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- APPLICATI�..� FOR �ONSTRUC7 _JN PERMIT � <br /> TO BE COMPLETED IN BLACK INK—PLEASE PRINT <br /> BUILDING DEPARTMENT HEATING SYSTEM: �GAS ❑ELECTRIC O <br /> 259-8810 <br /> 1 I DEMOLITION X COMBINATION ! BUILDING I 1 MECHANICAL f l PLUMBING f I SIGN <br /> OWNER MAIIADDRE55 CITY ZIP PHONE <br /> �rt>b►TH FAULHAaEF2 BI4 GRr�wN D►z-. �/BE�'Tr' 1�203 Zs�l -dst 2 <br /> TE�NApNT MAILADDRESS CITY ZIP PHONE <br /> VF- <br /> AHCHITECTORDESIGNER MAILADDRESS CITY ZIP PHONE Z,g'�j"Cj'11Ja� <br /> G�dt7�12.JG� ARU-fl"i'EL"Z� 701 t7F�"� `P� AVE.N•� 21S `�ATTtE 46109 �f.453Z <br /> G'N�L�TC�S��TL�Tz� MV �C 1 5S ��5� l � �V�I— /V"" V�ZII V � 1..���PH / V W.7 33L�/E�/ �� <br /> MECMANICIILCONTRACTOR MAILADDRESS CITY ZIP PH011�. I��� $TAT�EI.�C�NS�� <br /> NCT SELLOTEO � 'p.1`� h:: <br /> PLUMBINGCONTFACTOR MAILADDHESS CITY 21P PMONE STATELICENSE• <br /> nv-r s.e�� <br /> CLASS OF WORK <br /> ! J NEW �ADDITION ' i ALTERATION I i FEPAIR I I DEMOUTION i I. WOODSTOVE/FRPL INSERT i I BUILDING RELO( �TION <br /> d Qy� l{3 �L 1 1�. u� CONiACTP�RSONANDPHGYENO. <br /> CONTR�CT PRICE OF WORK �`� �K��T� K�VIN {IR����JMRk I�JI�'�'rl�H �L��J?O� <br /> DESCRIBEWORN�NOSOURREFOOiAGEINVOLVED 96q g.F, <br /> N�w �+o y� r�Tex. surE �sr�iz ui <br /> PROPOSEDl15EOFBUIl01NG ' I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br /> �JINGL/� F.M�� Kk���NC� APPLIGAi�ON AND KNOW THE SAME��O BE TRUE AND CORRECT.ALL <br /> LEGAL DESCRIPTION OF PROPEflT";56JWN BELOW Ofl AT!ACH FWR fAP1E5� PriOVI�i ��'i OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br /> WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br /> �or CO e�ocK _ o� �AI�-301G �IB��v NOT. TFiE GRANT'NG OF A PERMIT DOES NOT PRESUME TO GIVE <br /> AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br /> 11Qpl'ryv -R� -n.r�, p-� pF QvG�E,TT OT'iER STATE OR LOCAL LAW RE�ULATING CONSTRUCTION OR THE <br /> PERFORMANCE OF CONSTRUCTION.THAT I AM AUTHORIZED BY THE <br /> OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br /> — APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> CONTRACTORS LAW 18.27 RCW AND 296.200 WAC. <br /> X��. Q i��4 �/�3/�a <br /> PRQIECT ADDRESS swwr.runE o�re <br /> $�'4` G{tt�.�y,l r�/Zl vE cnv ausrc+ess iKEr+se No <br /> PLUMBIN6 MECHANICAL <br /> N0, TYPE OF FIXTURE OR ITEM FEE NO. TYPE OF EGUIPMENT FEE <br /> WATER CLOSET(TOILET) AIC—A/HNDLG UNITS—H.P. T— <br /> BATHTUB .,5; FORCED AIR SYSTEMS—B.tU. M E.A. ' <br /> LAVATORY(1NASH BA�IN) � UNIT HEATERS—B.T.U. M � <br /> SHOWEFi ' CLOTHES DRYERS ' <br /> KITCHEN SINK&DISP . �� VENTILATION FAN � <br /> DISHWASHER � RANGE HUOD <br /> LAUNDRY TRAY ' WATER HEATER ' <br /> CIOTHES WASHER � WOOD STOVE � <br /> URINAL ; METAL FIREPLACE 8 CHIMNEY ' <br /> DRINKING FOUNTAIN � FIREPLACE INSERT � <br /> FLOOR DRAIN � HEAT PUMP ' <br /> BACKFLOW PREVENTERS ; GAS PIPING � <br /> ROOF DRAIN�RAINLEADERS � E%HAUST FAN <br /> SINK(SERVICE—BAR,ETC.) � � <br /> , � — <br /> � � <br /> � � <br /> � <br /> � SUBTOTAL $ ; SUBTOTAL $ ' — <br /> PERMIT $ � PERMIT $ � <br /> TOTALFEE $ ' TOTALFEE $ ' <br /> FOR OFFICE USE ONLY: <br /> FRONTSETBACN/ REARSETBACN SIDESETBACK PLANCHECKNUMBER FEE RECEIPTNO <br /> �, S� s� a�� o � �3� — <br /> USE ZONE LOT AREA VACANT SITE FEES VALUATION FEE <br /> � ^�� 9 Z�' � �43 � <br /> �� BUILDING 7 ' <br /> TVPEOFCONTS.ALIOWABIE TYPEOFCONSTACTURL occUVAxtr xOorVaFluNCUNuS f,�. <br /> � �AWP � PIUMBING J i <br /> g���pF�p�. NO.OF STORIES BASEMENT MECHANICAL �D � <br /> 7 � <br /> A ADDITIONAL PLAN CHECK —i� <br /> OCCUPANCV LOAD FIFE SPRNKLEFS REO'D MEIGNT{IMITATION <br /> /Q � <br /> Q No '�T� SPRINKLER � <br /> PEASON FOR S�pINHLERS <br /> STATE BUILDING SURCHARGE � <br /> INTAKEBY PLANSAPPROVEDBV CITYOFEVERETT PUBLICWORHS '--�� <br /> J� 31yy LOCAL SALES ��, a� <br /> 3� TAX CODE IS 3105 TaTA� <br />