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APPLICATIQ'� FOR CONSTRUCT'°'lN PERMIT � <br /> 5 � 3 a ��� TO BE COMPLETED IN BLACK INK—PLEASE PRINT <br /> HEATING SYSTEM: �J GAS ❑ELECTRIC ��n' ''ti w`� <br /> BUILDING DEPARTMENT <br /> 259-8810 <br /> i � DEMOLITION I I COMBINATION �BUILDING ! 1 MECHANICAL �_! PLUMBING ❑ SIGN <br /> OWNEP � � ^h1AlULADOR[$$ �C ��� CI7! ZIP PNONE <br /> C Y\ 1 1 c}Y� � <br /> `J ' � V-/ 0 /`.1AILA VA�n� 1 " �NC11l�J � l ' �1.. . W`� 1 PH`UE��J "LL�J� <br /> ARCI�IIEC`ORDESIGNEP MAILADORESS^Il ` CITV ZIP PHONE <br /> Yti YQSS � Y� Y�'-.S i � <br /> GENERAL WaTR OR � MAIL FD�F�$ � � CITy'� � �7 O���� PHONE STATE LICENSE I <br /> V(, I.J F.� M � <br /> L1.� C7-•i� L V 1' � I �4 v�� <br /> ME�NICFLCONTRpCTOR MAIL�DDR 55 IV PMOH STATELICENSE> <br /> _C�►_2�"� c'��.. 5�cc-� �R-' �U�e c�. <br /> PLUMBINGCONT OR lAMLADDRE55 CITY ZIP PHONE STATEUCENSErt <br /> CONTRACT PRICE OF WORK <br /> 2z <br /> OESCii18E WORK ANO SOUARE FOOT�GE INVOLVED CONTACT PEFi50N AND ONE NO. <br /> l�� <br /> , e�.,� C�„��-4-� d� �cv, , �-E- �5 3 - ao ss <br /> I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br /> PROPOSEDUSEOFBl1I�DING ��n`_ APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECL ALL <br /> � PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TVPE OF <br /> �eca�oE�RIPTIONOFPPOPEBTV�SNOWNBELOWORATfACNTWOCOP � WORK WILL RE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br /> -� NOT. THE GHANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br /> �or V� - e�ocH 'l _ � AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br /> S.ak a't�(c�L OTHER STATE OR LOCAL L1W REGULATING CONSTRUCTION OR THE <br /> PERFGAMAP� 7F CONSTRUCTION.THAT I AM AUTHORIZED BY THE <br /> OWNER Ot „ F'ROPERTY TO PERFORM THE WORK FOR WHICH <br /> PAF � T xi.o r+u51QER — . ) ^O a Q� APPLICATIC,N IS MADE AND I COMPLY WITH THE STATE <br /> iq �l CONTRACTORS LAW 18.27 RCW AND 296.200 WAC. <br /> � 1 � ^ „ <br /> CONSiPUCTIONLOA_NLEaER.rD�ViE55.TELEPHONENUMBER �% I T\ � <br /> N �L "`ti"X /i —iy <br /> PROJECT ADDRESS s:c,� une T oae <br /> �/3� �'�L/ ��r�o�s.�ss���E�sE��o <br /> PLUMBING MECHANICAL <br /> N0. TYPE OF FIXTURE OR ITEM FEE NO. TYPE OF EOUIPMENT FEE <br /> WATER CLOSET(TOILET) A�C-AMNDLG UNITS-H.P. <br /> � P.ATHTUB _ _ ; � FORCED AIR SYSTEMS-B.T.U. M E.A. � <br /> 1} �_AVATORY�WASH Bi,SIN) I UNIT HEATERS-B.T.U. M <br /> � SHOWER � CLOTHES DRl'ERS �— <br /> KITCHEN SINK 8 DISP ; VENTILATION FAN ; <br /> t DISHWASH[R � RANGE HOOD � <br /> LAUNDRV TRAY WATER HEATER <br /> CLOTHES WASHER � WOODSTOVE ; <br /> URINAL METAL FIREPLACE(WOOD BURNING) � <br /> DRINKI�73 FOUNTAIN � FIREPLACE INSERT <br /> FLOOR DRAIN � � HEAT PUMP � T <br /> BACKFLOW PREVENTERS GAS PIPING ; <br /> ROOF DRAINS-RAINLEADERS EXHAUST FAN � <br /> SINK(SERVICE-BAR,ETC.) ; � <br /> � <br /> � , <br /> SUB TOTAL 5 SJB TOTAL S ; <br /> PERMIT � PERMIT 5 <br /> TOTAL FEE S TOTAL FEE S � <br /> FOR OFFICE USE ONLY: <br /> FPONTSETBf�K� REARSETBACK /�� �_ SI�ESET�� PIANCM C NUMBFN FE3G,vI � PELEIP�S��/ <br /> Zp , <br /> !(I%[P Ui <br /> ❑5[ZONE LOTAREA VACANTSITE FEES VALOATION FEE <br /> / <br /> ._. YES ,J NO BUILDING Z �) � � ' OU <br /> 1YPE 0�C01l57 NOAF STORIES acoocq[r ho c�mv¢ux6usrt5 � <br /> _� 2 "o'> pLUM81NG <br /> rro <br /> SIZE OF BLOG FIRE SPRINHLERS FEO'D BASEMENT / i <br /> I(o63., s� 'rp � l:� YES ;7%Np MECHANICAL G;�Ji � <br /> OCCUPANGYIO�D FIREALARMFEOD HEIGHTL9.IITATIpN ADDITIONALPLANCHECK — � <br /> I <br /> �� OTHER �� ; �� <br /> FEn50t! <br /> STATE BUILDING 3URCHARGE !- ;�-� <br /> i <br /> INTANEOY PLANSAPPROVEOBV CITYOFEVERETT PUBLICWORKS ��(� � O � <br /> .�f-� LOCAL SALES ' <br /> onTe � Zy �� TAX CODE IS 3105 TOTAL , y I.J--� <br />