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APPLICATIt�r�l FOR CONSTRUC7 �ON PERMIT <br /> TO BE COMPLETED IN BLACK INK—PLEASE PRINT �T <br /> HEATING SYSTEM: �GAS ❑ELECTRIC ❑ <br /> BUILDING DEPARTMENT <br /> 259-6810 <br /> L] DEMOLITION i-7 COMBINATION ❑ BUILDING i; MECHANICAL ❑ PLUMBING CI SIGN <br /> OWNE MAILADDPE55 re g�e� �T� ZIP FHONE — <br /> � ,��N // �/ �scs ��,��;;� x=�l .�S=-i5 �� <br /> TENANi MAIL ADDflESS CIN ZIP PHONE <br /> ARCHITECTORDESIGNER MAILADDRESS GITY ZIP PHONE <br /> GENERALCONTPACTOR ' MAILADDHE55 CITY ZIP PHONE STATEUCENSE� <br /> 7T� <br /> MECHANICALCONTflACTOH MAILADDRESS / CIN ZIP PHONE STATELI�F.NSE+1 p <br /> S'r'�ti1�ON �Itrl��+ do�D�7 -l7"=�./�✓/✓t` r��i�=j�L '924��3 �3=`�ci/O S�/A.1/�J�CS"/AC� <br /> PL11M81NGCONTRACTOfl MAILADDRE55 CITY 21P FHONE STATELICENSEI <br /> GLASS OF WOflK <br /> ❑ NEW f.l ADDITION I_I ALTERATION �RE?AIR L1 DEMOLITION f-1 WOODSTOVE/FRPLINSERT I I BUILDINGRELOCATION <br /> � � CONTACTPERSON���DI�NO. �� ����_ <br /> / � J <br /> CONTFACT PRICE OF WORK <br /> �DESCR WOfiKf NOSOUAREFOOTAGEINYOLVED <br /> � /Cii�' h'� l�t' �i`�iY�, <br /> PFOPOSE USEOFBUILDING I HEREBY CERTIFV THAT I HAVE READ AND EXAMINED 1�HIS ' <br /> - /tPPLICATION AND KNOW THE SAME TO BE TRUE AND CORFiECT.ALL <br /> LEGAL DESCRIPTIONOF PFOPERTV�SHOWN BELOW OR ATTACH FOUR COPIES) PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br /> � WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br /> � �or e�ocK oF NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br /> AUTHORITY TO VIOLATE OR CANGEL THE PROVISIONS 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 WORK FOR WHICH <br /> APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> CONTRACTORS LAW 7827 RCW AND 296200 WAC. <br /> i ^ <br /> x //�"�� �- %'/,�;^,� �'/-7� <br /> S�GNAtU�E D�tE <br /> PRQIECTADDRESS /�((]� /,`{��� (,J <br /> SS ���1� � \ V � �—/�"��� �RYBUSINESSIICCN5EN0. <br /> ' PLUMBING ` ' ' MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM FEE Nd. TVPE OF EOUIPMENT FEE <br /> � WATEH CLOSET(TOILET) � A/��/HNDLG UNITS—H.P. � <br /> BATHTUB ; FORCED AIR SYSTEMS—B.T.U. M t.A. ' <br /> LAVP.TORY(WASH BASIN) � UNIT HEATERS—B.T.U. M � <br /> SHOWER ' CLOTHES DFYEFlS � <br /> KITCHEN SINK 8 DISP ; VENTILATION FAN <br /> DISHWASHER � RANGE HOOD ; <br /> LAUNDRY TRAY ; WATEFl HEATER _� <br /> CLOTHES WASHER � VIOOD STOVE � _, <br /> URINAL ' METAL FIREPLACE&CHIMNEY _�_ <br /> DRINKING FOUNTAIN � fIREPLACE iNSEFT � _ <br /> FLOOH DRAIN � HEAT PUMP ' <br /> � BACKFLOW PREVENTERS ; GAS PIPING <br /> ROOF DRA�NS—RAINLEADERS � EXHAUST FAN ' <br /> SINK(SERVICE—BAR,ETC.� � � <br /> � <br /> � <br /> � � <br /> � <br /> � <br /> SUB TOTAL $ ; SUB TOTAI 5 <br /> � PERMIT $ � PEFMIT S � <br /> TOTAL FEE $ ' TOTAL FEE $ a ' <br /> FOR OFFICE USE ONLY: <br /> RECEIPT NO. <br /> FRONTSETBACN REARSETBACK SIDESETBACK PLANLHECK��9a FEE <br /> USE ZONE _�T AREA VACANT SITE FEES VALUATiON F'cE <br /> BUIIDING ' _ <br /> TYPEOfCONTS.ALLO�'IABIE TYPEOFC085CACiWL aCUPnNCr NOOFowFlux6UN�t5 � <br /> i <br /> enouv � PLUMBING w � <br /> SIZEOFBLO'v. NO,OFSTORIES BASEMENT MECHANICAL ✓�/ � UG� <br /> i <br /> ADDITIONAL PLAN CHECK � <br /> OCCUPANCYLOAD FIRESPRNKLEfl5RE0'D HEIGHTLIMITATION _ <br /> i <br /> SPRINKLER i <br /> REASON FOR SPRINKLEHS j <br /> STATE BUILDING SURCHARGE <br /> INiANEBV FLANSAPPROVEDBY CITYOFEVERETT PUBLICWORKS i <br /> LOCALSALES � <br /> TAX CODC IS 3105 TOTAL � <br />