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APPLICATIC�1 FOR C�iNSTRUCT'�N PERMIT � <br /> TO BE COMPLETED IN BLACK INK—PLEASE PRINT <br /> BUILDING DEPARTMENT HEATING SYSTEM: []GAS ❑ELECTRIC 0 <br /> 259•8810 <br /> ❑ DEMOLITION ❑ COMBINATION ❑ BUILDING CI MECHANICAL l�(PLUMBING ❑ SIGN <br /> OWNE MAILADDRESS CITY ZIP PMONE <br /> 5 �ri �. c��— 6aa9 C���< « <«r ��z� 3 35 S �.s" o3 � <br /> TENANT MAILADOFESS CITV ZIP PHONE <br /> AF"ITECTORDESIGNER MAILADDfiE55 CITV ZIP PHONE <br /> GENEflAL CONTflAGTOR MAIL ADDfl[C i pTY ZIP PHONE STATE IICENSE� <br /> MECHANICAL CONTRRCTOR MAI�ADDRFi55 CITY ZIP PHONE STATE LICENSE� <br /> PLUMBINGCONT ACTOR MAILADDRE55 CITV ZIP PHONE STATELICENSEM <br /> �4 vt'�S p1 �.w� 6 ��� � w�,�a, <br /> CONTRACT PRICE OF WOR <br /> i u �300� <br /> UESCRIBE RKANDSOUAREFOOTAGEINVOLVE� � � �ONTALTPERSONAN�PNONENO. <br /> b��fi�-�-���tm .�- ��e ; r ' �s t�ct� <br /> O G� S� VI i� I��ULI'�O t HEREBY CERTIFY THAT I HAVE READ AND E7CAMINED THIS <br /> PROPOSED USE OF BU oir� APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT.ALL <br /> d � ���� ' �''` PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br /> LEGALOESCRIPTIONOFPROPERTY�SHOWNBELOWORATTRCHTWOCOPIFS) WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br /> �or Bip�K 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 q[:GULATING CO�.''4��CTION OR THE <br /> — PERFORMANCE UF CONSTRUCT�UN.THAT I AM AU�nORIZED BY THE <br /> OWNEfl OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br /> APPLICATION IS MADE AND I CJMPLY WITH THE STATE <br /> PARCEL TA%I D.NUMBER CONTRACTORS LAW 1827 RCW AND 296.200 WAC. <br /> COtiSTRUCTION LO�N LENDER,ADDRESS,tELEPHONE Nl1MBER 1 <br /> PNOJECT DDRESS /` sKr+ n��-���`<� C�o�;�`� �S� <br /> CU � I �L�(�� �(��',(/.Q(� YVZU� cnruusmEssucEr�scvo — <br /> PLUMBING MECNANICAL <br /> N0. T/PE OF FIXTURE OR ITEM FEE NO. TYPE OF EOUIPMENT FEE <br /> WATER CLOSET(TOILET) � A/C—AiHNDLG UNITS—H.P. ; <br /> BATHTUB J 6u-u ; FORCED AIR SYSTEMS--B.T.U. M E.A. � <br /> LAVATORV(WASH BASIN) '�"�' . �NS +c , UNIT HEATERS—B.T.U. M ; <br /> SHOWER � CLOTHES DRYERS � � <br /> KITCHEN SINK R DISP � ; VENTILATION FAN ' <br /> � DISHWASHER � RANGE HOOD T— <br /> I LAUNDRYTRAY ; 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 DRAIN�RAINLEADERS � EXHAUST FAN � <br /> -SINK(SERVICE—BAR,ETC.) ; — � <br /> � ; <br /> � , -- � <br /> � - , <br /> ' <br /> i <br /> SUB TOTAL $ / ; � SUB TOTAL $ ' <br /> PERMIT $ cU i - PERMIT $ i <br /> TOTAL FEE $ '� TOTAL FEE $ � <br /> FOR OFFlCE USE ONLY: <br /> FPONT SETBACK REAR SETB/�CK SIDE SETBACK PLAN CNECK NUM9EP FEE RECEIPT NO. <br /> !�//aCo <br /> USEZONE LOTAREA VACANTSITE PEES VALUATION FEE <br /> ❑ YES G NO BWIDING <br /> 1YPEOftONST. NO-0FSTppIES ottuvutr xo.amv[wxcuxrts � <br /> LR01iP PLUMBING <br /> i <br /> 52EOFBLDG. FIRESPRINKLERSPE00 BASEMENT MECHANICAL � <br /> ❑ YES ❑ NO <br /> OCCUPAYCV LOAD FIRE�LARM REO'D HEIGMT LIMITATION ADDITIONAL PLAN CHECK � <br /> OTHER � <br /> REASON � <br /> STATE BUILDING SURCHARGE � <br /> INTAKEBY PL�NSAPPROVEDBY CITYOFEYERETT PUBLICWORNS � <br /> LOCALSALES � <br /> OATE TAX CODE IS 3105 TOTA� � <br />