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APPLICATIOW �OR CONSTRUC7IVN PERMIT °`�''°" <br /> ;. ,E., r, TO BE COMPLETED IN INK—PLEASE PRINT � <br /> cirvor <br /> eve rett HEATING SYSTEM: � GAS O ELECTRIC U __— ---� <br /> BUILDING DEPARTMENT <br /> 259-BB1G <br /> DEMOLITION COMBINATION BUILDING ECHANICAL PI.UMBING l SIGN <br /> 01YNEP MPILR�OR[55 f CIiV 21P %NONE(, ��� /�/^ <br /> ,I���,,•'S /(, 0!/�.t' , L � � <br /> / •f � 3 �G�-n�r.c,o�..� 6I '� �' tT i�'2o3 <br /> TENANT MFiLAD�RE55 GITY ]iP PHONE <br /> p � y� pRLNITECTOR0E51GNEA MAILRJ�RESS QTY 21P PHONE <br /> C F] y <br /> �7L G[N^ERN'I CION'TRhAC�TON MAIL ADDRE55 GITY ZIP PNONE LICENSE I <br /> Z (/W /��� <br /> K �] 'n�17' 1.�[GMANtGALGONIRAGTON MAILADDflE55 CITV 21P PMJNE UCENSEI <br /> O w o a �n,��--rt — <br /> � y I-�i <br /> FWMBiNGGONiFRCTOR MAILA�DRE55 GTY IIP PHONE LIGENSE� <br /> � �y �p 0.ASS OF WORK . � <br /> p NEW � ADDITION �ALTERATION � REPAIR � DEMOLITIOW � WOODSTOVE/FRPLINSERT BUILDINGRELOCATION <br /> � � (1 CONTACTPENSONRN�PNONENO. <br /> � <br /> � y � CONTRAGT PR�CE OF WORN U ` 1� L ..n-) <br /> N y DESCRiBEWOAKAN�50UAREFOOTRGEINVOlVEO � y�j� e�y G j �'�G�l <br /> ¢ M � �p� �y , „sst.p�.2'T4 <br /> '" C y PROPOSEDUSEOFBUILDING � � )� I HEREBY CEPTIFY THAT I NAVE READ AND EXAMINED THIS <br /> � [q � 0 APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT.ALL <br /> y PROVISIONS 7F LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br /> p tA LEGRLDESCRiPTIONOiFPOPERP'ISHOWNOEIOWOflAT7ACHF0URCOPiE51 WORK WIIL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br /> iot etocK oF NOT. THE GRANTING OF A PEflM1T DOES NOT PRESUME TO GIVE <br /> AUTHORITY TO VIOLATE OF CANCEL THE PROVISIONS nF ANY <br /> OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br /> PERFORMANCE OF CONSTRUCTION.THAT I AM AI;THORIZEO BV l"HE <br /> OWNER OF THIS PROPERTY TO PC-RFORM THE WORK FOR W'HICH <br /> APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> CONTRACTORS LAW 1027 RCW AND 296200 WAC. <br /> SIGNAiUREO G NTPRGTORORAUTMORIZEDRGENT DATE � <br /> X , . �� _ <br /> aaaecr nooaess <br /> ��� <br /> 6 � •�� J , �- qPPLICANTSCITV�U5�NE55 NSE OAN�OUSMESSNRME <br /> 1_� • v <br /> PLUMBING MECHAI�ICAL <br /> i��: NO. TVPE OF FIXTURE OR ITEM FEE NO. TYPE OF EOUIPMENT FEE <br /> WATER CLOSET(TOILET� A'C—NHNDLG UNITS—H.P. <br /> . BA1 HTUB FURCED AIR S`.'STEMS—B.T.U. M E.A. <br /> LAVATORY(WASH BASIN) UNIT HEATERS—B.T.U. M � <br /> SHOWER CL07HE5 DRYERS <br /> � VENTILATION FAN <br /> 1 I '. KITCHEN SINK R DISP �—*-- <br /> �� <br /> '� DISHWASHER RANGE HOOD <br /> LAUNDRVTRAY WATERIIEATER <br /> CLOTHES WASHER WOOD STOVE <br /> i I URINAL METAL FIREPLACE 8 CHIMNEY _ <br /> � DRINKING FOUNTAIN FIREPIACE INSERT <br /> . FLOOR DRAIN HEAT PUMP <br /> BACKFLOW PREVENTERS GAS PIPING <br /> � ,�' ROOF DRAINS—flAINLEADERS E%HAUST FAN <br /> � SINK(SERVICE—BAR,ETQ) � <br /> i <br /> i <br /> +. ,�► _ i <br /> i <br /> __, ., � <br /> SUB TOTAL $ SUB TOTAL S /S'i_ <br /> PERMIT $ PERMIT 5 IJ___ <br /> t TOT�LFEE $ T07. FEE S 30 '— <br /> �� <br /> FOR OFFICE USE ONLY: <br /> fRONT5E1[iRCK REARSETBALK SiDESETBACN PLRNCN[CNNUMBER �EE RECEIPTNO <br /> uselor+e �oi�Ree V�LANTSITE FEES VAIUATION FEE <br /> BUILDING <br /> TYPEOFCONB.PLLOWABIE iYFEOiCONSLALTURI Occaoxµ�v xOwNvuiwcuxus i <br /> wwv pLUA1dING <br /> i <br /> 512E OF BlDO. NOAi STONIES �ASEMENT MECHANICAL '�d " <br /> OCGUPANGYLOAD FIRESPRNKLERSRW'D HEIGNTLIMITATION ADOITIONALPLANCHECK <br /> ' OTHEfl <br /> -_i__ <br /> REASON FOR SPRiNNLERS � <br /> STATE BUII�ING SURCHARGE ! <br /> INTAKEBY FUNSAPPROVEDFIY CITYOFEVERETT PUBLICWORK$ � <br /> LOCRLSALES <br /> TAX COOE IS 3105 TOTAL �a ; — <br />