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APPLICATiC 1 FOR COPlSTRUCT"�N PERMIT � <br /> TQ BF COMPLETED IN E3LACK INK—PLEASE PRINT <br /> BUILDING DEPARTMENT HEATING SYSTEM: ❑GAS ❑ELECTRIC �] <br /> 259-8810 <br /> i7 DEMOLITION ❑ CqMBINATION C i BUILDi;JG ❑MECHANICAL ❑ PLUMBING :i SIGN <br /> o•�ien �.�aa nooa cin z�r rHorie <br /> ��.el'� ���S,�w � � a�i�o ����- �o� �' a3c -���9 <br /> � <br /> TEN�NT AAILAODRE55 / <br /> �m�� �Q /�� �/�� � �TJ�7��j ZIP PHONE <br /> ARCIIREC RDESIGNER IAAILAODRE55 CITV ZIP PHONE <br /> G�CONTR4CTOP ldAILAD�RE55 CITV ZIP PHGNE STATELICENSEP <br /> ���— <br /> MECHANICFL CONTP�CT R MAII A�DRESS CITV ZIP PHONE STATE UCEM1SE u <br /> PLUMBINGCONTR�CTOq �,IAILADDRESS CITV 21P PIIONE STATEUCENSEN <br /> GONTRACT PqICE OF WOFH <br /> DF.SCRIBE YlORK AND SOUARE FOOTAGE INVOLVED CONTACT PERSON AND PHONE NO. <br /> ((/� j��/'�- <br /> �� I HEREBY CERTIFY THA'i I HAVE READ AND EXAMINED THIS <br /> PRO?OSEDl15EOF�IIILDING APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT.ALL <br /> PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE JF <br /> LEGALOESCFIPTIONOFPROPEPTV�SHOWNBELOWORATT�CHTYfOCOPIES) WORK WIll6E COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br /> �or BLOCK oF NOT. THE GRANTING OF A F'EfiMIT DOES NOT PRESUME TO GIVE <br /> AUTHORITY TO VIOLATE OFi CANCFL THE PROVISIONS OF ANY <br /> _ OTHER STATE OR LOCAL LAW RECULATING CONSTRUCTION OR THE <br /> PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br /> OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br /> PARCELTA%I.D.NUMBER APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> CONTRACTORS lAW 1827 flCW AND 296.200 WFlC. <br /> CONSTRJCTION LOAN LEM1DER.ADORESS.TELEPHONE NUId�ER <br /> PROJECT ADDqESS sc�muai: / '-'�� � ��--��9� <br /> OAiC <br /> s�9 _ � .�e.F�. �,.���s,vEss�,�E�,�E�o <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXSURE OR ITEM FEE N0. TYPE OF E�UIPMENT FEE <br /> WATEfl CLOSET(TOILET) � A/C—NHNDLG UNITS—H.P. <br /> BATHTUB FOFCED AIR SYSTEMS—B.T.U. M E.A. � <br /> LAVATORY(WASH BASIN) � UNIT HEATERS—B.i:U. M <br /> SHOWEF CLOTHES DRYEFS , <br /> KITCHEN SINK&DISP - ; VENTILATION FAN <br /> DISHWASHER ---'— RANGE HOOD <br /> LAUNDRY TRAY ; WATER HE-ATER <br /> CLOTHES WASHER �- VJOOD STOVE ' <br /> URINAL METAL FIREPLACE(WOOD BURNING) � <br /> _ DRINKING FOUNTAIN FIflEPLACE INSERT 1 <br /> FLOOR DRAIN � HEAT PUMP , <br /> BACKFLOW PREVENTERS ' GAS PIPING � <br /> ROOF DRAINS—RAINLEADERS EXHAUST FAN ' <br /> SWI�(SFRVICE—BAR, ETC.) � � <br /> ' � <br /> � —— — <br /> � <br /> -i— <br /> SUB TOTAL S ; � SUB TOTAL S <br /> _ PERMIT S � /� PERMI7 S <br /> _ TOTAL FEE 5 ' TOTAL FEE $ � <br /> FOR OFFICE USE ONLY: <br /> FRONTSETBACK REARSETBACK SI�ESETBACK PLANCNECHNl161�[g PEE RECF TNO <br /> //.S'� 5c7. (RS � /d� <br /> usEz ' AREA VACANTSITE FEES VALUATION FEE <br /> �� _ �,�, , � ❑ YES �n pUILDING — �� � — <br /> iYPE0FC0'IST. NO.OFSTORIES o[[ucA1;tY u�.orp'�;FLUti6u!ai5 <br /> `po°P a�ur,toinc ' <br /> � <br /> SIZEOFBLOG. FIRESPqIhNIERSHEO'D BFSEMENi MECHANICAI <br /> ❑ YES ❑ NO <br /> OCCUPANCVLOAO FIREALAq61RWD NEI3HT�IldR�TION ADDITIONALPLANCHECK � <br /> � �C—UJ'� OTHER ' <br /> REASON <br /> i <br /> STATE BUILDING SUFCHARGE � <br /> INTAKE�V P�nr,snPaaoveoov � CITYOFEVERETT PUBLICWORKS i <br /> �M LOCALSALES � — <br /> DFTE 7 � ,�.�a]- TAX CODE IS 3105 TOTAL / � J <br />