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APPLICATIO; . FOR CONSTRUCTt�'N PERMIT � <br /> TO BE COMPLETED IN BLACK INK-PLEASE PRINT <br /> HEATING SYSTEM: ❑GAS �ELECTRIC O <br /> BUILDING DEPARTMENT <br /> 259•8810 <br /> ❑ DEMOLITION ❑ COMBINATION �y BUILDING ❑MECHANICAL ❑PLUMBING ❑ SIGN <br /> OYMER MAILAD�RESS CITV ZIP PHONE <br /> ,�,� l rl- [��o�i� /l�� 1-,`v�`r���� 1337 /(/ /g^'j�n Sr•, lf/t I✓.; 9�+'/>� �',��-D9/9 <br /> TENA1N[s I MAILADDRESS CITY /ZIP / PMONE <br /> ��h T �nV14 " 2��5 / 4��i1 ��!'J-�(iC/G�T. L./.' `J/��C, � � �) 2 � <br /> ARCHITECTORDESIGNE MAILAODRESS CITV IP PHONE n��!jrH� /, aGyL - <br /> /��,�ft, �, l/;���� 2 70/ �7, �� .St �,����� �-., %�=�/ <br /> GENERALCONTRRCTOR MAILADDRESS CITY ZIP PHONE ATELICEN ER <br /> h ✓n <br /> MECHANICAI�CONTRACTOR MAIL ADDRESS CITV 21P PHONE STATE LICENSE� <br /> �1 L <br /> PWMBINGCO TRACTOR MAILADORESS QTV ZIP PHONE STATELICENSEI <br /> e/lsr� r� . �-- _` <br /> CONTRACT PRICE OF WORK � <br /> T�- �y (3� � <br /> DESCRIBE WORN AND SOOARE FOO�AGE INVOLVE ,/ / ! n C� CONTACT PERSON AND PHONE NO. ,� / I �. //, ,' <br /> � 14 L./ � <br /> i <br /> � -f-e � i �. r:/.2 , - -lO (� <br /> i HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br /> PROPOSEDUSEOFBUILDING APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT.ALL <br /> a� . PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br /> �ec DESCflIPTIONOFPROPERTV�SHOWNBELOWOPATTACHTYOCOPIES) WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OH <br /> /� NOT. THE GRANTING OF A PERMIT OOES NOT PRESUME TO GIVE <br /> �or � `� a�ocK� oF AUTHORITY TO V�OLATE OR CANCEL THE PROVISIONS OF ANY <br /> t <br /> OTHER STATE OR LOCAL LAW REGULATING CONSTflUCT10N OR THE <br /> PERFORMANCE OF CONSTRUCTION.THAT 1 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 /> (� PRRCELTA%I.O.NUMBER CONTRACTORS LAW 18.27 RCW AND 296.200 WAC. <br /> � <br /> CONSTRU TIONLj1/�NLENDER,ADDRESS,TELEPHONENl1MBER <br /> � �'riz��—'���.,/l>�— '���/i'Y" <br /> PROJE ADDRESS swr��.une o <br /> � z�: CITYBIISMESSULEN5EN0 <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FlXTURE OR ITEM FEE NO. TYPE OF EQUIPMENT FEE <br /> WATER CLOSET(TOILET) � AIC—A/HNDLG UNITS--H.P. � <br /> BATHTUB FORCED AIR SYSTEMS--6.T.U. M E.A. ' <br /> LAVATORY(WASH BASIN) � UNIT HEATEPS—B.T.U. M � <br /> SHOWER ' CLOTHES DRYERS ' , <br /> KITCHEN SINK 6 DISP � VENTILATION FAN I � <br /> DISHWASHER � RANG H 0 � <br /> LAUNDRYT Y WATE H A ER ' <br /> CLOTHES SH R � WOO S E � <br /> URINAL ' META FI PLA E(WOOD BU ING ' <br /> DRINKING O N AIN � FIREPLACE IN RT � <br /> FLOOR Dfl IN � ' HEAT PUMP ' <br /> BACKFLO PREV NT RS ; GAS PIPING � <br /> ROOF DRAI RAINL ADERS � EXHAUST F,N � <br /> S�NK(SERVICE—BAR, TC.) � � <br /> � � <br /> � � <br /> � <br /> � � <br /> � � <br /> SUB TOTAL $ ' SUB TOTAL $ ' <br /> PERMIT $ � PERMIT S � <br /> TOTAL FEE $ ' TOTAL FEE $ ' <br /> FOR OFFICE USE ONLY: <br /> FRONT SETBACK flEAR SETBRLN SIDE SETBRCK PLAN CMECN MBEfl FEE PECEIPT NO. <br /> s �a <br /> USE 20NE LOT AfiEA VACANT SITE �FEES VALUATION FEE <br /> G YES ❑ NO BUILDING �� ' <br /> tYPEOFCONSi. NOOFSTORIES o[cuPAMcr NaawnwNGUH�tS <br /> cnao pLUMBING <br /> $IZEOFBLOG. FIflESPRINKLERSREO'D BASEMENT MECHANICAL � <br /> ❑ YES ,:J NO <br /> OCCUPANCY LORD FIRE ALARM REOD MEIGHT LIMITAiION ADDITIONAL PLAN CHECK i <br /> i <br /> OTHER � <br /> i <br /> REASON <br /> STATE BUILDING SURCHARGE � <br /> INTANEBY PLANSAPPflOVEDBV CITYOFEVERETT PUBLICWORKS i <br /> LOCAL SALES <br /> DATE TAX CODE IS 3105 TOTA� �� �l � �- <br />