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y,� � � APPLIC:ITIR'1'"! FOR CONSTRUCTC"�N PERMIT �� <br /> � TO BE COMPLETED IN BLACK INK--PLEASE PRINT F�„�/'��r <br /> �_/ <br /> BUILDING DEPARTMENT HEATING SYSTEM: f]GA� ❑ELECTRIC ❑ I <br /> 259-8810 <br /> ❑ DEMOLITION ❑ COMBINAl'ION ❑ BUILDING �((MECHANICAL ��1PLUMBING ❑ SIGN <br /> OWNEfl MAILADDRE55 �tY <br /> �\Q�Y t 1 Z�N ��03!_n PHONE <br /> TENANi - �S � 1 � \� L� I I �C��� 1 S� S W L I Y1r1U1IX�.1/ � �� ����_ <br /> MAIL AD�RESS ��T� <br /> ��\��[\� `/+ 1 1 ZIP PHONE <br /> ARCNITECTOROESIGNE ` `OeXI�!— ( � ++�� �� ��'�1i <br /> MAILADOflESa � � ( A1 ��-{� <br /> ��ry Z�P PHONE <br /> GENERAICONTqACTOR MAILAODRE55 CITV 2L' PHONE <br /> STATE LICENSE 1 <br /> MECHANICALCIXJTRACTOR MRILAODRESS CITV ZIP PHONE <br /> S7ATE LICENSE x <br /> PLUMdINCaCONTRRCTOfl MAILAODRESS CITY ZIP PHONE <br /> � � • OJ (,}1 �� �� (� /� � 'S]'� .f 1�STATE LICENSE� <br /> M PCtI l� \ \ �lO`��1�� � �,� �`�1�a�. T <br /> CANTRACTP ICEOFWORK ����'1��'�-'i=a,F�G pR�p� �°�tLQCn <br /> �7 �� <br /> DESCRIBE WORK AND SOUARE FWTAGE INVOLVED CONTA P RSON AND PIIOIIE NO. <br /> � \� ^� / <br /> �r�i--�i�7nt�A �L2�.Z-�`��ti <br /> � �"' �C l ..� �t <br /> 1 \o ��1� <br /> PROPOSEDUSE UILDING HEREBY CERTIFY THAT I HAVE READ qND EXAMINED THIS <br /> APPLICATIGN AND KNOW THE SAME TO BE TRUE AND CORRECT.ALL <br /> PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br /> LEGALDESCflIPTIONOFPROPERTV(SHOWNBELOWORATTACHiWOCOPIES) WORK WILL BE COMPLETED WITH WHETHEP. SPECIFIED HEREIN OR <br /> �or B��K aF NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br /> AUTHORITY TO 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 7HE <br /> OWNER OF 'fHIS PROPERT� 70 PERFORM THE WORK FOR WHICH <br /> PARCELTAXI.D.NUMBER APPLICATION IS MADE /�ND I COMPLY WITH THE STATE <br /> � � O CONTRACTORS LAW 1827 PCW AND?96200 WAC. <br /> CONSTRUCTION LOAN LENDEP,ADDRE55,TELEPHONE NUMBER <br /> , PRQJ�CTpDDRESS s�H� 1Q n �-� <br /> ` "') OATE <br /> C�iYBUSME55LICEN5EN0. ' � <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR REM FEE NO. TYPE OP EOUIPMENT FEE <br /> WATER CL(1SET(TOILET) � A/C-A/HNDLG UNITS-H.P. <br /> BATHTUB ; FORCED AIR SYSTEMS-B.T.U. M E.A. � <br /> LAVATORY(WASH BASIN) _ � UNIT HEATEflS-B.T.U. M <br /> SHOWER � CLOTHES DRYERS � <br /> KITCHEN SINK&DISP � ' VENTILATION FAN � <br /> DISHWASHER RANGE HOOD � <br /> LAUNDRYTRAY ' WATER HEATER , <br /> CLOTHES WASHER WOODSTOVE <br /> URINAL ; METAL FIREPLACE(WOOD BURNING) � <br /> -�� DRINKING FOUNTAIN � FIREPLACE INSERT � <br /> FLOOR DRAIN � HEAT PUMP <br /> � <br /> BACKFLOW PRFVENTERS ; GAS� IPING <br /> ROOF DRAINS-RAINLEADERS '� EXHAUST FAN � <br /> ) �SINK(SERVICE-BAR,ETC.) � � <br /> � <br /> � , <br /> � <br /> � <br /> � , ' <br /> SUB TOTAL $ ; SUB TOTAL $ <br /> PERMIT $ Z � PERMIT $ Z ; <br /> TOTAL FEE $ ' TOTAL FEE $ � <br /> FOR OFFIGE USE ONLY: <br /> FRONT SETBRCK REAR SETOACK SIOE SETBpCK PLAN CHECK NUMBER FEE RECEIPT NO. <br /> USEZONE LOTAREA VACANTSITE FEES VALUATION FEE <br /> ❑ YES ❑ NO <br /> TVaEOFLONS� NO.OFSTGRiES occuvnxw xo.orow[uixcuxns BUILDING � <br /> ceoua pLUMBING ' <br /> i <br /> SIZE OF BLDG. FIPE SPRINKLERS REO'D BASEMENT <br /> h1ECHANICAL � <br /> ❑ YES IJ NO <br /> OCCUPANCVLOAD FIREALARMRGO'D HEIGHTUlAITATION ADDITIONALPLANCHECK i <br /> REASON OTHER � <br /> S7ATE BUILDING SURCHARGE � <br /> INTANEBY PIANSAPPROVEOBY CITYOFEVERETT PUBLICWORKS � <br /> LOCALSALES � <br /> onre TAX CODE IS 3105 TOTn� � <br />