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APPLICATI�`�l FOR CONSTRUCT^�N PERMIT �, <br /> TO BE COMPLETED IN BLACK INK—PLEASE PRINT <br /> HEATING SYSTEM ❑GAS ❑ELECTRIC ❑ <br /> BUILDING DEPARTMENT <br /> 259-8810 �MECHANICAL ❑PLUMBING ❑ SIGN <br /> I ] DEMOLITION L� COMBINATION ❑ BUILDING ZP p„ONE <br /> IAAII ADORESS ��TM /� ^ — <br /> OWNEfl t�'1 ^ �('„IICVU "�SOV� 'LI - L <br /> N � A �a a T� CITY Zlp PNONE <br /> TENANT MAILAOORGSS <br /> ' CITY 21P PNONE <br /> ARCHITECTOROESIGNER MAILAUDRESS o,�F _ <br /> F� , 1 � � e ' �BcZ 7`�n K �, PHONE SiATELILENSE� <br /> CIiV 21P <br /> GENERAL NTRACTOR MAILADD •5 ICVUei � <br /> I .`J <br /> l��� , • Z�P PHONE y�_uy�'STATELICENSE+ — <br /> CITY <br /> MECNANICALCONTR CTOR MAILADORESS �� y�� � e Fb � 1 <br /> � _, � �I � � I PHONE STATELICENSE� <br /> PLUMBINGCONTflACTOfl MAllA00RE5S <br /> CITY Z�P <br /> CONTR�*ACT PRICE OF WO�R�K <br /> �N��'I�S�J�/� � CONTACT PERSON ANO PHONE NO: <br /> OESCPIBE WORN AND SOUARE FOOTAGE INVOLVED <br /> � 11'1. a IC 4�7 ' 0`7�G <br /> i - <br /> �1 Y � <br /> � F� �3 � E/4D5 I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br /> PROPOSEDUSEOF�UiI�ING APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT.ALL <br /> PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br /> LEG�L�ESCRIPTIONOFPROPERTY(SHOK'NBELOWORATTACHTWOLOPIES� NOT. THE GRANT�ING OF AD ERMITJDOESENOT PRIESUME TO GI�VE <br /> �ot s�ocK � ar AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br /> OTHER STAT':OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br /> S �j C7c�- ��`�� PERFORIv1ANCE OF CONSTRUCTION.THAT I AM AUTHORIZED BY THE <br /> OWNER OF 7HIS PROPERTY TO PERFORM THE WORK FOR WHICH <br /> aCj �(i�C�C^ APPLICATION IS MA�E AND I COMPLY WITH THE STATE <br /> PARCEI TAX 1.0.NUMBEfl CONTRACTORS LAW 1827 RCW AND 296.200 WAC. <br /> CONS UCTION LOAN LEN�R.AO�HESS.TELEPHONE NUMBER �j �ry 0 1 P o "1 , � �� r G~ <br /> � /�_ D�IE � <br /> SGNAiU1C '' <br /> PROJECTADDRESS — cirrausu+essucer+seNo <br /> tr MECHANICAL <br /> PLUMBING Np, TYPE OF E�UIPMENT FEE <br /> NO. TYPE OF FIXTURE OR ITEM FEE , <br /> WATER CLOSET(TOILET) � PJC—AIHNDLG UNITS—H.P. <br /> � FORCED AIR SYSTEMS—B.T.U. M E.A. <br /> BATHTUB � UNIT HEATERS—B.T.U. M ' <br /> LAVATOflY(WASH BASIN) ' ' <br /> � CLOTHES DRYERS � <br /> SHOWER � VENTILATIONFAN ' <br /> KITCHEN SINK B DISP � RANGE HOOD � <br /> DISHWASHER � WATEF HEATER <br /> IAUNDRY TRAY � WOOD STOVE � <br /> CLOTHES WASHER � METAI FIREPLACE(WOOD BURNING) ' <br /> URINAL � FIREPLACE I�SERT � ' <br /> DRINKING FOUNTAIN � ' <br /> , HEAT PUMP � <br /> FLOOR DRAIN � GAS PIPING <br /> BACKFLOW PREVENTERS � EXHAUSTFAN � <br /> ROOF DRAINS—RAINLEADERS � ' <br /> � <br /> SINK(SERVICE-3AR,ETCJ ' Q � <br /> � � <br /> � , <br /> , SUBTOTAL S � <br /> SUBTOTAL 5 pERMIT S � <br /> PERMIT 5 ' TOTALFEE 5 ' <br /> TOTALFEE 3 � � ' �� . I 7� <br /> � 5�� 4 <br /> FOR OFFICE USE ONLY: __ aeceirr r+o. <br /> SIOG:EIN4G: PtANCHECK ❑OER FE�� /'^S' /a <br /> FRONTSETBAGK REARSETOACK V `f / <br /> FEES VALUATION FEE <br /> LOTAREA VACANTSITE � <br /> USE20NE [] YES n N� pUIL�ING � - <br /> NO.OFSTORIES ou.vrusx no0vmtiluuauxn5 � <br /> lYPEOPtOK51. � r.awr pLUMBING � <br /> �N = 'e- ' <br /> , <br /> SIZE OF BLDG. FIPE SPPINKlEPS REOD CASEMENT �.�ECHANICAL � <br /> ❑ YES �NO ; <br /> - ADDITIONAL PLAN CHECK � <br /> FIREALARMPEO'D MEIGHTLIh11TAT10N �� <br /> OGCUPANCYIOAD � , � <br /> yCx, sn,ea ' <br /> nEa50r+ ,,/n �y� �,/^��,� STATE BUIL ING SURCHARGE ' <br /> /Y�J?T I/�!il�C�J� /v/si i.c� ' <br /> wrnKr:or ainNsnrreoveoov CITYOFEVERETT �uoucwonKs ' <br /> J/y) LOCAL SALES � <br /> TAX CODE IS 3105 TOTAL � <br /> onre j/,!/!1� f — - <br />