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APPLICATI(� V FOR CONSTRUCZ DN PERMIT � <br /> TO BE COMPLETED IN BLACK INK-PLEASE PRINT <br /> HEATING SYSTEM: U GAS ❑ELECTRIC ❑ <br /> BUILDING DEPARTMENT <br /> 259-8810 <br /> � 1 DEMC►UTION I I COMBINATION I ' BUILDING ECHANICAL i �PLUMBING SIGN <br /> 0 q MAILADORESS CITV ZIP PNONE <br /> �"E Z�'ri - 17527 <br /> �-��.� t-� ��'►'UVI� 2222 �.`�1��2�� �.� <br /> �Ey�NT MA�LADDflE55 I�I I L,/ vL,' "L" �� / 1✓� L�� ^LP• ' L )� ` �S� I <br /> LiL�t3 Q��f;�c,tl� � <br /> ARCHITEC�R ^ M;ILAUONESS�� �'QN� ( 2 ��y/.�� PMONE /�/J� � ! ���� <br /> /j�// l �" 11 ��/ �� l 1 � � <br /> �� ��(�ht 1 l.. <br /> GENERALCONTRACTOF MAILADOPESS CIN 21P PHONE STATELICENS <br /> �k-' S Rt��� 2s� � NC �`lo � �Je��c �� S� r r � �r Yro �f,'C TL►�02� <br /> MECMANICALCONTRACTOR MAILADDflE55 M _ G�iV n 21P PHONE ���TATEUCENSEt <br /> � � a�'� �`r <br /> PLUMBINGCONTRACTOR ` MAILADDRE55 CIiV Z�P PNONE STATELIGENSEY <br /> C�L�A�OF WORN <br /> I V NEW I I ADDITION I I ALTERATION i �, REPAIR I � DEMOUTION �. � WOODSTOVE/FRPL INSERT . BUILDING RELOCATION <br /> � _p-� CONTACT PEPSON ANO PHONE NO. <br /> CONTRACT PRICE OF WORK <br /> `= "ZN'``�1'�J ��42\ <br /> OESCPIBEWORKANDSOUAREFOOTAGEINVOLVED 1 � ��� �� f71 <br /> Ilv i�hhi-� -�2C S;S1-sM IN K�� � Y1u±i ]lJ _ <br /> PROPq,EDUSEOFBUILDING i HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br /> (J���A� APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT.ALL <br /> �� PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE QF <br /> LEGALUESCRIPTIONOFPROPERTV�SHOWNBELOWOFATTACNFOURCOPIES) y�ORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br /> �oT e�ocK oF NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br /> AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br /> OTHER STATE OR LOCAL LAW REGULATING 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 COtdPLY WITH THE STATE <br /> CONTRACTORS LAW 182 R N'AND 296.200 WAC. <br /> X °� g2 <br /> swuntue[ o"'E <br /> PR0.IECTADDRE55 � /� `J'�lJ`rl� — <br /> ] �� , �� qttBIISiYE55L�CENSENO <br /> PLUMBING MECH4NICAL <br /> NO. TYPE OF FIXTURE OR ITEM FEE NO. TYPE OF EOUIPMENT FEE <br /> WATER CLOSET(TOILET) � A/C—NHNDLG 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 ORYERS ;__ <br /> KITCHEN SINK&DISP ; VENTILATION FAN � <br /> DISHWASHER � RANGE HOOD <br /> LAUNORYTRAY ; WATERHEATER <br /> CLOTHES WASHER i WOOD STOVE ' <br /> � METAL FIREPLACE 8 CHIMNEY ' <br /> DR NKING FOUNTAIN � FIREPLACE INSEflT � <br /> FLOOR DRAIN HEF.T PUMP '_ <br /> BACKFLOW PREVeNTERS � GAS PIPI�G � <br /> ROOF DRAINS—RAINLEADERS � EXHAUST FAN ' <br /> SINK(SERVICE—BAR,ETC.) � � <br /> � <br /> � � <br /> � ' <br /> � <br /> SUB TOTAL $ ; SUB TOTAL $ ' ' — <br /> PERMIT $ � PERMIT $ J� ' <br /> TOTAL FEE 5 ' TOTAL FEE 5 � -' � <br /> FOR OFFICE USE ONLY: <br /> PLAN LNECN NUMBEF FEE RECEIPT NO. <br /> FRONT SETBACK REAR SETBACK SIDE SETBACN /� <br /> USE 20NE LOT AREA vncnnr sire FE S VALUATION FEE <br /> BUILDING ' <br /> TVPEOFCONiSRIlOWAOLE iYPEOFCONSCACiUAI o[cur,wtr x00�Owau4auYirS � <br /> cno�v � PLUMBING � <br /> � � <br /> SIZEOFBLDG. NO.OFST051E5 BASEMENT MECHANICAL � <br /> i <br /> ADDITIONAL PLAN CHECK � <br /> OCCUPANCVLOAD FIRESPRNNLEPSREO'D MEIGHTLIMITATION i <br /> SPFiINKLER <br /> REASON FOR SPRINNlERS � <br /> STAiE BUIIDING SURCHARGE <br /> INTAKEOV PIAN$AP RQVEDBY CITYOFEVERETT PUBLICW�RKS � <br /> LOCAL SALES � <br /> �% �'1 TAX CODE IS 3105 TOTAL <br />