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APPLICATIC�I FOR CONSTRIJCT"l�! PERMIT � <br /> TO EE CCMPLETED IN BLACK IIJK—PLEASE PRINT <br /> BUILDING DEPARTMENT HFATING SYSTEM: �(GAS ❑ELECTRIC ❑ _ � <br /> 259-8810 <br /> L! DEMOLITION �J COMBINATION L : BUILDING MECHANICAL ;i PLUMDING SIGN <br /> OWNcR MAILAODRESS CITY LP — <br /> PHDNE <br /> ��%�i(' Sv�..S I:LE,�i%�„� /k'e C� `,�3L�� � <br /> iGNRNi MAILApURE55 �ITV ZiP FHGNF <br /> ABCHIi@CTOR�ESIGNEfI MRILA��RE55 GTV ZIP PHONE <br /> GENFPALCCV'aF�:i!Ip NAILAD�fiESS CITY .JP PNONE STATELILENSE� <br /> MEGNAN�CSLCG�'iF4CTpq MPIL�DDRESS CITV ZIP PHONE STpTEUCENSLI <br /> E��. s,-;< : _�cet/��.-.ot- ? y ,�,�_ S �,�. qgz,�, 25'z—i,'ry E•�F/'/:siZ //,-7 <br /> PWMpINGC0111�IqCTOH MAILAO�R°55 CITV ZIP PHONE STATELICBNSEI <br /> CONTRaGT PRICE OF WORN — <br /> Co <br /> C77}� ' <br /> 0[SCRiOE WORN ANO SCUFRE FOOTAGE IN�'OWED CONTACT PERSON ANO PMONE NO. .y� <br /> �^:4/lic:F nccT ���c �,r�CnJA'! ?� `>.�,— J� L._� -� Y'f/ <br /> I HEREBY C[RTIFY THAT I HAVE READ AND EXAMINED THIS <br /> rnoaoseo use oc emioiNc APPLICATION AND KNO�V TI IE SAME TO BE TRUE AND CORRECT.ALL <br /> �S% PJE)L�7//��- PROVISIONS OF LAWS ANC ORDINANCES GOVERNING THIS TYPE OF <br /> LECALOESCRIPTIONOFPROPERTV�SHOWNBELOWORAifACNTWOGOPIES� WORK WILL BE COh�1PLETED WITH WH.THER SPECIFIED HEFEIN OR <br /> NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br /> �or e�ocrc oF — AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br /> OTHEP. STATE OR LOCAL LAW HEGULATING CONSTRUCTION OR TNE <br /> -- — PERFORMANCE OF CONSTRUCTION.THAT I AM AUTHORIZED BY i�HE <br /> OWNER OF THIS PROPERTY TO PERFORM TI1E WORK FOR WHICH <br /> APPLICA�fION IS MADE AND I COMPLY WITH THE ST4TE <br /> rnace�rnx i o.r+utiteea CONTRACTORS LAW 1827 RCW AND 296.200 WAC. <br /> CONSTRUCTION LOAN LENGER,AOCIRESS.TELEPIIONL YUMBER <br /> /� <br /> � � !.- <br /> -i <br /> PROJECT ADDRESS — xe��e� �'f w c�� �,`� � <br /> .�.°S �(.F_A�L.•/»' f?�/% f='% oivr�.�s�:.ssucreservo .. — <br /> PLUMBING MECHANICAL <br /> NO. TVPE OF FIXTURE OR ITEM FEE NO. TYPE OF EOUIPMENT FEE <br /> WATER CLOSET(TOILET) A�C—AIHNDLG UNITS—H.P. <br /> BATHTUB ; FORCED AIR SVSTEMS—B.T.U. � E.A. <br /> LAVATORY(WASH BASIN) � UNIT HEATERS—B.T.U. M <br /> SHOWER � CLOTHESORYERS �— <br /> _ KITCHEN SINK&DISP � ; VENTILATION FAN � <br /> DISHW�SHER RANGE HOOD � <br /> LAUNDRYTRAY ; WAT[R HEATER <br /> CLOTHES WASHER WOOD STOVE <br /> URINAL METAL FIREPLACE(WOOD BURNING) ! <br /> DRINKING FOUNTAIN FIREPLACE INSERT ; <br /> FLOOR DRAIN � HEAT PUMP �— <br /> BACKFLOW PREVENTERS _ ; GAS PIPING � '� <br /> ROOF DHAINS—RAINLEADERS � EXHAUST FAN <br /> SINK(SERVICE—BAR,ETC.) ; � �I <br /> � <br /> —T— I <br /> � ' I <br /> � , — <br /> I <br /> SUB TOTAL 5 SUB TOTAL S ' � <br /> _ _ PERMIT S PEFMIT S l ' � <br /> TOTAL FEE S TOTAL FEE 5 � � <br /> FOR OFFICE USE ONLY: � <br /> FBONiSEi�ACK R6IRSETOnCK SID[SETOACK PLANGHELKNUMd� iEE REGE�PTNO. <br /> / //�3 <br /> USEZONE LOiAREA VpCANT5ITE FEES VALUATION FEE ' <br /> ❑ YES ❑ NO BUILDWf, ' <br /> 1VPEOfLONST NOAFSTORIES acur4vcr NOcrc�uurvc,nns � --- - <br /> r.�o�.i> pLUMBING <br /> i <br /> SREOFBLDG. FIRESPPINNLEPSREOD BASEMENT � <br /> MF.CHANICAL i <br /> ❑ YES f_i NO -- <br /> OGCUPANCY lOAO PIRE ALARM FEOD HEIGNT LIMITATION ADDITIONAL PIAN CHECK � <br /> i <br /> OTHER i <br /> REASON <br /> --T' <br /> STATE�UILOING SURCHARGE ; <br /> INTAKERV PLAN54^PROVEDPY CITYOFEVERETT PUOLIC\70HK5 <br />� LOCAL SALES — <br /> on.e TAR CODE IS 3105 TOTAL <br />