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,� - <br /> APPLICATIG.� FOR CONSTRUCT.JN PERMIT � <br /> TO BE COMPLETED IN BLACK INK—PLEASE PRINT <br /> HEATING SYSTEM: GAS ❑ELECTRIC ❑ <br /> BUILDING DEPARTMENT <br /> 259-8810 <br /> L_I DEMOLITION � ] COMBINATION I 1 BUILDING ' � MECHANICAL I i PLUMBING L_I SIGN <br /> OVINER MAILADDRESS CITV ZIP PHONE <br /> �+9� 1�q�t.D�l , lozv-\ �1,, Qa..� �£S W ,lX. s��,r..«-�S �zs�s � `�as-+t4�v�! c�ti I-1�i t z-Zw�— <br /> TENANT MAILADORE55 CITY ZIP PHONE <br /> APCHITECT OR DESIGNER MAIL ADDRE55 CITV ZIP PHONE <br /> GENERFLCONTAACTOR MAILAODRE55 CITV 21P PHONE STATEIICENSE• <br /> /MECHANICALC TRACRIR MAILADDhc55 CITV 21P PHONE STATELICENSEI <br /> ( 1A7'1 ���� ��..._ . <br /> PWMBMGCONTRACTOR MAILAD RE55 CI1Y 21P PHONE STATELICENSEI <br /> CLASS OF WORK <br /> f I NEW I � ADDITION i �I ALTEHATION I I REPAIR I I DEMOUTION I I WCODSTOVFJPRPL INSERT I I BUILDING RELOCATION <br /> ' ^ CONTACT PERSON AND VHONE NO. <br /> CONTMCTPRICEOFWORK � Z� J �lh�3�'�R— <br /> DESCRIBE WORK AK�SOUARE FOOTqGE INVOLVED <br /> PROPOSEDUSEOfBUILDING i HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br /> 1 ��. �� APPLICAI�ION AND KNOW THE SAME TO BE TRUE AND CORRECT.ALL <br /> LECiAL DESCRIPTION OF PROP[RTV�SHOWN BELOW OR ATfACH FWR COPIES� PROVISIONS OF IAWS AND ORDINANCES GOVERNING THIS TYPE OF <br /> WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br /> �or e�ocK oF NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br /> AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br /> 07HER 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 /> CONTRACTORS LAW 18.27 RCW AND 296.200 WAC. <br /> x -�{-14 <br /> PRQIEGT ADDRESS SqN�iuRE o�rE <br /> �,� G�I ^ �ITYBUSWESSIiGEN5EN0 <br /> PLUMBINCi M CHANICAL <br /> NO. TYPE Oi FlXTURE OR ITEM FEE N0. TYPE OF EOUIPMENT FEE <br /> WATER CLOSE i(TOILET) � A/C—A/HNDLG UNITS—H.P. <br /> BATHTUB ; FORCED AIFi SVSTEMS—B.T.U. M E.A. � <br /> LAVATORY(WASH BASIN) � UNIT HEATERS—B.T.U. M ; <br /> —� <br /> SHOWER ' CLOTHES DRVERS � <br /> KITCHEN SINK&DISP � VENTILATION FAN ; <br /> DISHWASHER � RANGE HOOD <br /> LAUNDRY TRAV ; WATER HEATER <br /> CLOTHES WASHER � WOOD STOVE � <br /> URINAL ' METAL FIREPLACE 8 CHIMNEV � <br /> DRINKING FOUNTAIN � FIREPLACE INSERT � <br /> FLOOR DRAIN ' HEAT PUMP � <br /> BACKFLOW PREVENTERS ; GAS PIPING ; <br /> ROOF DRAINS—RAINLEADERS � EXHAUST FAN � <br /> SINK(SERVICE—BAR,ETC.) � � <br /> � � <br /> � � <br /> i <br /> � <br /> SUB TOTAL $ ; SUB TOTAL $ ' <br /> PERMIT $ � PERMIT $ � <br /> TOTALFEE $ ' TOTALFEE $ <br /> FOR OFFICE USE ONLY: <br /> FRONT SETBACK REAR SETBACK SIDE SETBALK PLAN L EGK NUMBER FEE PECEIFT NO. <br /> USE 20NE LOT AREA �ACANT SITE FEES VALUATION FEE <br /> BUILDING � <br /> 1YPEOiCONTS.RILOWABLE tYFiOFCONSiACiOAL acuwncr xoarownuxcuMrts , <br /> cnouv � PLUMBING i <br /> SIZE OF BLOC. NO.fiF STORIES BASEMENT MECHANICAL � <br /> � <br /> d:CUPANCY LOAD FIRE SPRNKLERS FEO'D HEIGHT LIMITATION ADDITIONAL PLAN CHECK � <br /> � <br /> SPRINKLER � . <br /> REASONfORSPRINNLERS <br /> STATE BUILDING SURCHARGE i <br /> INTAAEBY PLANSAPPROVEDBY CITYOFEVERETT PUBLICWORKS i <br /> LOCALSALES , <br /> TAX COOE IS 3105 TOTAL ; <br />