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APPLICATIQ"�' FOR CONSTRUCT!1N PERMIT � <br /> �(� � TO BE COMPLETED IN BLACK INK—PLEASE PRINT <br /> p <br /> HEATING SYSTEM: C]GAS ❑ELECTRIC <br /> B JILDING DEPARTMENT <br /> 259-8810 <br /> ❑ DEMOLITION ❑ COMBINATION ❑ BUILDING ❑MECHANICAL ❑PLUMBING ❑ SIGN <br /> O ER MAIL AODRESS CITY 7�' PMONE <br /> A� �.�d 1 �c�ti�.�� a3�g �C��C«..-6�,� ����n��7 w,� 9�3 3ss-S5�33 <br /> TEN T MAILADDRE55 CITY 21P fNONE <br /> \ \ C ( �. PC ( t � f <br /> �RCHITECT OR DESIGNER MRIL ADORESS CITY ZIP 7HONE <br /> ��i�R:a.1 �� Gk.r� �uo2� 3S'�"'�aS 7 Z <br /> GcNEFALCONTRACTOR MPILADDRESS CIN ZIP PHONG STATELICENSE� <br /> ��,� a�:� ,,�, l�ps � ,��.as�°- e�,Q�Z <br /> MECHANICALCONTRACTOR MAIL�DDflE55 CITY ZIP PHONE STATELICENSEt <br /> PiUMBINGCIXJTRACTOR MAILAODRESS CIiV 21P PHONE STATELICENSE• <br /> CONTRACT PRICE O�WORN <br /> �Y v / <br /> OcSCRIBE WOHK AND 50 �RE FOOTAGE INVOLVED CONTAC P RSON AND PHONE NO., ���`_/j��� <br /> ( .� c i <br /> ��i�v6 o�U � lL(A�:It>2 �ci-��a°n �' - <br /> • (D /C S-�` � I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br /> PROPOSED USE OF BUILDING APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT.ALL <br /> � � PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br /> ,LEGALDESCRIPTION PROPERTV WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br /> �or � -� BLOCK���m OF �� — �G — NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br /> / AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br /> �" — / $/ �J o%� L e T/� �C�JJ' T%• t RD OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br /> ` PERFORMANCE OF CONSTRUCTION.THAT I AM AUTHORIZED BY THE <br /> ��T / �GSf fTf il . OWNER OF THiS PROPERTY TO PEHFORM THE WORK FOR WHICH <br /> APPLICATION IS MADE AND I COMPLV WITH THE STATE <br /> PARCEL TAX 10.NUMBER CONTRACTORS LAW 7827 RCW ANO 296.200 WAC. <br /> - m _ o2 — bl - ODm n <br /> CONSTRUCTION LOAN LENDER,ADDRESS,TELEPHONE NUMBER Y �_k_ /� // ' <br /> '�� 7-i6-93 <br /> PROJECTADD SS 51(+N�iUFE ��*E <br /> LI_ �Lu� � U�� � CRYBIISMESSL�CENSENO. <br /> V— <br /> , PLUMBIN6 MECHANICAL <br /> N0. TYPE OF FlXTURE OR ITEM FEE NO. TYPE OF EOUIPMENT FEE <br /> WATER CLOSET(TOILET) � A/C—A/HNDLG UNITS--H.P. � <br /> BATHTUB ; FORCED AIR SYSTEMS—B.T.U. M E.A. ' <br /> IAVATORY(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 DRAIN ' HEAT PUMP ' <br /> BACKFLOW PREVENTERS ; GAS P�PING � <br /> pOOF DRAINS—RAINLEADERS � ExHAUST FAN � <br /> SINK(SERVICt—BAR,ETC.) � <br /> � ' <br /> � ' <br /> � ; <br /> � ' <br /> SUB TOTAL $ ; SUB TOTAL $ ; <br /> PERMIT $ � PERMIT $ i <br /> TOTAL FEE $ TOTAL FEE $ ' <br /> FOR OFFICE USE ONLY: � d ' <br /> FRONT SETBAGN flEAR SETBACN SIOE SETBACK PLAN CHECK NU6IBER F � RECEIPT NO. <br /> �, � -../ � � - Z Z, S 2?,�� <br /> USE ZONE— � LOT AREA VACANT SITE FEES VALUATION FEE <br /> ❑ YES ❑ NO BUILDING Z 23(0 ���75 <br /> flPEOFCONST. NO.OFSTORIES octUPurtr NaorDwilliHGUNnS � <br /> tP013 PLUMBING y <br /> � �_ <br /> SIZEOFBLOG. FIRESPRINKLEFSREO'D BASEMENT � � MECHANICAL � <br /> . 5� ��J ❑ YES Lti'NO ' <br /> OCCUPANCV LOAD FIRE AURM fiEO'� HEIGMT JLIMITRTION ADDITICNAL PLAN CHECK —T' <br /> ,(,. J C� / OTHER � <br /> REASON 'J^� <br /> STATE BUILDING SURCHARGE <br /> INTANEBY PLANSAPP�VEDBY CITYOFEYERETT PUBLICWORKS � <br /> J LOCAL SALES <br /> onre �L TAX CODE IS 3105 TOTAL �` '2.� <br />