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APPLICATIO`r' FOR CONSTRUCTI��N PERMIT � <br /> TO BE COMPLETED IN BLACK INK—PLEASE PRINT <br /> CHEATING SYSTEM: ❑GAS ❑ELECTRIC � — <br /> BUILDING DEPARTMENT <br /> 259-8810 <br /> ❑ DEMOLITION ❑ COMBINATiON ❑ BUILDING ❑MECHANICAL ;.e�lUM81NG C: SIGN <br /> � OWNER �AAILADDRESS CITV ZIP PNP�� <br /> G>d I�at��R i�,zz� .Fu,�R�77' y�o5 �ur�,eyr,FSN � .,� �So - � a a 7 <br /> TENANT IAAILADURE55 CITV ZIP P1N1�E <br /> .Si-0-M t� <br /> ARCHIiECTORDE5IGNEP IAAILADDRE55 CIN ZIP PHONE <br /> GENEBALGG':TRACTOR IAALLADDRESS CRV ZIP PHONE STATELICENSEa <br /> Ar��R cAHsi �i'aN�- �s�s-iaa 7 <br /> � MECHANICALCU'JTflAGTOR 61AILADORE55 CITV Z1P PHONE STATEUCENSEA <br /> PLUMBING CONTflACTOF MAIL AODRESS CITY T.1.' PMONE STATE LICENSE 1 <br /> FAv���`� ���uMGh�r ��vfr 7.�c�P.�ucTNw G,5/�a�P.,r�+ u��c �'8'�'as .26��8s�� F.ca.c�t7a �a� .p'✓ <br /> WHTRAGT PRICE OF WORN <br /> /O, Uoo r �v�.� �.�w c�77� 02�S - tlJ��� _ <br /> OESCRIBE WOqK AND SOUARE FOOTAGE INVOLVED LONTACT PERSON AND PHONE NO. <br /> I HERF.BI' CERTIFY THAT I HAVE READ AND EXAMINED THIS <br /> PROPOSEDUSEOFBUILDING APH�ICATION AND KNOW THE SAME TO BE TRUE AND CORRECT ALL <br /> PROVISIONS OF LAWS AND ORDINA�'CES GOVERNING THIS TYP� � ")F <br /> LEGALDESCRIPTIONOFPROPERTY�SHOWNBELOWORAiTACHTWOCCPIES) WORK WILL BL• COb:PLETED WITH WHETHER SPECIFIED HEFEIk JR <br /> NOT. THE GRANTItJG OF A PERMIT DOES NOT PRESUME TO ViVe <br /> �or e�ocK oF AUTHORITY TO VIVLATE OR CANCEL THE PROVISIONS OF ANY <br /> OTH[R STATE OR LOCAL LAW ReGULATING CONSTRUCTION OR THE <br /> PERFORMANCE OF CONSTRUCTION.THAT I AM AUTHOflIZED BY THE <br /> OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHIGH <br /> APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> PARLEL TAX I.D.NUMBER CONTRACTORS LAW 1827 RCW AND 296200 WAC. <br /> CONSTfll1CTION LOAN LENDER.A�DFlE55.TELEPHONE NUM6EF q,� <br /> �,t,�•�*ud ( - !3 —9 S� <br /> PROJECT ADDRESS s�c �'uaE oA�E <br /> yyoq F'.v�w.� u>,ay �vr�PrrT CIiYBU51NE55LILEN5EN0 <br /> PLUMBING MECHANICAL <br /> NO. TYPE OP FIXTURE OR ITEM FEE NO. TYPE OF EOUIPMENT FEE <br /> WATER CLOSET(TOILET) � FVC–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 I � <br /> SHOWER ' CLOTHES DRYERS ' <br /> . KITCHEN SINK 8 CISP � VENTILATION FAN � <br /> DISHWASHER � RANGE HOOD ' <br /> LAUNDRY TRAY ; WATFR HEATER � <br /> CLOTHES WASHEfl � WOODSTOVE ' <br /> / URINAL ; METAL FIREPLACE(WOOD 3URMP�) ' <br /> DRINKING FOUNTAIN � FIREPLACE INSERT __ _ � � _ <br /> � HEA'i PUMP ' <br /> FLOOR DRAIN - <br /> BACKFLOW PREVENTERS ; GAS PIPING _ � <br /> ROOF DRAINS–RAINLEADERS � EXHA�.;T FAN ' <br /> � <br /> SINK(SERVICE–BAR,ETC.) I _ _�— , <br /> � ' <br /> � ' <br /> � ; <br /> SUB TOTAL $ ; � SUB TOTAL 8 ; <br /> PEHMIT $ �O �� PERMIT $ � <br /> TOTAL FEE S � ' � TOTAL FEE S ' <br /> FOR OFFICE USE ONLY: <br /> FROIJT SETBACK REAfl SEiBACK SI�E SETBACK PLAN CHECH NUMBER FEE RECEIPT NO. <br /> �/ L 3 <br /> USEZONE LOTPREA VACANTSITE FEES VALUATION FET <br /> rJ YES ❑ NO BUILDING ' <br /> TYPEOFCONST. NO.OFSTORIES OCCUVAn[v NOC�awELLwGUNrtS �)�1 � �,} <br /> eaouP PLUMBING �V 7 � ��� <br /> �.—r— <br /> i <br /> SREOFOLOG. FIRESPflINI(LERSREO'D BASEMENT MECHANICAL � <br /> ❑ YES ❑ NO i <br /> ADDITIONAL PLAN CHECK � <br /> OCWPANCVLOAD FIqEALARMREO'0 NEIGHTLIMITATION i <br /> i <br /> OTHEFt i <br /> REASON � <br /> STATE BUILDINU'SURCHAFiGE � <br /> INTANE6Y PLANSAPPRCVEDBY ��TyOFEVERETT PUBLICWORKS � <br /> LOCALSALES � <br /> oqTE TAX CQ�L IS 3105 TOTAL � <br />