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APPl.ICATI(^�1 r01� CONSTRlJ�7`17N PERMIT � <br /> TO BE COMPLETED IN BLACK INK—PLEASE PRINT <br /> BUILDING DEPARTMENT HEATIN�SYSTEM: ❑GAS G ELECTRIC ❑ � <br /> 259-8810 <br /> D DEMOLITION 1=J COMBINATION ❑ BUILDING ;r�FAECHANICAL ❑ PLUMBING ❑ SIGN <br /> OWNER tdqILAODRES$ CITY ZIP PNONE <br /> S P/�'lER �,f�vF,�Tics' q/5 / � � ' '�LS'�i,�c GL'�i4 - <br /> TENANT �MAIL A�09 SS CITY ZIP PHONE� <br /> n���'��/- �rfri�r�c.C`S. /��r'/��A�� ����� �'✓v��r�r., ��r/%1j awe��'7f; l�/F <br /> ARCHITECT OR DESIGNEfl AIL ADDRE55 CITV ZIP y PHOHE <br /> GENERAL CONTRAC.OR MAIL A��RESS f.l7V ZIP PHO�JE STATE LICENSC N <br /> '7Cb'�S' �.iCJf�i�C/il�f/ C�%'. �N� • �'�' /` 5'� �ii.�2./E<r �iri/�� /`v0�'r'�lc-lf ?v/-s�S�r.o� <br /> MFCHANICALCONiRACTOB MAI AO�RE55 CI Y ZIP PHONE � STATE CENSE�-��� <br /> �a c�'�`,sl.r%� �r�T.dG � �' 7�� � J', /f��r� �2� �" l. �Q����j-�.,�'� �'c�ra/fi#�/5�,f j. <br /> PLUMBINGCOhfRACTOR MAILADDRE55 CITY IIP HONE STATELIGE SEp <br /> CONTRACT PRICE OF WORH� � �C . i <br /> � <br /> DESf,R E WOFi�(AND SOUAqE F ipGE IN OIVED � ��! CONTACT PE O�NtAND PHUNE NO. I z�,�._ � r%—`JS�S� <br /> J C <br /> l� .1 � r . A � C) <br /> �'" ��`_��F ���� r ' � HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br /> PROPOSED USE OF rILOING APPLICATIGN AND KNOW THE SAME TO BE TRUE AND CORRECT.ALL <br /> �4 PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TVPE OF <br /> LEGAIDESGRIPTIONOfPROPERTY�SHOWNBELOWORATTACHTWOCOPIE51 WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br /> NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br /> �oi BLOCK oF AUTHORITY TO VIOLATE OR CANCEL THE F'ROVISIONS OF ANY <br /> OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br /> PERFOFMANCE OF CONSTRUCTION.THAT I P.M AUTHORIZED BY THE <br /> OWNER OF THI� PROPERTY TO PERFORM THE WORK FOR WHICH <br /> PARCELTAXI.D.Nl1M0ER APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> CONTP.ACTO 5 LAW 827 RCW AND 296.200 WAC. <br /> CONSTRl1CilON LOAN LEN�EP.ADDRE55.TELEPHONE NUMBER <br /> Pf10JECT ADDRESS � unrur,e� o�—Z���p <br /> arv oesir+ess i¢ervse Ho. <br /> PLUMBING MECHANICAL <br /> N0. TYPE OF FI%TURE OR ITEM FEE NO. TYPE OF EQUIPMENT FEE <br /> WATER CLOSET(TOILET) � A';—A�HNDLG UNITS—H.P. I <br /> . BATHiUB ; FORCEDAIRSYSTEMS—B.T.U. M E.A. � <br /> LAVATORY(WASH BASIN) UNIT HEATERS—B.T.U. M ; <br /> . SHOWER � CLOTHES DRYERS � <br /> KITCH'cN SINK&DISP � � VENTILATION FAN ; <br /> DISHWASHER RANGE HOOD � <br /> LAUNDRY TRAY ; WATER HEATER ' <br /> CLOTHES WASHER � WOODSTOVE � <br /> URINAL ; METAL FIREPLACE(WOOD BURNING) � <br /> DRINKING FOUNTAIN � FIREPLACE INSERT ; <br /> FLOOR DRAIN � HEAT PUMP —� <br /> BACf:FLOW PFEVENTERS ; GAS PIPING ; <br /> ROOF DRAINS—RAINLEADERS � EXHAUST FAN � <br /> SINK(SERVICE—BAR,ETC.) ; ' <br /> � <br /> _ i � <br /> SUBTOTAL S ; SUB70TAL 5 ? ; <br /> F'ERMIT S � PERMIT S �� <br /> TOTAL FEE 5 ; TOTAL FEE S J� <br /> FOR OFFICE USE ONLY: <br /> PFGNT SETBACK REAq SETBACK SIDE SETBACK PLAN CHECK YUMBER FEE BECEIPT NO. <br /> ,5/2�/ <br /> usetoNe LOTAREA VAC�NTSITE FEES VALUATION FEE <br /> ❑ YES C NO BUILDING i <br /> TYPEOFCONST. NO.OFSTORIES d'4uPn6�a r.0afvxFwnGU'u15 <br /> LflO�P PLUMBING ' <br /> �T <br /> 52EOFBLO'u. FIRESPflINKLERSFEO'� Bf.SEMENT MECHANICAL � <br /> � ❑ YES ❑ NO ; <br /> OCCUPANCV LOAD FIRE ALARM REO'D NEIGMT LIMIiATION ADDITIONAL PLAN CHECK � <br /> � <br /> OTHEF <br /> i <br /> REASON �— <br /> STATE BUILDING SURCHARGE i <br /> INTANEBY PIANSAPPROVEDDY CITYOFEVERETT PUBLICWOFKS � <br /> LOCAL SALES ' <br /> onre TAX CODE IS 3105 TOTAL I <br />