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APPLICATIC�'1 FOR CONSTRUCT'�N PERMIT � <br /> TO BE COMPLF.TED IN BLACK INK—PLEASE PRINT <br /> HEATING SYSTEM: �GAS ❑ELECTRIC �,1 _ <br /> BUILDING DEPARTMENT <br /> 259-8810 <br /> C] DEMOLITION ❑ COMBINATION I 1 BUILDING ! I MECHANICAL ❑PLUMBING ❑ SIGN <br /> OWNER M�ILADDRE55 CITY ZIP PHONE <br /> �n.�s S Ro-�,N�e i6�v-Eac-cr-c��t �,u� e��Err- �8,zr3 sv�-y�8s <br /> TENANT MAILAD�RESS CITV 21P PNONE <br /> ARCNITECTOflDESIGNER MAILADDRE55 CIiV ZIP PHONE <br /> GENERAL CONTqRCTOR MRIL ADDRE55 CITY ZIP PHONE STATE UCENSE t <br /> �c�/��' .D�T,,,,.�,,:.fe./� C� E �ake <- C� E 1 <br /> MEGHANICALCONTRRCTOR MAILAUDRESS CITV ZIP PMONE ST�TELICENSEt <br /> PLUMBING CONTBACTOR MAIL ADDRE55 CITY ZIP PIIONE STATE LICENSE• <br /> � <br /> CONTiiACT PRIGE OF WORK <br /> DESCRIBE WORK AND SIXIARE FOOTAGE INVOLVED CONTqCT PERSON AND PHONE NO. <br /> REKoa�. oF D�ctC. T �O� 1 N <br /> OF w �NrJd�..J I HEREBY CERTIFY THAT I HAVE READ AND EXAMIN=D THIS <br /> PROPOSED USE OF BUILDING APPLICAT�ON AND KNOW THE SAME TO BE TRUE AND CORRECT.ALL <br /> \�,yt PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TVPE OF <br /> IEGRLDESCRIPiIONOFPFOPERTV�SNOWNBELOWOHATiACHTYJOCOPIES� WORK WILL BE COMPLETEO WITH WHETHER SPECIFIED HEREIN OR <br /> C ccr�o�� NOT. THE GFANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br /> wr �1 e�ocK oF �---� qUTHORITY TO ViOLATE OR CANCEL THE PROVISIONS OF ANV <br /> OTHER STATE nR LCCAL lAW REGULATING CONSTRUCTION OR THE <br /> PERFORMANCE OF CONSTRUCTION.THAT I AM AUTHORIZED BY THE <br /> -��/0 — Oee �o�-] — 000$ OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br /> � APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> PARCEL TAX I.O.NUMBER CONTRACTORS LAW 18.27 R^CW AND 296200 WAC. <br /> CONSTRUCTION IOAN LENDER,ADDFESS.TELEPNONE NUMBER ``7//� �/ <br /> C716��(-e'�OG- r. � e �rt,F— � �.. u_�..�.....-�. 'f' /Z-9� <br /> PROJECT ADDRESS si erune o�r� <br /> V OUSiNE55liC[NSE NO <br /> PLUMBIN6 MECNANICAL <br /> N0. TYPE OF flXTURE OR ITEM FEE N0. TYPE OF EOUIPMENT FEE <br /> WATER CLOSET(TOILET) � A/C—AiHNDLG UNITS—H.P. <br /> BATHTUB ; FORCED AIR SYSTEMS—B.T.U. M E.A. ' <br /> LAVATORY(WASH BAS�N) � UNIT HEATERS—B.T.U. M � <br /> SHOWER CLOTHES DRYERS ' <br /> KITCHEN SINK 8 DISP � VENTILATION FAN � _ <br /> DISHWASHER � RANGE HOOD ' _ <br /> LAUNDRY 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.) I <br /> ' � — <br /> � ' <br /> SUB TOTAL $ ; SUB TOTAL $ ' <br /> PERMIT $ � PERMIT $ � <br /> TOTALFEE S ' TOTALFEE S ' <br /> FOR OFFICE USE ONLY: � -, �C� m <br /> FFONT SETBACN , REAR SETBA,K SIDE SETB��K PLAN CME K NIIMBE FEE RECEIP NO. <br /> � S 20 = � �� <br /> USE20NE �OTANEA VACpNTS1TE FEES VALUATION FEE <br /> �� ❑ VES �NO BUILDING 6� � i <br /> TYPEOFf.ONSi. NO.OFSTORIES oc[uaArttv HOorOvnwNGUNrts � <br /> KIS ��i �pW,3 I PWM�ING i <br /> T <br /> SIZE OF BIDG. FIRE SPFINKLERS REO'D BASEMENT � � MECHANICAL ' <br /> � ❑ YES 'Y'NO � <br /> � � ADDITIONAL PLAN CHECK � <br /> OCCUPANCY�AD PIRE ALAR�AD NEIGHTIIMITAT�N <br /> ZII � <br /> C7 OTHER i <br /> REASON � <br /> STATE BUILDING SURCHARGE � <br /> INiAKEBV PLANSAPPRQVEOBV CITYOFEVERETT PUBLICWORNS i <br /> J �u LOCAL SALES � <br /> DATE rL9 S3 TAR CODE IS 3105 TOTA� � � <br />