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4�7 <br /> APPLICATIC�i FQR CQNSTR�J�:T�1N PERMIT � <br /> TO BE COMPLETED IN BLACK INK—PLEASE PRINT <br /> HEATING SYSTEM: ❑GAS ❑ ELECTRIC ❑ � <br /> BUILDING DEPARTMENT <br /> 259-8810 <br /> C] DEMOLITION ❑ COMBINATION CI BUILDING ❑ MECHANICAL ❑PLUMBING Cl SIGN <br /> OWt:EH MAIL ADDRE55 QTV ZIP PHONE <br /> Ml� .B .�,P -3�?o-/�2��,.A✓�. �/� sti;�� s%� r�.�/4��« � ���� <br /> iENANT MAILADDRE55 CITY ZIP PNONE <br /> �i � A R;��/s Lli�l�m���c� S�l.?3 Cl/lrnrcch tn/�.i - Ev<rc /1'i !,/fl. <br /> ARCHITECTOROE6IGNER MAILADDFE55 CITY ZIP � PMONE <br /> GENERALCONTRACTOR MAILAD09E55 CITY ZIP PNONE SiATELIGENSE• <br /> MECHANICALCONTRACTOR MAILADDR[55 CITY ZIP PHONE STATELICENSE• <br /> SM��'h ��c Siit�� y.�! q S„ Ur�l1�r�( %�i,�,,,�� u//�- 9�v�� /U�3-�s��_ <br /> PIUMBING CONTRACTOR All ADDPESS CITV 21P PHONE TATE LICENSE n � <br /> r D . <br /> CONTRACT PRICE OF WORK <br /> UESCRIBE WORK AND SOUARE FOOTAGE INVOLV�D CONiACT PEHSON AND PNO NO. <br /> �fC � � e <br /> i HEREBY CERTIFY THAT I HnVE READ AND EXAMINED THIS <br /> PROPOSEO USE OF BUILDING APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT.ALL <br /> PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br /> IEG�IDESCRIPTIONOFPROPERTY�SHOWNBELOWORATfACHTWOCOPIES) WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OF <br /> �or BLOCK oc NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br /> AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br /> OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br /> PERFOR�7ANCE OF CONSTRUCTION.THAT I AM AUTHORIZED BY THE <br /> OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br /> APPLIGATION IS MADE AND I COMPLY WITH THE STATE <br /> PARCEL TA%I.D.NUMBER CONTRACTORS LAW 18.27 RCW AND 296.200 WAC. <br /> CONSiRUCT10N LOAN LENOEP,AOORE55.TELEPHONE NUMBER I <br /> � � I 1 <br /> PROJECT ADD 8S s ""'u"' o"'E <br /> CItV9U ESSULFNSENO <br /> PLUMBING M ANICAL <br /> • N0. TYPE OF FIXTU OR ITEM FEE NO. TVPE OF E�UIPMENT FEE <br /> WATER CLOSET(TOILET) � AIC—NHNDLG UNITS—H.P. � <br /> BATHTUB ; FORCED AIR SYSTEMS—B.T.U. M E.A. ' <br /> LAVATORY(WASH BASIN) � UNIT HEATERS—B.T.U. M � <br /> SHOWER ' CLOTHESDRYERS � <br /> KITCHEN SINK 8 DISP � VENTILATION FAN ; <br /> DISHWASHER � RANGE HOOD � <br /> LAUNDRY TFAY ; WATER HEATER <br /> CLOTHES WASHER � WOODSTOVE � <br /> URINAL ; METAL FIREPLACE(WOOD BURNING) ' <br /> DRINKING FOUNTAIN I FIREPLACE INSERT - � <br /> FLOOR DRAIN � HEAT PUMP <br /> BACKFLOW PREVENTERS ; GAS PIPING � <br /> ROOF DRAINS—RAINLEADERS � EXHAUST FAN � <br /> SINK(SERVICE—BAR,ETC.) � � <br /> _ , <br /> � <br /> � � <br /> SUB TOTAL $ ; SUB TOTAL 5 ; <br /> PERMIT $ � PERMIT 5 � <br /> TOTAL FEE S ; TOTAL FEE 5 ' <br /> FOR OFFICE USE ONLY: <br /> FNONT SETBACN REAR SETBACK SIDE SETBACN PLAN HECN NUMBE FEE AECEIPT NO. <br /> usezoNe LOTAPEA �ACANTSITE FEES VALUATION FEE <br /> � � � ❑ YE5 ❑ N� OUILDING � <br /> IYPE Of CONSi. NO.OF STORIES ot[uD�.N[r x0 M V�v[um'6uHu5 i <br /> j]„ � �9�Z �+ ' PLUMOING i <br /> -r�� <br /> SIZEOFBLDG. FIRESPRIqKL[RSREO'� BASEMENT MECHANICAL � <br /> Y�j.!j u YES ❑ NO � <br /> OCCUPANLYLOAD FIREALAR�JI�.yIREOD HEIGNTLIMITATION A�DITIONALPLANCHECK i <br /> Y(�7 OTHER ' <br /> REASON <br /> NM�fj STATE BUILDING SUFICHARGE i <br /> r• � , <br /> INTAHE�Y PLANSAPPROVEDBY CITYOFEVERETT PU�LICWOAKS <br /> (IM LOCAL SALES <br /> onr� �`1 �� TAX CODE IS 3105 TOTAL <br />