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APPLICATIC�I FOR CONSTRUCT'`�N PERMIT � <br /> TO BE COMPLETED IN BLACK INK—PLEASE PRINT <br /> HEATING SYSTEM: ❑GAS ❑ELECTRIC ❑ <br /> BUILDING DEPARTMENT <br /> 259-8810 <br /> ❑ DEMOUTION ❑ COMBINATION C I BUILDING i 1 MECHANICAL i I PLUMBING Ci SIGN <br /> OWNER MAILADDRFSS CITY ZIP PMONE <br /> fGAQo%E F��'E sr�tK 390•� F,Go�y ED'EX�7l u�iF 9P.10 / �SF-G�88 <br /> TENANT MAILRDDRE55 CITY ZIP PMONE <br /> ARCNIiECTOR�E5IGNER MAILADDRESS CITV ZIP PHONE <br /> GE EFpLCONTRA TOR M ILADDRE S ��s�'(�`�}A/�7C��c4L�r' Z�P PHONE STAT LICENSE� �,/ <br /> /1rlcpf,o �Rh►�o �pniS� A� d�'s,t�o�G r✓a, �'6�7 G7s-�is� ItoLl3ci?I a•� <br /> MECHANICALCONTRACTOR MAILAUDFESS CITY ZIP PMONE STATELICENSE-' <br /> PLUMBING CONTRACTOR MAIL ADORE55 CITY ZIP PHONE STATE LICENSE� <br /> GONTRACT PR E OF WORN <br /> 6 g�e•ov <br /> DESCflIBE WORK AND SOURRE FOO7AGE INVOLVEfI �,�`��r CONTpCT PERSON AND PHONE NO. <br /> pp erw�••• <br /> C/�i3/NElS �eMl/�,[s ,��v+e�" �Qa�t ��,Pe9ti <br /> I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br /> PPOPOSFD USE OF BUILDING APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT.ALL <br /> PROVISIONS OF LAWS AND ORDINANCES GOVERNING TH�S TVPE OF <br /> LEGALDESCRIPTIONOFPROPERNlSHOWNBELOWORPTTRCHTWOCOPIES� NOT THELGRA T�ING OF AD ERMIT/DOES NOT PRIESUME TO GOE <br /> �oT e�ocK oF AUTHORITV TO VIOLATE OF CANCEL THE PROVISIONS OF ANY <br /> � � • OTHER STATE OR LOCAL LAW REGULATING CONSTRUCT�ON OR THE <br /> PERFORMANCE OF CONSTRUCTION.THAT I AM AUTHORIZED BY THE <br /> OWNER OF THIS PROPERTY T'� PERFORM THE WORK FOR WHICH <br /> APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> PAPCEL TA%I D.NW IBER CONTRACTORS LAW 18.27 RCW AND 296200 WAC. <br /> CONSTPl1CTION LO�N LENDER.ADORE55,TELEPMONE NUMBER x�� //�/j� _ ��/S�F� <br /> PROJECTADDRF,$$,O� �f� <br /> S�iu'aE ( " ' '�— oue <br /> S� [IiV BUSME55 UCENS[NO <br /> PL'JMBING MECHANICAL <br /> NO�TNPE OF flXFURE OR iTEM FEE NO. TYPE OF EQUIPMENT FEE <br /> WATER CIOSET(TOILETj � A/G—NHNDLG UNITS—H.P. � <br /> BATH i UB � FORCED AIR SYSTEMS—B.T.U. M E.A. ' <br /> � LAVATORY(WASH BASIN) � UNIT HEATERS—B.T.U. M � <br /> � SHOWER CLOTHES ORYERS ' <br /> KiTCHEN SINK 8 DISP VENTILATION FAN __T_ <br /> DISHWASHER � RANGE HOOD <br /> LAUNDRY TRAY ; WATER HEATER � <br /> CLOTHES WASHER WOOD STOVE ' <br /> URINAL ; METAL FIREPLACE(WOOD BURNING) ' <br /> DRINKING FOUNTAIN � FIREPLACE INSERT � <br /> FLOOR DRAIN � HEAT PUMP ' <br /> BACKFLOW PREVENTEFS � GAS PIPING _ � <br /> ROOF DRAINS—RAINLEADERS � EXHAUST FAN ' <br /> SINK(SERVICE—BAR,ETC.) � � <br /> � <br /> � ' <br /> � <br /> � � <br /> � � <br /> SUB TOTAL $ ; SUB TOTAL $ <br /> PERMIT $ � PERMIT $ � <br /> TOTAL FEE S TOTAL FEE $ ' � <br /> FOR OFFICE USE ONLY: <br /> FPONTSETBACK REARSETBACK SIOESETBACK PUNCM CRNUMBER� <br /> FEE RECEIPTNO. <br /> USEZONE LOTPREA <br /> VACANTSITE FCES VALUATION FEE <br /> ❑ YES ❑ NO BUILDING � <br /> TYPEOFLON51. NOOFSTORIES O[CUvsYtv x00iVMluxGUHrtS � <br /> "AWP P�UMBING ' <br /> SREOFBLDG. fIRESPRINNLERSREO'D BASEMENT MECHANICAL � <br /> G YES u NO <br /> ADDITIONAL PLAN CHECK ' <br /> OCCUPANCY LO�� FIRE ALARM REO'0 HEIGHT LIMITAT�ON � <br /> OTHEH ' <br /> i <br /> REASON <br /> STATE EUILOING SURCHA(iGE <br /> i <br /> INTAKCBV PIANSAPPROVEDBY CITYOFEYERETT PUBLICWORKS � <br /> LOCALSALES ; <br /> oArE TAX CODE IS 3105 TOTAL � <br />