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APPLICATIC'11 FOR CONSTRUC'L aN PE��.�MIT <br /> TO BE COMPLETED IN BLACK INK—PLEASE PRINT � <br /> BUILDING DEPARTMENT HEATING SYSTEM: q GAS ❑ELECTRIC ❑ --� <br /> 259•8810 <br /> (lf DEMOUTION ❑ COMBINATION O BUILDING ❑MECHANICAL ❑PLUMBING ❑ SIGN <br /> OWNER MAILADORESS GITY ZIP PHONE <br /> �QGIF i��DWA�E �IS2'! 3�0�� A,�c, w- �'lF �t$7-oY <br /> TENANT MAILR�DRE55 CITY ZIP PHONE <br /> ARCHITECTORDESIGNER MAI�pDDPE55 CITY ZIP PHpNE <br /> � GENERALCONTRACTOP MAILADORESS CITY Ilp ppONE STATCL'CENSE� <br /> SI&'1ZItK- CON`•c�. CO. ' <br /> MECHANIGALCONTRACTOR MAILADORE55 CITY ZIP PHONE STATEIICENSEI <br /> PLUMBINGCONTR�CTOA M�ILADORE55 CITY ZIP PHONE ST�TELILENSEI <br /> CONTRACT PRICE OF WOHK — <br /> DESCHIBE WOHK AND SOUARE FOOTAGE INVOWED CONTACT PERSON AND PHONE NO. <br /> /'Yl D (�i/ S <br /> 1 HEREBY 1ERTIFY THAT I HAVE READ AND EXAMINED THIS <br /> FROPOSED USE OF BUILDINO APPLICATION AND KNOW i HE SAME TO BE TRUE AND CORRECT.ALL <br /> �� PROVISIONS OF LA1YS AND ORDINANCES GOVERNING THIS TYPE OF <br /> tEGA:DESCRIPTIONOFPROPERTV�S110WN8ELOWORATfACNTVOCOPIES� WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEFEIN OF <br /> �oT e�xK oF NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME i0 GIVE <br /> AUTHOFITY TO VIOLATE OR CANCEL THE PROVISIpNS 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 PEHFORM THE WORK FOR WHICH <br /> APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> PARLEL A%1.0 UMB R CONTRACTORS LA1!' �827 RCW AND 296200 WAC. <br /> . 37 - v - l,b/ •Gr�o� <br /> CONSTPUCTION IOAN IENDER,AD�RE55.TELEPHONE NUMBER <br /> � /V�� � <br /> PROJECTADDRE^.�4 3a I� �� roruruna o.r¢ <br /> � CITY WSME55 LICCNSE N0. <br /> PLUMBING MECHANICAL <br /> N0. TYPE OF FlXTURE OR ITEM FEE N0. TYPE OF EUUIPMENT FEE <br /> WATER CLOSET(TOILET) � A/�A/FINDLG UNITS—H.P. , <br /> BATHTUB ; FORCED AIR SYSTEMS—B.T.U. M E.A. � <br /> LAVATORY(WASH BASIN) � UNIT HEATEHS—B.T.U. M ; <br /> SHOWER ' CLOTHES DRYERS � <br /> KITCHEN SINK 8 DISP � VENlILATION FAN � <br /> _ , <br /> DISHWASHER � RANGE HOOD , <br /> LAUNDRYTRAY ; WATER HEATER � <br /> CLOTHESWASHEH � WOODSTOVE ; <br /> URINAL ; METAL FIREPLACE(WOOD BURNING) � <br /> DRINKING FOUNTAIN � FIFEPLACE INSERT ; <br /> FLOOR DRAIN � HEAT PUMP � <br /> BACKFLOW PREVENTERS ; GAS PIPING ' <br /> ROOF DRAINS—RAINLEADERS � EXHAUST FAN � <br /> _ SINK(SERVIC� -BAR,ETC.) ; � <br /> � ; <br /> � � <br /> � , <br /> SUF,TOTAL $ ; SUB TOTAL S ' <br /> PFRMIT $ � PERMIT $ ; <br /> TOTAL FEE $ ' TOTPL FEE S ' <br /> FOR OFFICE USE ONLY: <br /> FRONTSETB�CK PEARSETBACK SIOESETBAGK PLANCHECNNUMBER FEE RECEIPTNO. <br /> USE20NE LOTARER VRCANTSITE FEES VALUATION FEE <br /> ❑ YES ❑ NO BUILDING ; <br /> TMEOFCONSi. NO.OFSTOPiES accur�xcx rro.pow[mwcurin5 <br /> �pWP PLUMBING � <br /> SREOFBLDG, FIRESPRINKLERSREO'� B�SEMENT MECHA4ICAL i <br /> O YES ❑ NO <br /> OCCUPANCVLOAO FIREAIARMREOD HEIGHTLIMITATION ADDITIONA�PLANCHECK � <br /> OTHER � <br /> REASON �— <br /> S7A7E BUILOING SUqCHARGE i <br /> INTAKEBV PLANSAPPROVEDBY CITYOFEYERETT PUF7LICWORKS � <br /> LOCALSALES <br /> DATE TAX CODE IS 3105 rorn� � <br />