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APPLICATI('�1 FOF� CONSTRUCT ��N PERMIT � <br /> TO BE COMPLETED IN BLACK INK—PLEASE PRINT <br /> HEATING SYSTEM: ❑GAS ❑ELECTRIC ❑ <br /> BUILDING DEPARTMENT <br /> 259-8870 ❑ SIGN <br /> ❑ DEMOLITION ❑ COMBINATION L 1 BUILDING ❑ MECHANICAL ❑PLUMBING <br /> OWr1ER MAILADDR 55 CIN ZIP PHONE <br /> � lr,, �.��z� ��=3 3�1� -3� `= �� <br /> �a��Q�1K 4�J�- c+Ylin���t�� ` <br /> TENANS,q MAILADDRESS � ���� Z�P PHONE <br /> J� In1e—� ��n, t�p PHONE <br /> �CMITECTOR,�SIGNER MAILADDRESS <br /> ����'�� � PHO4E STRTE LICENSE� <br /> GENEflAICONTR OR MAILAODRE55 ��TY Z�P <br /> D�l� �zY1 k <br /> MECMANICA�CONTRAGTOR MAIL ADDRESS CITV ZIP PNONE STATE LICENSE Y <br /> PLUA�BINGCONTRACTOR MPILADDRESS CITV ZIP PMONE SiATELICENSE� <br /> Cry/(�tAACT PRICE OF WORK <br /> T� Q�, lJU <br /> DESCRIBE WORK AND SOUARE FOOUGE INVOLVEO CONTACT PEPSON AND PHONE NO. <br /> �C J- u l� <br /> ��1✓� Y' . �n W��G�_ <br /> (�jY\V�WV"'� I HEREBY CERTIFY TI1AT I HAVE READ AND EXAMINED TH!S <br /> PROPOSEDUSEOFBUILOING APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT.ALL <br /> �+� �.��� PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br /> I.EGRLDESCRPTIONOFPROPERTVISHOWNBELOWORATiACHTWOCOPIES) WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br /> � NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br /> �ot e�ocK �'O -'—n'tlbF �'� K — AUTHORITY TO VIOLATE OR CANCEI. THE PROVISIONS OF ANY <br /> O?HER STATE OR LOCAL LAW REGULA'fING CONSTRUCTION OR THE <br /> PERFORMANCE OF CONSTRUCTION.THAT I AM AUTHORIZED 0Y THE <br /> OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br /> APPLICATION IS MADE ANC I COMPL'f WITH THE STATE <br /> PARCEL TAX L�.NUMBER CONT GT S LAW 18.2 �RC AND 296.200 WAC. <br /> `�1'l 1 — �u ' O`i l — O 1 u l— � ) <br /> CONSTRl1CT10N LOAN LENDEP,ADDRE55,iELEPHONE NUMBER 1 �Y� �^��/_C., 7 <br /> n��� T � <br /> $�GNRiUFf. �,T� <br /> PROJECTADDFlESSI'pU� ���'n <br /> TD •� . cirvouswessucEu�Ervo <br /> PLUMBING MECNANICAL <br /> N0. TVPE OF F�XTURE OR ITEM FEE NO. TYPE OF EOUIPMENT <br /> FEE <br /> WATER CLOSET(TOILET) � M'C—NHNDLG UNITS—H.P. ' <br /> BATHTUB ' FORCED AIR SVSTEMS—B.T.U. M E.A. ' <br /> LAVATORY(WASH BASIN) � UNIT HEATERS—B.T.U. M � <br /> SHOWER � CIOTHES DRYERS � <br /> KITCHEN SINK 8 DISP � � VENTILATION FAN __T_ <br /> � DISHWASHER � RANGE HOOD <br /> LAUNDRY TRAY ; YJATER HEATER � <br /> CLOTHES WASHEF � WOOD STOVE ' <br /> URINAL METAL FIREPLACE(WOOD BURNING) ' <br /> DRINKING FOUNTAIN � FIREPLACE INSERT ' <br /> FLOOR DRAIN � FIEAT PUMP � <br /> BACKFLOW PREVENI ERS ; GAS PIPING ' <br /> ROOF DRAINS—RAINLEADERS � EXHAUST FAN ' <br /> SINK(SERVICE—BAR,ETC.) � � <br /> � <br /> � <br /> � <br /> � <br /> SUB TOTAL $ ' SUB TOTAL $ � <br /> PERMIT $ � PERMIT 5 � <br /> TOTAL FEE $ ' TOTAL FEE S <br /> FOR OFFICE USE ONLY: ReeeiPr No. <br /> FRONT SETBACN P°Ap SET9ACK SIDE SETBACN FLAN CNECK NUMBEfl FEE <br /> l0T AREA VACANT SITE FEES VALUATION FEE <br /> USEZONE � ai1 <br /> ❑ YES ❑ NO BUILDING �vj> ��� <br /> TVPEOFCONST NO.OFSTORIES OC[uwHCv NOOfV�vEw�6usu5 j <br /> �`�1° PLUMBING ' <br /> SREOFBIDG. FIRESPRINKLERSREO'0 BASEMENT MECHANICAL � <br /> ❑ vEs r_� No ; <br /> OCWPANCV LOAD FIRE ALAFM REOD MEIGNT LI611TATION A�DITIONAL PLAN CHECK � <br /> OTHER <br /> REASON — / � c�1� <br /> STA7E BUILDING SURCHARGE <br /> . <br /> INTAKEBY PLANSAPPROVEOBV CITYOFEYERETT PUBIICWORKS � <br /> LOCRL SALES ��7 1 S� � <br /> oATE TAX CODE IS 3105 TOTAL <br />