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APPLI�ATIC� FOR CONSTRUCT"`hN PERMIT <br /> TO BE COMPLETED IN BLACK INK—PLEASE PRINT � <br /> BUIIDING DEPARTMENT � HEATING SYSTEM: i]GAS ��ELECTRIC ❑ <br /> 259-8810 <br /> I DEMOUTION I ! COMBINATION �BUILDING I 1 MECHANICAL i 1 PLUMBING SIGN <br /> OWNER ldAI�ADORESS CRV 21P PHONE�1 /� <br /> Jk4ldiE� 4•��Y'(; �FSif-�il '��Cr1tT. /�S-�7� �PL. $C' ��p?(/ECC /•t�5� �I�aU[i� /�t�o� -0�'70'� <br /> iENFNT 11AILADORESS CITY ZIP PHONE <br /> - <br /> dRCMIiECTORDESIGNER MAILAOORESS CITY 21P PvpNL <br /> �.^�/ a[d-� <br /> GENERALCONTRACiOF AIAILADORESS pTV ZIP PHONE STATELIC[NSErc <br /> 5�9ur� S�a�ires y� %</3k%� <br /> IAECHANICALCONTRACTOR MAIIAD�PE55 GTY 21P PMONE STATELICENSEe <br /> S/`9U[� <br /> PWM1IBINGCO(N�iF`�/CTOR 61AILADDRESS CITY 21P PNONE STATELICENSEp <br /> �-�T �! <br /> CONTRApi PRICE OF WORK <br /> DESCRIlE YlORK qND SOURqE POOTAGE INVOLVED <br /> / ES�/�LYIJ� ��'�CJ S(1l �.�7" �ONTACT PERSON AS P����N�O 4 S /Q hC��� <br /> I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br /> PROPOSED USE OF Bl1ILDING APPLICATION AND KNOW THE SAME TO BE TRUE AND CqRRECT.ALL <br /> �— PROVISIONS OF LAWS AND ORD�NANCES GOVERNING THIS TYPE OF <br /> LEGALDESCFI TIONOFPqOPEFTY�SHOYJNBELOWORATTnACHT14000PIES� WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OH <br /> �ar e�p�K oF -S'r ?j�.Ct( NOT. THE GRANTING OF A PEFMIT DOES NOT PRESUME TO GIVE <br /> AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br /> (\ OTHER STATE OR LOCAL LAW REGULATING CONSIHUCTION OR THE <br /> —�-�'t— PERFORAIANCE OF CONSTRUCTION.THAT 1 AM AUTHORIZED BY THE <br /> �L�� OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br /> PFPCERq%ID.NUMBER APPLICATION IS MADE AND I COMPLY WITH THE STATF <br /> CONTRACTORS LAW 18.27 RCW AND 296200 WAC. <br /> CONSTRUCTIONLO�NLENDEP.AOORESS.TELEPHONE NUMBER <br /> sd/. �¢`�p. BcrtNc�cc S��lp•-�?�( L �(, ///�' rX'� <br /> PF.OJECTADDRESS sw ne �r� <br /> �L1.[�i i W,4�/ � � �s�vEss�«�:s���o <br /> PLUMBING HANICAL <br /> NO. TYPE OF FIXTURE OR ITEM FEE TVPE 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 BASIN) UNIT HEATERS—B.T.U. M ; <br /> SHOWER � CLOTHES DRYERS <br /> KITCHEN SINK 8 DISP ; VENTILATION FAN � <br /> DISHWASHER � RANGE HOOD �— <br /> LAUNDRYTRAY WATER HEATER � <br /> CLOTHES WASHER � WOODSTOVE <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.) , <br /> � <br /> � <br /> � <br /> � <br /> SUB TOTAL S ' SUB TOTAL S <br /> PERMIT 5 PERMIT 5 ; <br /> TOTALFEE S ' TOTALFEE S � <br /> FOR OFFICE USE ONLY: <br /> FRONTSETB�CN REAPSETOACH / SIDESET�ACK / PLANCNECKNUhI6ER FEE RECEIP7N0. <br /> Zo ' � �-la��I ��� D� <br /> usezoNe �ornaea VACANTLRE FEES VALUATION ` FEE ' <br /> �Z �? 2� ��� YES ��:�' NO BUILDING �a C��/O ��l(!� � C�D <br /> iYPEOF�ONSi. NO.OFSTORI S OC[ueAw.r r:oo�Cnuir.Gu':rt5 <br /> �-N Z qa3 � PLUMBING i <br /> _—T— <br /> 512E OF BLDG. FIRE SPRINNLERS FEO'U BASEMENT MECHANICFL � <br /> IS'� �+�an - ves ✓o � <br /> � <br /> OCCUPANCY LOAD FIRE ALARM REOD NEIGMT LIIAITATION ADDITIONAL PLAN CHECK � <br /> REnSON � �O / OTHER ���C n� I� � �'V <br /> STATE BUILDING SURCHARGE -�?��D <br /> INTAKEBV PLAIJSAPROVGD�Y CITYOFEVERETT PUBLICWORKS 20i(_/G <br /> � �-, LOCAL SALES <br /> onrE �� Z �q3 TAX CODE IS 3105 rorn� �,S-�C�J—C <br />