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♦ <br /> 1 <br /> APPLICATIt.� FOR CONSTRlJC7 _JN pERMIT ���� <br /> TO BE COMPLETED IN BLACK INK—PLEASE PRINT <br /> HEATING SYSTEM: U GAS ❑ELECTRIC ❑ <br /> BUILDING DEPARTMENT <br /> 259-8610 <br /> ;I DEMOLITION CI COMBINATION ?X BUILDING � 1 MECHANICAL i l PL�JMBING i 1 SIGW <br /> OWNER MAILADDRE55 CI ZIP PHONE <br /> �(`A+a Ic Lu+� 2c� S�',t� ��c2�x� wv�y F�xa�d 9��� 2�-/- oi� � , <br /> TEN NT MFILAUDRESS J��n' ZIP PHONE <br /> C� l4�\ c Cu�2meT 5130 /63 z`�vicec,R�e••, 11�A �B.�C�� 2�2 — y9 ? 7 <br /> ARCHITEGTORUESIGNER MAILADDRE55 �F CITY V ZIP FHONE <br /> / l.�q��o�� �H-t � �- . S/3c� ��ex2s e�w 1�1a<< �d�2c�� WA 652-65'4/ <br /> �GEtIER ONTRACTOR MAILADDRESS LIiY � PHONE STATELI-ENS_,!� <br /> O' �• <br /> MECHANIt;ALCONTflACTOR MAILAUDRESS GITV 21P PHON STATELICENSEA <br /> PLUMBING CONTRACTOR MAIL AODBESS CI^/ ZIP PHONE STATE LICENSE a <br /> �!.�.cJ f—.�P <br /> CLASSOF WORK <br /> L 1 NEW I.. ADDITION i_! ALTEHATION I 1 REPAIR I I DEMOLITION I I WOODSTOVE/FRPL INSER'f i I BUILDING RELOCATION <br /> CONTACT PERSON ANO PHONE N7. <br /> CONTRACT PPILE OF WORN <br /> DESCRIBE WORK AI�D SOUAR[FOOTAGE INVCLVEU <br /> PflOPOSEDUSEOF wc I HEREBY CERTIFY THAT I HAVE READ ANII EXAMINED THIS <br /> _�i\ 'C�JT• APPLICATIO�AND KNOW THE SAME TO BE TRUE AND CORRECT.ALL <br /> �e ALOESCFIP710NOFPROPEPN�SHOWNBELOWORATfACHFOUHCOPIES) PROVISIONSOFLAWSANDORDINANCESGOVERNINGTHISTYPEOF <br /> WORK WILL BE COMPLETED WITF'WHETHER SPECIfIED HEREIN OR <br /> �oT BLOCN oF NOT. THE GRANTING OF A PERMIT DOES NOT PRESIi1,4�_ TO GIVE <br /> AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br /> OTHER STATE OR LOCAL LAW REGULATING CONSTI7UC1'ION OR THE <br /> PERFORMANCE OF CONSTRUCTION.THAT I AM AUTHORIZED BV THE <br /> OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br /> APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> CONTRACTORS LAW 18.27 RCW AND 296200 WAC. <br /> r� �� �i�. I � I�� <br /> P OJECT�p�BE55 Si MC . �AT� <br /> JI � ���� CITYfiU51N[SSLICENSENO �_ <br /> PLUMBIIJG MECHANICAL <br /> N0. TYPE OF FIXTURE OR ITEM FEE NO. TVPE OF E�UIi'�+AENT FEE <br /> W/\I ER CLOSET(TO�LET) � A/C—AIHNDLG UNITS—H.P. � <br /> BATHTUB ; FORCED AIR SYSTEMS—B.T.U. M E.4. ' <br /> LAVATORY(WASH BASIN) � UNIT HEATERS=6.T.U. M � <br /> SHOWER ' CIOTHES DRYERS <br /> KITCHEN SINK 8 DISP � VENTILATION FAN <br /> DISHWASHEfl � R4NGE HOOD ' <br /> . LAUNDRY TRAY ; WATER HEATER _ ' <br /> CLOTHES WASHER � WOOD STOVE � <br /> URINAL ' METAL FIqEPLACE&CHIMNEY ' <br /> DRINKING FOUNTAIN � FIREPLACE INSERT � <br /> FLOOR DRAIN HEAT PUMP ' <br /> BACKFLOW PREVENTEfiS ; GAS PIPING � <br /> —� <br /> ROOF DRAINS—RAINLEADERS EXHAUST FAN ' <br /> SINK(SERVICE—BAR,ETC.� �'/ �—' <br /> � ' <br /> -- � <br /> � <br /> � ; <br /> � T <br /> i <br /> � '?UBTOTAL $ /ci d SUBTOTAI $ ; <br /> PERMIT S �o � PERMIT $ � <br /> TUTAL FEE 5 , y '._ TOTAL FEE $ ' <br /> FOR OFFICE USE ONLY: <br /> FRONTSETBACK REARSETBACK SIDESETBACK PLANCHECKNUMBER FEE RECEIPTNO. <br /> _3�3 � <br /> USEZONE LOT\REA �ACANTSITE FEES VALUATION FEE <br /> BUILDING <br /> TYPEI!�CONiS.ALIOWABLE TYFEOfGONST.AC70.1L aG:uv�1¢v NOOiVAEIuhGUNrtS � <br /> �aa1P � PLUMBING � �/ �� <br /> i <br /> SIZE OF BLDG. NO.OF STORIES BASElAENT MECHANICAI � <br /> i <br /> OCLUPANCY LOAO FIRE SPRNNLEHS REO'D HEIGHT LIMITATION ADOITIONAL PLAN CHECK � <br /> i <br /> SPRINKLER � <br /> REASON FOR SPRINNLERS <br /> STATE BUILDING SURCHARGE � <br /> a- <br /> INiPNEBY PLANSAPPROVEOBY CITYOFEVERETT PUBLICWORKS i <br /> LOCAL SALES � <br /> TAX CODE IS 3105 TOTAL 3 y ; �e <br />