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Q <br /> .�T" � AppLICATIQ�y �0i'� CONSTRUC�'t�N pERMIT � �� <br /> TO BE COM?LETEO IN BLACK INK—PLEASE PRINT <br /> . HEATING SYSTEM: U GAS ❑ELECTRIC ❑_ — <br /> BUILDING DEPARTMENT <br /> ���� 259•8810 <br /> � p� f I � DEMOLITION COMBINATION ' BUIt DING :�(MECHANICAL— , I PLUMBIkG SIGN �»u�I' <br /> ri pyMEq MRILAD�RESS /L � p� /pCItV ZiP PMONE � <br /> �.��� :: ��-c�fe. �n- S(l5 �SL� /1'�c� u��� !��1s��IlG �1�2�u (o1`t� 12�J <br /> � �p� MAIIADDRESS CITV ZIP PNONE <br /> ��� � � <br /> ARCHITEG�ORDESIGNER MAIIR�ORE55 CITV 2�F PHONE <br /> p� GE RALCONT A�10R MAiL�DORE55 CITY 21P PMONE STATELICENSE+ <br /> p,,� � �oL,t�v.c(i�. �i2 5 7S /l,r< itJC— A1'inasoi��c. �i��o C��`I t Z7� (GK( D�o,�'' I G,�j nl� <br /> MECM/�N�CONTMGTOR M�ILADDRE35 CITY ° 21P PHONE STATELIGENSE� <br /> �°€3� i. �.�. � <br /> Or � PLUMBING TRACTOR MAILAODRESS CITY ZIP PMONE 87RTELICENSE• <br /> H � <br /> ClAASOF WOHK <br /> �M� p i.i NEW Q!ADDITION I � ALTERATION REPAIR � DEMOLITION �, -� WOODSTOVE/FRPL INSERT �� B�ILDING RELOCATION . � <br /> ��� ` COYTACT PEPSON ANO PMONE N0. <br /> f CONTR�CTPRICEOFWORK �.`7�/�� � <br /> ��� 3 DESCPI E WORN�ND SOUIHE FO(JIAGE INVOLVED � � � <br /> � 5 � 1'oM <br /> PROPOSEOUSEOFBUILDING i HEREPY CERTIFY THAT I HAVE READ AND E%AMINED THIS <br /> '—� �a APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT.ALL <br /> LEGFL�ESGRIPTIGNOFPOPERttISHOWNBELOWORAiT�CMFOURCOPIES) PROVISIONSOFLAWSANDORDINANCESGOVERNINGTHISTYPEOF <br /> WORK IVILL BE COMPLETEO WITH WHETHER SPECIFIED HEREIN Oa <br /> 4 �pr etocK oF NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br /> AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br /> . � OTHER STATE OR LOCAL LAW REGULATING CONSTRUC?ION OR THE <br /> � � PERFORMANCE OF CONSTRUCTION.THAT I AM AUTHORIZED BY THE <br /> OWNER OF THIS PROPERTY TO PEFiFORM THE WORK FOR WHICH <br /> 4 APPUCAT N IS M DE AND I COUPLY WITH THE STATE � <br /> - CONTRA RS LAW .27 RCW AND 296200 WAC. <br /> " x / L/`l7-Gj� <br /> �� PR �TA�DRESS /� s�� uR� n+fE <br /> S �J9�/ �(,��>t� �� L��'� r.��rvnusiNess��ceNsrrvo <br /> � k PLUMBING MECHANICAL <br /> , ���'' t NO. TYPE OF FIXTURE OR ITEM FeE NO. TYPE OF EQUIPMENT FEE I <br /> Iti WATEh CLOSET!TOILET) A�C—A/HNDLG UNITS—H.P. � <br /> f + ; FORCED AIR SYSTEMS—B.T.U. M E.A. ( <br /> BATHTUB <br /> LAVATORY(WASH 9ASIN) � UNIT HEATEAS—B.T.U. M I <br /> C�� � � CLOTHESDRYERS ' <br /> SHOWER <br /> � KITCHEN SINK 8 DISP Z VENTILATION FAN __� i <br /> � DISHWASHER RANGE HOOD � <br /> I LAUNDRYTRAY WATER HEATER I <br /> ' � `�' { CLOTHES WASHER WOOD STOVE � '� <br /> URINAL METAL FIREPLACE 8 CHIMNEV '— I <br /> � DRINKING FOUNTAI;v FIREPLACE INSERT <br /> I FLOOR DRAIN HEAT PUMP : <br /> � � � BACKFLOW PREVENTEHS GAS PIPING � � <br /> I �t� ' ROOF DRAINS—RAI�LEAOERS E%HAUST FAN ;__ �. <br /> � , SINK(SERVICE—BAR,ETG) , <br /> i <br /> , ���I , - - <br /> I <br /> ! ' SUBTOTAL $ SUBTOTAL S � <br /> ,_�' .• PERMIT S PERMIT 3 ' <br /> ` TOTALFEE $ TOTALFEE 5 <br /> FOR OFFICE USE ONLY: <br /> FRONT SETOACN REAR SEiBACK SIDE SETB4GK PLAN CNECN NUMBER FE[ RECEIPT NO. <br /> 3lD-�y'S <br /> useio�ue LOTAREA �'ACRNTSITE FEES VALUATION FEE <br /> BUILOING <br /> IYPEOFLONiS.ALLOWABIE 7YPEOfCON51.ACiUAt IXNOAN:v xaMVN[uixGUVrts <br /> 4qWP � PLUMBING � <br /> i <br /> SIZEOF9LOG. NOAFSTORIES BASEMENT MECHANICAL � <br /> OCCl1PRNCYIOAD FIRESPliNHLEP5flE0'0 MEIGHTLIMITATION ADDITIONALPLANCHECK <br /> SPRINKLE�i <br /> FEASONfORSPRINNLEPS <br /> ----i— <br /> STATE BUILOING SU�CHARGE <br /> i <br /> INTANEBV PLRNSr1PPPOVEDOY CITYOFEVERETT PUOLICWORNS i <br /> LOCAL SALES � I <br /> TAX CODE IS 3705 rorn� <br />