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APPLICATION FOR CONSTRUCTI'4N PERMIT � <br /> TO BE CUMPLETED Ik BLACX INK—PLEASE PRINT ��+�. rTr <br /> BUILDING DEPARTMENT HEATING SYSTEM: ❑GAS U ELECTRIC J � <br /> 259-8810 <br /> ❑ DEMOLITION ❑ COMBINATION ❑ BUILDING A'I�ECHANICAL ❑PLUMBING i_1 SIG"1 <br /> OWNER MAILAODRE55 CITV ZIP PHONE <br /> �`�.�cl Lc�4. - �� �F 1����� � �7�� <br /> TENANT MAILADDRESS CITV 21? PHONE <br /> A,.1 l�I�,/�`� � 1� ) F_o��' �F{r�f.� <br /> ARCHITECTOPDESIGNER MAILADORESS C�TV ZIP PHONE <br /> GENE ALCONTRACTOR MAILADDRE55 CITV ZiP PHONE STATELI ENSE� <br /> ////// � �n� tir �. ��, �T-�z 7 �oo �1-loe� ���i �c� 5�� quti_��g -�( to ouFf�c�Nro3� <br /> f �.IECHANICRL CONTqACTOR MAIL ADDRE55 pTV ZIP PHONE STATE LICENSE M <br /> �i <br /> PLUMBING CONTRACiOR MAIL AUDFE55 CITY ZIP PHONE STqTE LIGENSE t <br /> CONTRALT PFICE OF WORK <br /> .� <br /> DESCflIBE WORK AND SOUARE FOOTAGE I� LVED CONTACT PERSON ANC PHO.NE NO. <br /> – �Z � (1 <br /> ' C.. (Lf� ��F'i r <br /> I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br /> PROGOSED USE OF BUILDING APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT.A!L <br /> PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br /> ICGALDESGRIPTIONOFPROPEFTV�SHOWNBELOWORATTACHTYOCAPIES) WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br /> �or �LOCK oF NOT. THE GRANTINu OF A PERM�T DOES NOT PRESUME TO GIVE <br /> AUTHORITY TO VIOLATE OR CANCEL 'iHE PFiOVISIONS OF ANY <br /> OTHER STATE OCAL LAW REG I G CONSTRUCTION OR THE <br /> PERFORMAN OF CONST TI .TH T I A THORIZED BY THE <br /> OWNER T S R RTY PERF R WORK FOR WHICH <br /> PARCELTA%I.D.NUM9EF APPLt ATI I ADE D I O P WITH THE STATE <br /> CONT C VJ 18.27 W AND 20 AC. <br /> CONSTRUCTION LOAN LENDER.ADDRESS.TELEPHONE NUMBER <br /> PROJECT ADDRESS C . saH�ruae oer <br /> � L. � L, �� crtv ousiNEss i ae r+o <br /> PLUMBING MECHAN AL <br /> NO. TYPE OF FIXTURE OR ITEM FEE NO. TVPE OF E�UIPMENT FEE <br /> WATER CLOSET(TOILET) � 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 CLOTHES DRYERS � <br /> KITCHEN SINK 8 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 /> FLOOR DR,�IN � HEAT PUMP � <br /> BACKFLO\Y PREVENTERS ; GAS PIPING p I ; <br /> ROOF ORAINS—RAINLEADERS � EXHAUST FAN <br /> SINK(SERVICE—BAR.ETC.) ; <br /> � <br /> � � <br /> � � <br /> � � <br /> � <br /> i <br /> SUBTOTAL $ ; SUBTOTAL $ 0� ' <br /> PERMIT $ � PERMIT $ / � <br /> TOTAL FEE $ ' TOTAL FEE $ � <br /> �OR QFPICE USE UNLY: <br /> FRONT SETBACK REAR SETBACK SIOE SETBACN PLAN CH CK NUMBER FEE REGBIPT NO. <br /> �->' �- -' <br /> USEZONE LOTAREA VACANTSIiE FEES VALUATION FEE <br /> ❑ YES C_I NO gUILDING � <br /> TYPECFLONSi NO.OFSTORIES occurnn'tr riowrnv[wxcuNrts � <br /> cnouo pLUMBING ' <br /> SIZE OF BLOG. FIRE SPPINKLERS PEO'D BASEMENT MECHANICAL � <br /> ❑ YES u NO / <br /> OCCUPANCV LOAD FIRE ALARM REO'D HEIGHT LIMITATION ADDITIONAL PLAN CHECK <br /> OTHER <br /> REASON <br /> . STATE eUILDING SURCHARGE ; <br /> INTAKEBY PLANSAPPROVEDBV CITYOFEVERETT PUBLICWORKS <br /> LOCALSALES <br /> on,e TAX CODE IS 3105 rora� <br />