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��� <br /> APPLICATIQ"'� 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 /> ❑ DEMOLITION I J COMBINATION ❑ BUILDING ❑MECHANICAL CJ PLUMBING I i SIGN <br /> OWNER MAKADDHE55 CITY ZIP PNONE <br /> �_LvFA/L S9GK GC6Y.w�t��✓ IR. ,�- ��J`�LIvJ ZSTS- 29f/o <br /> TENANT IMILINDRESS CITY ZIP PHONE <br /> �RCNITECTOR DESIGNEP MAII AD�flESS CITY 21P PNONE <br /> OFNEPALCONTMCTOR MAiL�DDRE55 CITY ZIP P110NE ST�TELICENSE� <br /> :AECMIINN:AI.CONTRACTOR AUILADDRES$ GIiY 21P PMONE STATELICENSE• <br /> �•,'� s �Ts�(�!?...E.7,•c ��r�EAw,v..rv,C✓� eP'i 9�m� 2sZ-.�i�S/ �/sxb�/z�,i7 <br /> PIUMBN(7CONTMCTOf` MAILIIDDRESS CI7Y ZIP P110NE STATE�IGENSE� <br /> CJNTIUCT PRICE OF WOfIK <br /> f Z7y� <br /> DESCRIBE WORK AND SOUME FOOTAGE INVOLVED CONTACT PERSON AND PNONE NO. <br /> o� % <br /> I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br /> PROPOSEO LISE OF BUILDING APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT.ALL <br /> �i�,�7Y,� PROVISfONS OF LAWS AND ORDINANCES GOVERNING THIS TVPE OF <br /> LEGALDESCRIPTIONOFPiqPERTY�SNOWNBELOWORATTACHTYYOCOPIES� WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br /> NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br /> �oT e�ocK � AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF AN� <br /> '�� OTHER STATE OR LOCAL LAW REGULATING CONSTfiUCT10N OR THE <br /> PERFORMANCE OF CONSTRUCTION.THAT I AM AUTHORIZED BY THE <br /> OWNER OF THIS PROPERTV TO PcRFORM iHE WORK FOR WHICH <br /> APPLICATION IS MADE AND 1 COMPLY WITH THE STATE <br /> PARCEL TNf LD.NUMBER CONTRACTORS LAW 18.27 RCW AND 296.200 WAC. <br /> CONSTRUCTN7N LOAN LENDER.ADDRESS.TELEIMIONE NUMBER ///� <br /> v/ �i_�O /J����/ <br /> PN ECT ADDIiE88 s '"' E <br /> CIIY BUSH1E59lREN5F ND <br /> PLUMBIN6 MECHANICAL <br /> Np. TYPE OF flXTUNE OR tTEM FEE NO. TYPE OF EOUIPMENT FEE <br /> WATER CLOSET(TOILEn � AIC—NHNDLG UNITS—H.P. � <br /> BATHTUB ; PORCED AIR SYSTEMS—B.T.U. .A. ' <br /> UVATORY(WASH BASIN) � UNIT HEATER�B.T.U. M �_ <br /> SHOWER ' CLOTHES DRYERS ' <br /> KITCHEN SINK 6 DISP � VENTILATION FAN � <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 /> � <br /> FLOOR DRAIN � HEAT PUMP ' <br /> BACKFLOW PREVENTERS ; GAS PIPING <br /> ROOf DRAINS—RAINLEADERS � E%MAUST FAN � <br /> SINK(SEHVICE--BAR,ETC.) � <br /> � ' <br /> � ' <br /> � ' <br /> � ' <br /> i ' <br /> SUB TOTAL S � SUB TOTAL S ' <br /> PERMIT E ' � PERMIT S � � <br /> TOTALFEE S ' TOTALFEE $ ' <br /> FOR OFFICE USE ONLY: <br /> FRONTSETMCK REARSETBACK SIDESETHACK PLANCHECK,N�UMB�ER FEE RECEIPTNO. <br /> �Y� <br /> USE20NE LOTAPEA VACANTSITE FEES VALUATION FEE <br /> ❑ YES ❑ NO BUILDING ' <br /> TYffOFtONST. NO.OFSTORIES occuvu¢r xoaow[wxcuxns � <br /> �AWP PLUMBING � <br /> SIZE OF BLOG. FIRE SPRINKLEflS REO'D BASEMENT MECHANICAL ' <br /> ❑ YES ❑ NO � <br /> OCCUPANCYLOAO FIRE/�IARMRE00 NEIGHTLIMITATION �1D�ITIONALPLANCHECK � <br /> OTHER ' <br /> REASON <br /> STATE BUILDING SURCHARGE � � <br /> INTAI(EBY PLANSAPPROVEDBY CITYOFEVERETT PUBLICWORNS i <br /> LOCALSALES <br /> DATE TAl(CODE IS 3105 TOTAL � <br />