COMPLETED IN BLACK INK—PLEASE PRINT ��r <br /> HEATING SYSTEM: U GAS U ELECTRIC rJ I <br /> BUILDING DEPARTMENT <br /> 259-8810 <br /> "' DEMOUTION f i COMBINATION i BUILDING �MECHANICAL ❑PLUMBING ❑ SIGN <br /> OWNEF MFII ADORE55 CITY ZIP PNOtlE <br /> NiC� MAt� Lr� 3"'� li A'h f�v�IE _ ��ir�.,c -�iBDc�y �15(�-,���o� <br /> TENANT ' �, IAAILADDFE55 CITY 21P PMONE <br /> � � (� 1 <br /> � <br /> ARCNITECTORDESIGNEfl lAAILAUOPESS CITV ZIP PHONE <br /> P�5 i - 1� C � I 8� - 7J� Kr�� '�! � �� - <br /> GENERALC�NTRACTOR' IAAILADD S CITV ZIP PMONE STAiELICENSEa <br /> 5�L �. . � �J �CVU2� C'1 i . <br /> MECHFNICALLONTR CTOR MAILADDRL55 CIT1 ZIP PHONE ,yL_�.`,SiATELICENSEs — <br /> ' �1 /' -, '1 r�. �.�.%1 9 vc�c� .58 i -�f b � , � <br /> ' 1, �. - <br /> PW1dBINGCONT!IACTOR MAILADDFESS GIN ZIP PHONE STATELICENSEu <br /> CONTRACT PFICE OF WORN <br /> ��N. 7 [�9 . D <br /> DESCRIBE WOPH AND SOIIARE FOOTAGE INVOLVED CONTACT PEPSON AND PHONE N0. <br /> T n v < < im.' an�c1 �Il>>-fo�lCe 7 <br /> �'3 � �I UJ �% �"I' S3 H�PDS -� I II�DS � HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br /> PROPOSEDUSEOF6UILOING CA11� APPLICATION AND KNOW THE SAME TO BE TRUE AND COflRECT.ALL <br /> �� p 1 Y �1 ' v o PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br /> LEGALDESCPIPTIONOFPFOPERTV�SHOWNBELOWORAiTACHTWOCOPIES� WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEFEIN OR <br /> NOT. THE GRANTING OF A PERMIT DOES NOT PFESUME TO GIVE <br /> �or e�ocK oF AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br /> OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION Grl THE <br /> PERFORMANCE OF CONSTRUCTION.THAT I AM AUTHORIZED BY THE <br /> OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br /> APPLICATION IS MADE AND I COMPLY WITH THE BTATE <br /> PARCEL TA%I.D.NlIMBER CONTRACTORS LAW 18.27 RCW AND 296.200 WAC. <br /> CONSTRUGTION LOAN LEIJOER,A�DRESS,TELEPHONE NUM6ER <br /> LlSrb� x 1 -,rin , �� .-, > '7��1 �c,u <br /> vcnniuee oR'E <br /> PROJEO�DDRESS i - <br /> Z �� f �— S �r� _J � cmousmessucervser:o <br /> PLUMBING V MECHANICAL <br /> N0. TYPE OF FI%TURE OR ITEM FEE NO. TYPE OF E�UIPMENT FEE <br /> WATER CLOSET(TOILET) 1_ A/C—AIHNDLG UNITS—H.P. � <br /> BATHTUB ; FORCED AIR SYSTEMS—B.T.U. M E.A. ' <br /> LAVATORV(WASH BASIN) � UNIT HEATERS—B.T.U. M � <br /> SHOWER � CI.OTHES DRYERS � <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(WOOU BURNING) ' <br /> DRINKING FOUNTAIN � FIREPLACE INSERT � � <br /> FLOOR DRAIN � HEAT PUMP ' <br /> BACKFLOW PREVENTERS ; GAS PIPING � <br /> ROOF DRAINS—RAINLEADERS � EXHAUST FAN ' <br /> SINK(SERVICE—BAR,ETC.) � , <br /> � R <br /> � <br /> I SUB TOTAL $ ' <br /> SUB TOTAL S � ; <br /> PERMIT S � PERMIT S � <br /> TOTAL FEE 9 ' TOTAL F E 5 <br /> FOR OFFICE USE ONLY: � �� ��� <br /> FROIJTSETBACK REARSETBACK SIDESETBACK PLAN�JHECKt�JiJ¢1,BER _ FE�^ �` RECE��S�� <br /> �/. I V',/ �� � <br /> t�1 �d � <br /> USE20NE LOTAREA VACANTSITE FEES VALUATION FEE <br /> ❑ YES ❑ No BUILOING <br /> iYPEOFCONST. NO.OFSTORIES acuvnqCr i.oOfP:tiwvcUuitS ' <br /> � � �aouv PLUtABIN� � <br /> � �� <br /> SIZEOFBLDG. FIFESPRINKIEflSREO� BASEMENT MECHANICAL � <br /> y�� � YES No 3 :�s <br /> OCCUPANCYLOAD FIREA�ARIAFEOD HEIGHTLIMITATION ADDITIONALPLANCHECK <br /> Y{� 1 � ,20 <br /> L'�9 OTHEP ,��1 )I. � I� � ' <br /> f1EA50N � <br /> tirxi /A///�j—�[�J� �����- STATE BUILDING SURCHARGE � <br /> niv� �cr�rTi � <br /> INTNKE�Y PIANSAPPROVEDBV CITYOFEVERETT PUBLICWORK$ � <br /> �fM LOCALSALES T <br /> DATE g ,� � - TAX CODE IS 3105 TOTAL ; <br />