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APPLICATtQ�' FOR CONSTRUCT�N PERMIT � <br /> TO BE COMPLETED IN BLACK INK-QLEASE PRINT <br /> BUILDING �EPARTMENT HEATING SYSTEM: �,GAS ❑ELECTRIC �J -� <br /> 259•8810 <br /> O DEMOLITION L� COMBINATION ;�1 BUILDING �MECHANICAL ❑ PLUMBING O SIGN <br /> OWNER AIAILADLRESS CITV 21P PHONE <br /> �/fG �L��lJ/V 7��0 CJ'��✓u.onoA✓� �✓C�1�En� JJs�� aa8-i�a-9 <br /> TENANT MAIL ADDRESS CITV 21P PHONE <br /> ARCHITECT OF DESIGNER MAIL A�DRESS CITY 21P PHONE <br /> GENERALCONTRACTOq MAILADDRE55 CITY ZIP PHONE STATELICENSEt <br /> MECHANICAL CONTRACTOR MAIL PDDRESS CITY ZIP PNONE STATE UCENSE t <br /> .z�E-�a��,���e�y /9�si-L �!>,..�,-� t,� .�ynr,✓u�oo� 9f�o3G ���-��i.r z��a,r�so�G.r� <br /> PLUMBINGCONiRACTOR MAILAOOREiS GTV ZIP PHONE STATELICENSE� <br /> CONTRACT PRICE OF WORK T , <br /> �i �V <br /> DESCRIBE WORK AND SOUARE FOOTqGE INVOLVEO CONTACT PEflSON AND PHONE NO. <br /> v <br /> � A - �� <br /> I HEREBY CERTIFY THAT I HAVE READ AND EXAMINtD THIS <br /> PROPOSEDUSEOFBUILDING APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT.hLL <br /> PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br /> LEGALDESCflIPTIONOFPROPEFTV�SHOWNBELOWORATTACHTVOCOPIES� WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br /> NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br /> �or o�ocK aF AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br /> OTHER STATE OR LOCAL LAW REGULATING CONS7RUCTION 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 /> PARCELTA%I.D,NUMBER CONTRACTORS LAW 18.27 RCW AND 296.200 WAC. <br /> �os - Oo - O - O O <br /> CCNSTRUCTION LOAN LENDEF.ADDpESS.TELEPHONE NUMBER ' <br /> x .�G�.� ���B�yY <br /> SiGNA1 [ D�iE <br /> PROJECT ADDRESS /�� �a)'J.s/ <br /> . ���0 �'LEA/L<JUO� /7�C cirveusiuEs ucEvsewo <br /> PLUMBING MECHANICAL <br /> � NO. TYPE OF flXTURE OR ITEM FEE NO. TYPE OF EOUIPMENT FEE <br /> WATER CLOSET(TOILEn � A/C-A�HNDLG UNITS-H.P. � <br /> BATHTUB ; / FORCED AIR SYSTEMS-B.T.U. M E.A. ' <br /> . LAVATORY(WASH BASIN) � UNIT HEATERS-B.T.U. M � <br /> SHOWER ' CLOTHESDRYERS ' <br /> KITCHEN SINK 8 DISP VENTILATION FAN � <br /> DISHWASHER � RANGE HOOD ' <br /> LAUNDRY TRAY ; / WATER HEATER ' <br /> � <br /> CLOTHES WASHER � WOOD STOVE � <br /> URINAI METAL FIREPLACE(WOOD BURNWG) ' <br /> DRINKING FOUNTAIN � FIREPUICE INSERT � <br /> FLOOR DRAIN � HEAT PUMP ' <br /> BACKFLOW PREVENTERS ; �.Z GAS PIPING � <br /> ROOF DRAINS-RAINLEADERS � EXHAUST FAN � <br /> � SINK(SEFVICE-BAR,ET0.) <br /> � <br /> � ' <br /> � ' <br /> SUBTOTAL 5 ; SUBTOTAL $ B ' � <br /> PERMIT $ � PERMIT 5 S � � <br /> TOTAL FE•E 5 TOTAL FEE $ ' � <br /> FOR OFFICE USE ONLY: <br /> FPONT SEiBACN fiEAR SETB�CN SI�E SEiBALR PIAN CHECN NUMB R FEE RECEIPT NO. <br /> l���5 <br /> USE ZONE LOT AREA VAC4NT SITE FEES VALUATION FEE <br /> ❑ YES � N� BUILDING ' <br /> iYPEOFC@I57. NOOFSTOPoES aCUPANtr uDINONTlu4GLN�,15 � <br /> c"0uP PLUMBING <br /> S2E OF BLDG. FIRE SPflINKLERS REO'D BASEMENT MFCHAN!CAL � y� <br /> ❑ YES ❑ NO ' <br /> OCCIIPANf,YLOAD FIREALARMREOD HEIGHTUMITATION ADDITIONALPLANCHC-CK � <br /> i <br /> � <br /> OTHER � <br /> --r— <br /> REASON � <br /> S7ATE BUILDING SURCHARGE <br /> MTAKEBY PLANSAPPFOVEDOY CITYOFEVERETT PUBLICWORKS i <br /> LOCALSALES <br /> DATE TAX COUE IS 3105 TaTAL <br />