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APPLICATIC l FOR CONSTRUCT�N PERMIT <br /> TO BE COMPLETED IN BLACK INK—PLEASE PRINT � <br /> BUILDING DEF,Iri fMENT HEATING SYSTEM: 'J GAS � LECTRIC 0 � <br /> I259-8810 <br /> I I DEMOLITION �COMBINATION I 1 BUILDING I l MECHANICAL I I PLUMBING I_1 SIGN <br /> OWNER �,1qILqDDRESS CITV ZIP PNONE <br /> 'd i�lchaaL�ah.�r�,> �io .�'e.�n.�PAa�. ,,,[^/ r'•� � n J�-�+ <br /> TENANT MFILADDRESS O /'�� C JC /I l�_J�G� L,1J�J—/�9 O <br />�I {� CITV ZIP PNONE � <br /> �JCLYJC L�J' (1�/vG <br /> ARCNIT CTORDESIGNER�� MAILADDRESS CITV ZIP PHONE <br /> iGENERAL:ONTRACTOR �� MAILq��RE55 CITY 21P PHONE STATELICENSEM <br /> MECHANICALCONiRFCTO�/ MAILADDRESS CITY ZIP PMONE STATEUCENSE� <br /> PLUMBINGCONTFACTOR MAILADORE55 CITV 21P PNONE <br /> // STATE LICENSE tl <br /> CONTRAGT PRI�FOWORK �� ^a ry <br /> � �� � <br /> O � <br /> DESC IBE 1 ORK ANO SOUARE FOOTAGE IN OLVED CONTACT PEflSON AND PMONE NO ���� <br /> ��:o n` -�m,�, .rao�?G�,�c; ' <br /> 4na� Gcc�o�/ c,% e c e� - �'2Z <br /> ,4wTn e � -� <br /> �� �- i HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br /> PROPOS :EOFBUILUING qppLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT.ALL <br /> PROVISIONS OF LAWS AND ORDINANCES GOVEflNING THIS TYPE Of <br /> ' LEGALOESCRIPTIONOFPRCPEflN�SMOWNBELOWORARACHTW�oaies���'`�' NOT. THELGRANTIO GPOF A ERMITJDOES NOT PRIESUMEETOIGNE <br /> ' LOi�� BLOCK �I� �F LGLU/[C � oL S_ <br /> � AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br /> OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br /> PERFOR�7ANCE OF CONSTRUCTION.THAT I AM AUTHORIZED BY THE <br /> OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br /> PARCELT � � NUMBER APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> �S���j`�� �� _ �j'�f CONTRACTORS LAW 1827 RCW AND 29fi.200 WAC. <br /> CONSTRUCTIONLOANLENDER.AUORESS.TELEPHONENUMBEfl � � J/ <br /> ��%3',G�fJkt� bf�yt0-� o�–/��f� <br /> PROJECT AD�pRESS y��,A,un� o„iE <br /> �Cf/U Ge�inmPieG�CL �AVC� (/PieP� C✓ cn.euswessucer+scr�o - <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FI%TURE 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 /> LAVATORY(WABH BASIN) i UNIT HEATERS—B.T.U. td ; <br /> SHOINER � CLOTHES DRYERS � <br /> KITCHEN SINK 8 DISP ; VENTILATION FAN <br /> DISHWASHER � RANGE HOOD , <br /> LAIiiJDRY 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 PIPING � <br /> ROOF DRAINS—RAINLEADERS � EXHAUST FAN / ; <br /> SINK(SERVICE—BAR,ETC.) � , <br /> , � <br /> T <br /> 1 � <br /> � 1 <br /> I � <br /> SUB TOTAL S ' SUB TOTAL $ ' <br /> PERMIT S � PERMIT S <br /> TOTAL FEE 5 ' TOIAL FEE S � <br /> FOR OFFICE USE ONLY: <br /> FFONTS@TBACK REARSETBACK 5'DESETBACK PLANCHECKNUMBER FEE RECEIPTNO. <br /> � � i � . � � , I �7, .S 9 � �o�' <br /> usezo e LOTAREA VACANT51 FEES VALUATION FEE <br /> ! C YES � NO BUILDING Z'� 3Z Z 'JZ� <br /> 7vPE0FCON5i. NO.OFSiOR�Es aeuvnr�er xoo�oxe.uueur;i�s <br /> �' /,,/, � �q� PLUMBING � <br /> SIZE OF BLDG. FIRE SPRINKLEF75 REO'D BASEMENi .�i <br /> S�c .p � �O MECHANICAL � �,. <br /> C! YES ❑ NO �— <br /> � <br /> IX:CUPANCYLOAD FIREALAPMREOD HEIGNTUMITq710ft ADDITIONALPLANCHECK `� <br /> A u ZS ' <br /> OTHER <br /> REASON <br /> STATE BUILDING SURCHARG[ ) <br /> WTAHEBV P'_ANSA P�EDBY CITYOFEVERETT PUBLICWORKS � .' <br /> LOCAL SALES "T— <br /> o�re /¢ TAX CODE IS 3105 T�7AL • ' <br /> J <br />