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APPLICATIQ ' FOR CONSTRUCT!—�N PERMIT � <br /> TO BE COMPLETED IN BLACK INK—PLEASE PRINT <br /> BUILDING DEPARTMENT HEATING SYSTEM: ' GAS ❑ELECTRIC ❑ —� <br /> 259•8810 <br /> I"1 DEMOLITION �COMBINATION �[:1 BUILDING i J MECHANICAL �.I PLUMBING I 1 SIGN <br /> O NEP AIML AO[1RE55 CITY 2�P PHONE <br /> �a n. o�• �e1�4�a�( 5��� -s-ss-'sw /�.0 rc �275- 3S3 95'SSD <br /> TENANT MAILAD�RESS CITY 21P PNON[ <br /> ARL ITECTOfiDE51GNER MAIIA�OPESS CITY 21P PHONE <br /> /►�����«e D�•�: ell e 6 o I Pa�� /{� 1►,wfc, �t'�ra�s- 7 y2 - 6 Y � - <br /> GENERAL CONTRACTOR h111L ADDRESS CITV ZIP PNONE STATE LICENSE t <br /> �u�2o !h`D�»�s S�i� -s�� sr. s�r h� kk-. 9F'rz�r 3s� 4s�o (�o/ /09 S�'7 <br /> ME 4ANICA�.,ONTR�CTOR MAILADDRE55 CI� 21P PHONE STATEUCENSEr <br /> �%� � r _ /�i�s��s /`/!S 1'S�•a a�ry:�c, t'v�e 1�` /`�SZo � 2s9- 6666 <br /> PWMPINGCON CTOR MAILADORE55 -� CITV ZIP PHONE STATELICENSEY <br /> Gtlafe� lvcr(�s�, 100� - /7Z�Sf. S,E, tb'290 `6�''-•gt2� <br /> CONTiiACT PRICE OF WORH <br /> DESCRIBE.Y!p RK AND 5Ol1ARE FODTAGF INVOLVED A �! / CO CT PERSON AND PHONE . P��4 // ���� ��L`T <br /> �OnS7L4cT�toq O { �Ue!✓ rCS�`q"QhTfal 4 Fx-O4 P � •� �c� <br /> �o.i, o f' Z 3 y`� s . �Y <br /> 1 � (� �` I HFREBY CERTIfY THAT I HAVE READ AND EXAMINED THIS <br /> PROPOSE�USEOFBl1ILDING �/ APPLICATION AND KNOW THE SAME TO BE TfiUE AND CORRECT.AlL <br /> S ��7J I a- �Git, � lS �PS � �T rS�'� PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br /> �EGALDESCRI�'�:ONOfPPOPE TY�SHOWN�ELOWORAii�cNTWOCOPIES WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br /> L0T13 j D -�aawr�s �'a � /�G 4PS� �«4�� NOT. THE GRANTING OF A PERMIT DOES NO7 PRESUME TO GIVE <br /> p ^ AUTHORITY TO VIOIATE OR CANCEL THE PROVISIONS OF ANY <br /> �y�� y o •�-•�C ��4 f `F�t he 0�F �t c0✓Lic.f" i 4 UQL OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br /> /� PERFORMANCE OF CONSTRUCTION.THAT I AM AUTHORIZED BY THE <br /> �f pY PI4fS P , b 7 K��D��S Q7 Sn�. C � OWNER OF THIS PROPERTY TO PEflFORM THE WORK FOR WHICH <br /> �_�� APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> PARGe��ax�D.NUMBEF CONTRACTOHS LAW 18.27 RCW AND 296.200 WAC. <br /> G� � -� d�U"" Q Z-'� --�� � � ///JJJ <br /> GONSTRUCTIONLOANLENDER,ADDRESS.TELEPHONENUMBER � „�' �,/`��� L_ c� � <br /> x �"7.._�. / /,� <br /> PROJEC7 D ESS �.. sKrm,unc . o^iE <br /> y� � � GQ{���Pv u ��/Yl�B� arrausir�ewucer�seno <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM FEE NO. TYPE OF EOUIpMENT FEE <br /> WATER CLOSET(TOILEn / A�'C—A�HNDLG UNITS—H.P. <br /> a., BATHTUB / ' / FORCED AIR SYSTEMS—B.T.U. M E.A. <br /> LAVATORY(WASH BASIN) UNIT HEATERS—B.T.U. M � <br /> SHOWER / ' � CLOTHES DRYERS ' <br /> KITCHEN SINK&DISP � VENTILATION FAN <br /> DISHWASHER � RANGE HOOD � <br /> LAUNDRYTRAY ' WATERHEATER � <br /> CLOTHES WASHER � WOODSTOVE <br /> URINAL METAL FIREPLACE(WOOD BUFNING) � ; <br /> DRINKING FOUNTAIN � FIREPLACE INSERT � <br /> FLOOR ORAIN HEAT PUMP ' <br /> BACKFLOW PREVENTERS ; GAS PIPING � _ <br /> ROOF DRAINS—RAINLEADERS T— EXHAUST FAN i � <br /> � ' SINK(SERVICE—BAR,ET0.) ; � <br /> � <br /> � � <br /> � '�) �.�7i7 <br /> _ � <br /> II i <br /> SUB TOTAL S ; SUB TOTAL S <br /> PERMIT 5 PERMIT 5 <br /> TOTAL FEE 5 ' TOTAL FEE 5 ' <br /> FOR OFFICL USE ONLY: <br /> FRONTSETBPCK REARSETBACK SIDESETBACK PLANCHEC NUMBE FEE RECE/IP�iNO. <br /> i � � ��� �,. �rmah� '7.5 � �`�a��? � � 7 rl���� <br /> USE20NE LOTAqREA �/ VACANTSITE FtES VALUATION FEE � <br /> �S � / G�I' Z T ?� YES �%: NO BUILDING p8 _�� ; �C%" <br /> iYPFOiCONST. NO.OFSTORIES LRuvuttr noorCNauh;Wd�s <br /> � 2 `'a ' / PLUMBING �Y� <br /> 523��SFl� FIRESPRINNLERSRE00 BAS,NENT � MECHANICAL � <br /> 7 S.� G.�12 D i-' YES "t%NO . �� <br /> OGCUPANCVLOAD FIflEALARMREO�O NEIGMTUMITATION ADDITIONALPLANCHECK i � <br /> -7�,i i <br /> /j �D c(� OTHER r � <br /> RE�SON <br /> STATE BUILDING SURCHARGE <br /> MTFKEBV PUNSAPPROVEDOY CITYOFEVERETT PUBLICWORKS �' � � � <br /> J F� LOCAL SALES <br /> o,,,E 3 � � , TAX CODE IS 3105 TOTAL "/� �(�_n <br />