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APPLICATIC -l FOR CONSTRUCT� ')N PERMIT � <br /> TO BE COMPLETED IN BLACK INK—PLEASE PRINT <br /> BUILDING DEPARTMENT HEATING SYSTEM: 'J GAS ' ELECTRIC �J <br /> 259-8610 <br /> f 7 DEMOLITION f 1 COMBINATION f 1 BUILDING Ci MECHANICAL ❑ PLUMBING i] SIGN <br /> ONMER MAILADDRE55 CIiY 21P PNONE <br /> Horst �+ . Petzold Sr. 7I0 Edward Ave Everett 9820I 339-OI63 <br /> TENANT MAILAODRE55 CITV ZIP PNONE <br /> qRCNITECT Ofl DESIGNEP MAIL AD�RE55 GTY ZIP PNONE <br /> EPRLCONTRACTOR MAILADDRESS CITV ZIP � PNONE STAiEUCENSE� <br /> �:�1�,����� ��/o�7 l�''i����7� �� ���. ,,,.. - <br /> i: <br /> MECNANICALCONTflACTOR AIAI�A�OR[55 CITY 21P PHONE STATEUCENSEM <br /> PLUMBINGGONIRACTOR MAILA7�RE55 CITY ZIP PHONE SiATEIICENSEM <br /> CONTRACT PqIGE OF RN <br /> 7"� <br /> _� ��� <br /> DESCPIBE WORN RND�OU�RE FOOIAGE INVGLVED CONTACT PERSON�ND PNONE NO <br /> �dn_ — <br /> i HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br /> anorosE�{15E OP BuaDING APPUCATION AND KNOW THE SAME TC BE TRUE AND COR!'ECT.ALL <br /> �� PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br /> LEG ESCRIPTIONOFPROPERTYISHOWNBELOWO�ATTAGMTWOCOPIE51 WORK WILL �F. COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br /> - NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br /> �or BLOCH oF -- AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br /> OTHER STATF OR LOCAL LAW aEGULATING 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 /> PARC TAX I D NIIM�ER CONTRACTORS LAW 18.27 RCW AND 296.200 WAC. <br /> - 3�a9a - 3- oa�s -000/ /J / ! <br /> CONSTRUCilONL04NlENDER.ADDRESS.TELEPNONENUMBER x Jj�������/1� ' �/a�I �`, <br /> yv (/Y/ 1�� G �f' <br /> /PR JECT ADDRESS sicHuuAr �"*� <br /> � I� r.dR�ard I�V2 . EVBPP.'tt: Cf3Gt1 q z' r.n.eus�,rassucrr�si_r:o <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM FEE NO. TYPE OF EQUIPMENT FE[ <br /> WATER CLOSET(TOILET) � A'C—A�HNDLG UNITS—H.P. <br /> BATHTUB ; FORCED AIR SYSTEMS—B.T.U. M E.A. <br /> LAVATORY(WASH BASIN) UNIT HEATERS—B.T.U. M �_ <br /> SHOWER CLOTHES DRYERS ' <br /> KITCHEN SINK 8 DISP ; VENTILATION FAN � <br /> �— RANGE HO D <br /> DISHWASHE � <br /> LAUNDRY TRA ' WATER HEAT ' <br /> CLOTHES WASHE � WOOD STOVE � <br /> URINAL ; METAL FIREPLACE( D BURNING) ' <br /> DRINKING FOUNTAIN FIREPLACE INSERT <br /> FLOOR DRAIN � HEAT PUMP ' <br /> BACKFLOW PREVENTERS ; GAS PIPI4G � <br /> ROOF DRAINS—RAINLEADERS � EXHAUST FAN ' <br /> � <br /> SINK(SERVICE—BAR,ETC.) � <br /> � ' <br /> � <br /> � ' <br /> SUB TOTAL S SUB TOTAL 5 <br /> PERMIT $ PERMIT 5 <br /> TOTALFEE 5 TOTALFEE 5 ' <br /> FOR OFFICE USE ONLY: /��`'"=�-' <br /> F90NTSETBACK RE�RSETB�CK/ SIDESETO� J PL�NCHLf.K :UI.'CLR FEE q' REGEIPTt�B. <br /> ZO � '��`; �•�d�. lJ //', ', — � <br /> wEzor+e _� LOTAREA vncu+rsrte , FEES VA�UATION FEE <br /> .,: YES 'l NO Bw�oiNc '�V �-�I i ,�-� <br /> iYPE OF L@14. ��O OF Si0RIE5 Mu:nxcv r;o or Gxuu'�t,uNnS J � <br /> � ` 0°3 PLU6I�ING � <br /> - J , <br /> SIZEOF B FIRESPRINKLERSREOD �ASEME� � MECH�NICAL � <br /> �✓�# � C�I�I�.ICa � ."' NO i _ <br /> 9 SE 5�v �� J � <br /> OCCUPANCVLOAD FlREALARIAREOD HEIGlrtLIAIIT�T14N <br /> ADDITIONALPLANCHECK �� �`�j <br /> i <br /> �J � � OTHEfi � <br /> REASON � � <br /> STATE BUILDING SURCHARGE �;3�' <br /> i <br /> PlTANEBY PIANS�`P?��E�OY CITYOFEVERETT PUBLICWORKS � -� f <br /> j T� LOCAL SALES <br /> p TAX CODE IS 3105 rora� "%'��� 'J� <br /> DFTe / � .rJ- /� --— _ _ _ <br />