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APPLICATIO" � FOR CONSTRUCTf �N PERMIT � <br /> TO BE COMPLETED IN BLACK INK-►�LEASE PRINT <br /> DUILDING DEPARTMENT HEATING F'lSTEM: GAS _Ll ELECTRIC ❑__ __ � I <br /> 259-8610 <br /> II <br /> i 1 DEMOLITION C 1 COMBINATION I 1 BUILDIMG �MECHANICAL ❑ PLUMBING ❑ SIGN � <br /> OWNER AI\IL�DDRE55 CIN ZIP PHONE I <br /> �����o„tr ssoy F�,.�y s�ue �veretl wc�4k�1 a�,q- �� a... + <br /> T[NANT AIqILAD�R[SS <br /> CITY 21P PHONE <br /> �'� <br /> AFCHITECTOPDESIGNER AIAILADORE55 GTY ZIP PHONE <br /> GENEPALCONTqqC70R MAILAODRESS CIiY ZIP PHONE STATE�ICENSEt <br /> ldELHFNICALCONiRFCiOR MFIIA�ORESS CITV ZIP PNONE STATELICENSEt <br /> �c�li�w_t�ci�-�na 12oz �ur�rN� it SS �uere �-f ux� 9Qzoi 3� -�3yc� Se4 u� h�99d � <br /> PLUMBINGCONTdACTOR b;pILqDORE55 CITY ZI? PHONE STATELICENSEr <br /> CONTRACi PRICE Of WOPK — <br /> [�L�.°� <br /> �[SCRIBE WORN AN�SOU�RE FOOTAGE IIlVO�VED CONi�GT PERSON AND PHONE N0. <br /> � � <br /> i HEREBY CERTIFY THAT I HAVE REAC .�.ND EXAMINED THIS <br /> �r�oPoseo use F BWLDING AppLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT.ALL <br /> S� � PROVISIONS OF LAWS AND OR�INANCES GOVERNWG THIS TYPE OF <br /> ILGAl0E5CfiIPT10NOFPROPERTY�SHOlVNBEIOWORARFCHTWOCOPIES� WORK WILL BE COMPLETED WITH WHETHER SPECIFIEU HEREIN OR <br /> i�r D�aK pp NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br /> AUTHORITY TO VIOLATE OR C�NCEL THE PROVISIONS OF ANY <br /> OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br /> PERFOFMANCE OF CONSTRUCTION.THAT I AM AUTHORIZED BY THE <br /> OWNER OF THIS PROPERTV TO PERFORM THE WORK FOR WHICH <br /> an�w�rnxio.Nuueea APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> �1/��1 - (X��-DO 1=0pp "7i CONTRACTORS LAW 1827 RCW AND 296200 WAC. <br /> cqN57RUCTION�OAN IENDER,�DDRESS.T[LFPNONE NNd�ER _11'���_",�'�'7 <br /> § � � � <br /> PRQ J��F.Ci ADDRE S s�a:nruee o��E <br /> 325UU Fr�d �.�Pre+� � �€Zd 1 �,��A�:„«<<,«����:� -- <br /> PLUMBING MECHANICAL <br /> N0. TYPE OF FIXTURE OR ITEM FEE N0. TYPE OF EOUIPMENT FEE <br /> WATEP CLOSET(TOILET) � A'C—A�HNDLG UNITS—H.P. <br /> 8ATH1.1B FORCED AIR SYSTEMS—B.T.�. M E.A. <br /> LAVATOF'.Y(WASH BASIN) UNIT HEATERS—B.T.U. M <br /> SHOWER � CLOTHESDRYERS �— <br /> KITCHEN SINK 8 DISP � VENTILATION FAN <br /> DiSHWASHER RANGE HOOD —�— <br /> LAl1NDRY TRqY 1VATER HEA'i ER � <br /> _ CLOTHES WASHER � WOODSTOVE <br /> _ URINAL � METAL FIFiEPLACE(WOOD BURNING) � <br /> DRINKING�=OUNTAIN ; FIREPLACE INSERT � <br /> FLOOR DRAIN � HFAT PUMP '-- <br /> BACKFLOW PREVENTERS G.4S PIPING � <br /> _ ROOF DRAINS—RAIIJLEADERS EXF'AUST FAN <br /> SINK(SERVICE—BAR,ETC.) � — <br /> � — <br /> __ SUB TOTAL 5 SUB TOTAL 5 <br /> ''ERA11T 5 PERMIT S <br /> TOTAL FEE S TOTAL FEE S <br /> FOR OFFICE USE ONLY: <br /> IRO4TSET�ACK REARSETPFGN SIOESETO�CN PLAIlCH'cIX NU1.1�[H c[[ REC6PitIJ <br /> �� ..,�•� <br /> USEZOVE LOTAREA VACANTSIiE FEES VALUATION FEE <br /> r YES f : NO BUiLDiNG <br /> hPEGf(ONS7 NO.OFSTORiES o[cavnt-v r.oC�Pxnur.:unns -- _ <br /> �aa'� PLUM1IBING . <br /> SiZE OF BLDG. FIRE SPRINKLERS REO'D BASEAIENT i <br /> � YES I� NO �`�ECHANICAL <br /> OCCtIPr1NGY LOAD FIqE ALARM REOD NEIGHT IIMITATION ADDITIONAL PLAN CHECK <br /> REASON <br /> OTHER <br /> —T <br /> STATE BUILDING SURCHARGE <br /> IYTAKEBY PLAHSAPPflOVEDO� CITYOPEVERETT PUBLICWORKS ��— I <br /> LOCALSALES 1 <br /> DAiE TAX CODE IS 3105 TOTAL <br /> I <br />