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APPLICATIQ'�' FOR CONSTRUCT�'►N PERMIT � <br /> TO BE COMPLETED IN BLACK INK-PLEASE PRINT <br /> BUILDING DEPARTME�JT HEATING SYSTEM: ig GAS ❑ELECTRIC ❑ � <br /> 259-8810 <br /> Cl DEMOLITION I I COMBINATION I_1 BUILDING iJ MECHANICAL 1 PLUMBING ❑ SIGN <br /> OWNEfi M41lA�pRE55 CITV ZIP PNONE <br /> �obbv I.vaaan e'3�50_y FndcY�iAi�P FtlPmi-fiu �a `�IfiZ01 a59-5��a. <br /> TENANT � IAAILAOORESS C�ITY--._ <br /> ZIP PHONE <br /> ARCHRECTORDESIGNEfl MAILA�DRE55 CITY ZIP opONE <br /> GENER4L CONTRNCTOR MAIL AODPE55 CITY ZIP PMONE STATE LICENSE Y <br /> MFCN�NICALWNTfiACTOR AIAILADDRESS CITY ZIP PIIONE STATELICENSEt � <br /> �au�e�.� Nra�,ra iaoa r1�es�-rn�t�� fiPr�i�-w� 9S�ZdI 353'33�fy sEr� i>,hnq90 _ ' <br /> PLUMBINGCONTRACTOq MNLADDRESS CITY TIP PHONE STATELICENSEa <br /> 1 <br /> CONTRACT PRICE OF WORK <br /> �a . <br /> DESCRiBE WOBN ANO S�UAFE f00TAGE INVOLVED CONTACT PEPSON AND PNONE N0. <br /> i HEREBY CERTIFY TH�T I HAVE READ AND EXAMINED THIS <br /> PROPOS use oF UILDING APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT.ALl <br /> PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br /> LEGALOESCRIPTIONOfPROPERTV�SH0IYNBEL0IYORARACHTWOCOPIES� WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br /> �a' BLOGK aF NOT. THE GRANTIPlG OF A PERMIT DOES NOT PRESUME TO GIVE <br /> AUTHORITV TO VIOLATE OR CANCEL THE P90VISIONS 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 /> rnt�ce�rax i o.ruuti+eeq CONTRACTOFS LAW 18.27 RCW AND 296.200 WAC. <br /> LONSiRUCT10NLOANLEN�EF.ADDRESS.TE EPHONCNUMOFR <br /> PROJ��9�rma�- 3fro� �i-,day .�,� �icrf - �{� p ���/ <br /> �S s�cu�iur�c �"���� o�, �`� <br /> / crtr ouswcss�Ku.�se�+o <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTUPE OR ITEM FEE N0. TYPE OF EOUIPMENT FEE <br /> WATER CLOSET(TOILET) AIC—AiHNDLG UN!TS—H.P. <br /> BATHTUB FORCED�IR SYSTEh1S—B.T.U. M E.A. <br /> LAVATORY(WASH BASIN) i UIJIT HEATERS—B.T.U. M <br /> SHOWER CLOTHES DRYERS <br /> KITCHEN SINK 8 DISP i VENTILATION FAN <br /> DISHWASHER RANGE HOOD —�— <br /> LAUNDRYTRAY ; WATER HE�TER � <br /> CLOTHES WASHER WOOD STOVE <br /> URINAL ; METAL FIREPLACE(WOOD BURNING) <br /> DRINKING rOUNTAIN � I FIREPLACE INSERT <br /> FLOOR DRAIN HEAT PUMP <br /> BACKFLOW PREVENTERS ; I G�S PIPING <br /> ROOF DRAINS—RAINLEADERS EXHAUST F�N <br /> SINK(SERVICE—BAR,ETC.) ; <br /> � i <br /> _ i <br /> i <br /> —_T <br /> SUB TOTAL S ; SUB TOTAL 5 <br /> PERMIT 5 � PERMIT $ <br /> TOTAL FEE S ; TOTAL FEE S <br /> FOR OFFICE USE ONLY: <br /> FRONTSETBIICK REFRSETBACK SIDESETBACK PLdNCHECKNUMOER FEE RECEIPTNO � <br /> G S . <br /> usezor+e �pTqqEp vneanr5ire � FEES VALUATION FEE <br /> C YES ❑ NO BUILDING I ' <br /> 7VPEOFCONST. NO.OFSTORIES o:a:.�•.:r Nooro�t�u�,asUhiA ' <br /> ��0J� PLUMEING <br /> � <br /> ' �i <br /> SIZE OF BLOG. FIRE SPRINNLERS REO'D BASEMENT � <br /> MECHANICAL � <br /> ❑ YES C NO — <br /> OCCUPANCYLOAD FIREALARMRE�'D NEIGNTLIMITATION A�DITIONALPLANCHECK i <br /> i <br /> OTHER <br /> REp50N <br /> STATE BUILDING Sl1RCHARGE ; �, <br /> INTAKEBV PLANSFPPPOVEOBY CITYOFEVERETT pUI3LICWORKS � � <br /> LOCALSALES <br /> �n7E TAX CO�E IS 3105 TOTAL <br />