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APPLICATIO_ . FOR CONSTRUC�nN PERMIT � <br /> TO BE COMPLE7ED IN BLACK INK—PLEASE PRINT <br /> HEATING S'YSTEM: �AS U ELECTRIC U <br /> BUILDING DEPARTMENT <br /> 259-8810 <br /> ❑ DEMOLITION � COMBINATION ❑ BUILDING �LN�ECHANICAL ❑PLUMBING ❑ SIGN <br /> <�O NEF MAILADDRE55 CITY ZIP HDNE <br /> p �.�-I i.�.�� `l�,LZ., �'1 Grm A .��n - I ,F�" S�- �E. .� ) 9S��x��l <br /> TENANT ` W1(��AD�RESS /' CIN I 21P PHONE <br /> CT(�'1 �� 1�'ll` 11Z7� r '�f(<'U <br /> ARCHRECTOflDESIGNEfl IAAILADDRE55 CITV ZIP PHONE <br /> GENERALCONTRACTOR MAILADDRE55 CITY ZIP PHONE STATELICENSEn <br /> i�az N � C�.,.;�, � ., 1305 S C���a.� ��.�� _ bso - izz� <br /> MECHANICALCO�ITP.4C'OF MAILA��RES CITV 1 A ZIP PNCNE Sil1TELICEYSEA <br /> ��naR V� 7�n� � .� 7sm z�z C��m��c� l�(� y� 67z-iowY �Cl�'3 v�AN1C08r�AG <br /> PLUMBINGCONTflACTOR MAILAD�RESS S"� CITV ZIP PHUNE STATELICENSE� <br /> CONTflACT PRICE OF WORK <br /> — •� <br /> UESCflIBE ORK PNOSOUAREFOOTAG�fNVOLVEU C TPERS N PHON NQ � <br /> 'P.,.� cJoc wo c {�'c;�n n � � > > !" 1 �,.. �S GIZ -/UQ�( <br /> �N7 �'�) �L �b��/� �I.�< 7h,...� <br /> i <br /> 't'ifti r i'n- � h � i HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br /> pao SEO USE 'BUILOINc, APPLICATION AND KNOW THE SAME TO 8E TRUE AND CORRECT.ALL <br /> E. ' � � ,,.�}' PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br /> LEGALUESCRIPTIONOFPROPEflTV�SHOWNBELOWORATfACHTWOCOPIES� WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br /> NOT. THE GRANTING OF A PERMIT�DOES NOT PRESUME TO GIVE <br /> �ot BLOCK oF AUTHORITY TO VIOLATE OR CANCEL THE PROV�SIONS OF ANY <br /> OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br /> � PERFORMANCE OF CONSTRUCTION.THAT I AM AUTHORIZED BY THE <br /> OWNER OF THIS PROPERTY TO PERFORM THE WOFK FOR WHICH <br /> APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> PARCEL TA%I.D.NUMDEP CONTiiACTORS LAW 1827 RCW AND 296.200 WAC. <br /> CONSTRUCTIONLOANLENDER,ADDRESS.TELEPHONENUMBER �/ I <br /> U / <br /> ,� ,.,�I, a�v�-�� 7—R^4Y <br /> PROJECT DRESS S�GNF UPE o�TE <br /> �� LILY BUSME55 LICENSE M1'0. <br /> PLUMB G MECHANICAL <br /> � N0. TYPE OF FIXTURE OR ITEM FEE NO. TYPE OF E�UIPMENT FEE <br /> WATER CLOSET(��i01LET) A/C—A/HNDLG UNITS—H.P. � <br /> BATHTUB ; FORCED AIR SYSTEMS—B.T.U. M E.A. ' <br /> LAVATORY(WA:,H BASIN) � UNIT HEATERS—f3.T.U. M � <br /> SHOWER � CLOT'riES DRYERS ' <br /> KITCHEN SINK 8 DISP VENTILATION FRN � , <br /> DISHWASHEfl � RANGE HOOD ' <br /> LAUNDRY TRAY ; WATER HEATER ' <br /> CLOTHES WASHER � WOOD STOVE � <br /> � URINAL ; METAL FIREPLACE(WOOU BURNING) ' <br /> �� DRINKING FOUNTAIN I FIREPLACE INSERT � <br /> � FLOOR ORAIN � HEAT PUMP ' <br /> BACKFLOW PREVENTERS i GAS PIPING � <br /> ROOF DRAINS—RAINLEADERS � EXHAUSI'PAW � <br /> SINK(SERVICE—BAR,ETC.) � � <br /> � ' <br /> — � ' <br /> � <br /> � <br /> — � � <br /> SUB TOTAL $ ; SUB TOTAL S ; <br /> PERMIT $ � PERMIT $ � <br /> TOTALFEE $ ' TOTALFEE $ ' <br /> FOR OFFICE USE ONLY: <br /> FRONiSETBACK REAfiSETBACK SIDEuET�ACK PLANCHECKNUMBEH FEE RECEIPTNO. <br /> USE20NE LOTAREA VACANTSITE FEES VALUATION FEE <br /> ❑ YES ❑ NO BUILDING ' <br /> TYPEOFCONST. NO.OFSiOfilES ocCUCN�tY NOafOMIIMGuurtS i <br /> �AM'P PWMBING i <br /> --r <br /> 52E OF BLOG. FIRE SPRINKLERS HEU'D BASEMENT MECHANICAL � <br /> ❑ YES ❑ NO � <br /> OCCUPANCY LOAO FIqE ALARM MEO'D MEIGHi LIMITATION ADDITIONAL PLAN CHECK i _ <br /> i <br /> OTI'=R i <br /> T <br /> REASON � <br /> ' STATE BUILOING SURCHARGE � <br /> INTAKEBV PLANSAPPPOVEDBY C?TYOFEVERETT PUBLIGWOHKS i ' <br /> LOCALSALES � <br /> DATE TAX CODE IS 3105 TOTAL i <br />