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APPLICATIO�► FOR CONSTRUCT4�N PERMIT � <br /> TO BE COMPLETED IN BLACK INK—PLEASE PRINT <br /> HEATING SYSTEM: U GAS ❑ELECTRIC ❑ <br /> BUILDING DEPARTMENT <br /> 259•8810 <br /> ❑ DEMOLITION ❑ COMBINATION ❑ BUILDING MECHANICAP oNE ❑PLUMBING ❑ SIGN <br /> OWNEH A7AILAODRESS CITY 21P <br /> G'�� �f►'e 1o/Zl ��rsF�e�✓ E�e��'t7- Wn 98�ay r <br /> CITV ��{ PHONE <br /> TE�J� n MPIL AUORES /� 'V ,�� // ^� ' /� _ jJ � <br /> -'j� n �l S /la� e � �/ �J�.,�-r y cU� .r / .S <br /> � � rC^ � S CI7V ZIP PHONE <br /> ARCH ECTORDGSIGNER MFILADORE55 <br /> CITY ZIP PHONE STATE LICENSE N <br /> GENERALCONTRACTOF MAILADDRESS �/,5.�0� y�f,�i �,1�3�Y� <br /> �a66 L'o„s 30/6 OYEl1/���/e� su.:� ��a se��f/ �� 5gras 1�6�1 <br /> PHONE STATE UCEN E �{. . <br /> MECHANICAICONTRACTOR MAILAL`DRESS ��TM �� •���/R/l� �/���Z� 1-� � �� r\ ���m <br /> ,ie cti e F E�4 i33aoa f� 30v1 l8�//�„ �lw/ � <br /> PLUMBINGCONTRACTOR MAILA�ORE55 <br /> GTY ZIP PHONE STATE LICENSE a <br /> CONTRACTPRIGEOFWORK �/ � L O' �`�-�•J— <br /> J �i`i S <br /> CONT�CTPERSONANDPHONENO.�%_m 2e�n �G�/ VI(�/��Iz/ <br /> DESCRIBEWORKANOSO AREFOOTAGEINVOLVEO (i� � i <br /> �� J`' � /� �r� 30� <br /> ,Q����'G�P��p� �.,p� iv�—S i HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br /> vi <br /> PflOPO5EDU5EOF BUIL�G �/ APPLICATION AND KNOW THE SAME TO BE TRUE AND COFRECT.A <br /> �CS�" ��r�� p� /� � PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br /> IEGFlOESCflIPTIONOFPROPERTY(SHOWNOELOWORATTACHTWOCOPIES) WORK WILL BE COMPLETED WITH WHETHER SPECIFIEO HEREIN OR <br /> NOT. THE GRANTING OF A PERMIT DOES NOT PAESUME TO GIVE <br /> �or e�ocK oF AUTHORITY 70 VIOLATE OR CANCEL 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 FROPERTY TO PERFORM THE WORK FOR WHICH <br /> � APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> anRce�rnx i.o.NUMeea - CONTRACTORS LAW 18.27 RCW A�D 296.200 WAC. <br /> � ^ <br /> CONSTRUCTIONLOANLENDER.AODRESS,TELEPHONENUMBEH '/ � ���� <br /> SiGNni � E <br /> PROJECT ADDRESS LItV BIISINE55 LICENSE N0. <br /> PLUMBING MECHANICAL <br /> N0. TYPE OF FI%TURE OR ITEM <br /> FEE NO. TYPE OF EOUIPMENT FEE <br /> WATER CLOSET(TOIL�T) i A/C—AIHNDLG UNITS—H.P. ' <br /> � FORCED AIR SYSTEMS—B.T.U. M E.A. ' <br /> BATHTUB ; ; <br /> LAVATORY(WFSH BASIN) � UNIT HEATERS—B.T.U. M �— <br /> � CLOTHESDRYERS � <br /> SHOWER , ; <br /> KITCHEN SINK&DISP � VENTILATION FAN <br /> . DISHWASHER � RANGE HOOD ' <br /> LAUNDRYTRAY ; WATERHEATER � <br /> , VJOOD STOVE ' <br /> CLOTHES WASHER �� <br /> � METAL FIREPLACE(WOOD BURNING) ' <br /> URINAL ; ; <br /> DRINKING FOUNTAIN FIREPLACE INSERT <br /> � HEAT PUMP � <br /> FLOOR DRAIN GAS PIPING ' <br /> BACKFLOW PFEVENTERS � EXHAUSTFAN � <br /> ROOF DRAINS—RAINLEADERS ' � <br /> -SINK(SERVICE—BAR,ETC.) � ; <br /> � <br /> _ � <br /> , � <br /> i � <br /> � <br /> SUB TOTAL $ ' SUB TOTAL $ � <br /> P[RMIT S � PERMIT S ' <br /> � TOTAL FEE $ TOTAL FEE S ' <br /> FOR OFFICE USE ONLY: aeceiar ruo. <br /> PLAN CHECK NUldBER FEE <br /> FFONTSETDACK REARSETBAGK SIDESETBACK �/��� <br /> LOTAREA Vf.CANTSITE FEES <br /> VALUATION FEE <br /> USEIONE <br /> ❑ YES ❑ N� BUIL�ING � - <br /> i <br /> ttPE0FC0115i. ND.OFSTORIES accuvu�[r r�0.0icwEuixGUxnS i <br /> c^WP PLUMBWG ' <br /> �--•— <br /> � i <br /> SIZEOF9LDG. FIRESPRINKLEPSFEO'D BASER7ENT lAECHANICAL <br /> p YES ❑ NO � � <br /> ADDITIONAL PLAN CHECK <br /> OCCUPANCV LOFD FIflE ALARlA REO'D HEIGMT LIAIITATION � <br /> i <br /> OTHER �— <br /> REASON I <br /> - STATE BUILOING SURCHARGE ' — <br /> i <br /> i <br /> INTAKEBV PL�NS �`OF1Y CITYOFEVERETT PUBLICWORKS � <br /> LOCALSALES <br /> ATE ,(�_R_ q�j TAX CODE IS 3105 TOTAL <br />