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APPLICATIO'1 FOR CONSTRUCT( ,N PERMIT � <br /> TO BE COMPLETED IN BLACK INK—PLEASE PRINT <br /> BUILDING DEPARTMENT HEATING SYSTEM: GAS ❑ELECTRIC ❑ <br /> 259-8610 <br /> I 1 DEMOLITION I i COMBINATION I i BUILDING �MECHANICAL �� PLUMBING [ 1 SIGN <br /> 01.hER MqILA0DRE55 UTY ZIP PHONE <br /> (Y�0.f`MFFA.LI_ L.'lipQl�y1/� \r �11 '}fFri �U �j�[CGI� IA74 9�lUl 1,�'�07 h <br /> TLNANi MAILADOPE55 CITV ZIP PHON[ <br /> ARCMITECTOflDESIGNER MAILAD�FESS CITY 21P PHONE <br /> \ <br /> GCNCRALCONTR�CTOR MAILAODRE55 CITV ZIP VNONE STATELICENSE/ <br /> IdEC11AN:CAL GONTRACTOR MAIL qD�RESS GRY ZIP PHONE ST4TE UCENSE• <br /> �auiecu 11Pai-i�a i�o� chec{-nu+ �£� C�c� q8Zo1 353-33u'-� Sec� �ho990 L <br /> PWMBINGCONTRqCTOP � ld41LA�DRE55 CITV ZIP PMONE STATEUGENSEe <br /> WNTRP.CT PRIGE OF WORN <br /> ����� <br /> �ESCPI EWORKANDSOUAREFOOTAGEINVOLVEO CONTACTPERSONANDPNONENO. <br /> � V�rj�) Cl� GLLYV� {yr <br /> i HERFBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br /> PROPOSED USE OF BUILD�NG APP�ICATION AND KNOW THE SAME TO BE TRUE AND CORRECT.ALL <br /> � �� , PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS NPE OF <br /> i�cn�oescnirrioNOFpRoaEarv�Sr+owNee�owoRnrrncnTwocoPiEs1 WORK WILL 8E COMPLETED WITH WHETHER SPEqFIED HEREIN OR <br /> NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br /> ior OLOCK oF AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANV <br /> OTHER STATE OR LOCAL LAW REGULATWG CONSTRUCTION OR THE <br /> PERFORMANCE OF CONSTRUCTION.THAT 1 qM AUTHORIZED BY THE <br /> OWNER OF THIS PROPERTY TO PEflFORM THE WORK FOR WHICH <br /> APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> r�nnce�tnx i o.r+uueEr+ CONTRACTORS LAW 18.27 RCW AND 296200 WAC. <br /> COhSTRUCTIONLOANLENDER.A�DRE55.1ELEPHONENUMBER q ' � � <br /> PROJECTADDRESS si�une—�'�l"''O�'1—'�� <br /> 3�i8 �-�e� �k q�s2o 1 ��i� -- <br /> GII V pu5NC5S uCE NSL NO <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM FEE NO. TYPE OF EOUIPMENT FEE <br /> WATER CLOSET(TOILET) A/C—A/HNDLG UNITS—H.P. <br /> _ BATHTUB FORCED AIR SYSTEMS—B.T.U. M E.A. <br /> LAVATORV IWASH BASIN) UNIT HEATERS—B.T.U. M ; <br /> SHOWER ' CLOTNESDRYERS <br /> KITCHEN SINK 8 DISP � VENTILATION FAN <br /> �ISHWASHER RANGE HOOD —T <br /> LAUNDRY TRAY ; INATER HEATER <br /> CLOTHES WASHER WOOD STOVE <br /> URINAL METAL FIREPLACE(WOOD BURNING) <br /> DRINKING FOUNTAIN FIREPLACE INSERT <br /> FLOOR DRAIN � HEAT PUMP <br /> BACKFLOW PREVENTERS � GAS PIPING <br /> ROOF DRAINS—RAINLEADERS � EXHAUST FAN <br /> SINK(SERVICE—BAR,ETC.) ; <br /> � <br /> —T— <br /> ; — <br /> —�-- <br /> SUB TOTAL 5 ; SU8 TOTAL S <br /> PERMIT 5 PERMIT g <br /> TOTAL FEE S TOTAL FEE $ <br /> FOR OFFCCE USE ONLY: <br /> FRONTSETBnCK flEAR5EIBACK SIDESEiO�CK PLnYCHECNNUMBER FGF. Rf:CEIPTNO <br /> 3� <br /> USE20NE LCTqREA VACANTSITE FEES VAIUATiON FEE <br /> !, YES I.J NO BUILDING <br /> ttPEOFCONSI NOOPSTORIES o[Nrurcv r:0amvtluYuunS -- <br /> �pa� PLUMBING � <br /> SIZE OF 9lDG. FlRE SPRINKLERS PEO'D BASEMENT MECHANICAL <br /> i YES G NO <br /> OCCUPANCV LOAO FIRE AIARM qEOD NEIGHT LIMITATION ADDITIONAL PLAN CHECK <br /> OTHER � <br /> REASON _ <br /> __�—_ <br /> STATE BUILDING SURCHARC.E � <br /> iNinKEOv PLANSAPPROVEOBY CITYOFEVERETT pUBLICWORKS � <br /> LOCALSALES <br /> n,,,e TAX CODE IS 3105 TOTAL <br />