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ppPLICATIO"1 FOR CONSTRUCT�N PERMIT � <br /> TO BE COMPLETED IN BLACK INK—PLEASE PRINT <br /> HEATING SYSTEM: ❑GAS ❑ELECTRIC O <br /> BUILDING DEPARTMENT <br /> 259•8810 <br /> 1=1 DEMOLITIf'N ❑ COMBINATION I�BUIrvDING ZPMECHANICAL oNE [ PWMBING CI SIGN <br /> M�IL ADDRE55 <br /> Om+ER `, . e {�C' R v�s� EVtw� � � !Z 0.0 � <br /> G���w �A��r�— � ; CIiV 21P PHONE <br /> TENANT MAILADDRE55 <br /> � � � ZIP PHONE 7's�'bsy�� <br /> ciTv ^ <br /> ARCHITECTOflDESIGNER MAILADDRESS �a 1 G��HGr� V� �� �� 9�po' <br /> }=. . 1, � V C✓Q Z�p PHONE STATE UCENSE■ <br /> AIL ADDRE55 ��ry p <br /> . GENERAL CONTRAC^TQ'�R� A � �ll h�� C J� / �A � p a-U� 'J.5 � 1 S <br /> � �..n�K '/YV, 111 �.�/-E4- V\ �i e <br /> �`R�w... ��TM Z�P PNONE STATE LICENSE t <br /> MECHANICALCONTRRCTOH MAILADDRE55 <br /> ���, Z�p PNONE STATE LIGENSE t <br /> PLUMBINGCONTRACTOR MAILAODRE55 <br /> CLASS OF WORK <br /> I-I NEW I I ADDITION I ALTERATION I.1 REPAIR I I DEMOLITION IJ WOODSTOVE/FRPL INSERT f I BUILDING RELOCATION <br /> CONTAGi PERSON AND PHONE NO. -I <br /> CONTRRCT PRICE OF WORK ���✓� ``�� �� <br /> UESCRIBE WORK AND SOUAPE FOOTAGE INVOLVED � <br /> �J ` f <br /> � F ERTIFY THAT I HAVE READ AND EXAMINED THIS <br /> rqoposeousEOF euaort+ APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT.ALL <br /> PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br /> LEGALDESCRIPTIONOFPROPEHN�SHOWNBELOWORATTACHFOURCOPIES) yyORK WILL BE COMPLETED WITH WHETfiER SPECIFIED HEREIN OR <br /> LaT B��K aF NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br /> AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br /> PERFORMANCE OFOCONS RUCTION.�THAT 1 AM AUTHORI ED BY THE <br /> OWNER OF THIS PROPCRTY TO PERFOFiM THE WORK FOR WHICH <br /> ApPLICATION IS MADE AND I CORIPLY WITH THE STATE <br /> CONTRACTORS LAW 18.27 RCW AND 296200 W/�AC. ` <br /> / / /L�t/,/5c =>'�—. <br /> n �1�— <br /> X ... _ OC �v��rlJr 1�—ao - `l 2 <br /> OAIE <br /> SiGN�NRE ( l�)'��Cf �%.�. <br /> PRQIECT ADDRE55 � �,A 9 g a� I <br /> / ^�- y LIttBU5�NE55LICEN5EN0 <br /> � ��� �� MECHANICAL <br /> PLUMBING TYPE OF EOUIPMENT FEE . <br /> FEE N0. <br /> N0. TYPE OF FIXTURE OR ITEM � q��yHNDLG UNITS—H.P. <br /> � WATER CLOSET(TOILET) � , FORCED AIR SYSTEMS—B.T.U. M E.A. <br /> BATHTUB � UNIT HEATERS—B.T.U. M ' <br /> 3 LAVATORY(WASH BASIN) , CLOTHES DRYERS � <br /> SHOWER � VENTILATION FAN � . <br /> KITCHEN SINK 8 DISP � RANGE H000 � <br /> DISHWASHER � WATER HEATER � <br /> LAUNDRYTRAY � WOODSTOVE � <br /> CLOTHES WASHER , METAL FIREPLACE 8 CHIMNEY � <br /> URINAL � FIREPLACE INSERT ' <br /> DRINKING FOUNTAIN , HEAT PUMP � <br /> FLOOR DRAIN � GAS PIPING <br /> BACKFLOW PREVENTERS � EXHAUSTFAN <br /> ROOF DRAINS—RAINLEADERS � <br /> SINK(SERVICE—BAR,ETC.) ' <br /> _ � <br /> � , <br /> � <br /> � , <br /> i � <br /> SUB TOTAL $ ' SUB TOTAL S <br /> � PEFMIT $ ' <br /> PERMIT $ ' TOTAL FEE $ ' <br /> TOTAL FEE 5 � <br /> 7 <br /> FOR OFFICE USE ONLY: FEE RECEIPT NO _ <br /> SIOE SETBACN PLAN CMECN NU BE - <br /> FRONTSET9ACN REARSETBACK ' <br /> FEES VALUATION FEE <br /> LOTAREA VACANi51TE � <br /> USEZONE � <br /> BUILDING � <br /> o[cuo�Mr xonuMtuMGUNns <br /> TVPEOfLONiS.ALLOWABIE ttPEOiCON51.RC1UAL �q�P . pLUMBING <br /> � <br /> i <br /> NO.OF STORIES BASEMENT MECHANICAL <br /> SIZE OF BLDl7. � <br /> ADDITIONAL PL1N CHECK ' <br /> OCLUPANCY IOA� FIPE SPRNKLEHS REO'D MEIGHT LIMITATION � <br /> SPRINKLER ' <br /> i <br /> REASON FOR SPRINNLERS STATE BUILDING SUflCHARGE � <br /> INTANEBY PLANSAPPHOVEDBY CITYOFEVERETT PUBLICWORKS � <br /> LOCAL SALES � <br /> TAX CODEIS 3105 TOTAL ' <br />