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APPLICATIQ�! FOR CONSTRUCT'"lN PERMIT � <br /> TO BE COMPLETED IN BLACK INK—PLEASE PRINT <br /> HEATING SYSTEM: ❑GAS ❑ELECTRIC ❑ � <br /> BUILDING DEPARTMENT <br /> 259-8810 <br /> J DEMOLITION ❑ COMBINATION '_ I BUILDING t] MECHANICAL i_i PLUMBING ❑ SIGN <br /> OWNER ` 1AAILAD�RESS CITV ZIP PHONE <br /> SISKI�N .�//d F✓ERETTA✓�. FVE�('ET 9$7U/ a?S� �3688 <br /> TENANT MAILADORE55 CITV 21P PHONE <br /> /�EN 13xdu,�Al l�G? //38 Sd�TliA� G.�A I8�4�/ �4,�-D�.�p � 89-/777 <br /> ARCHITECTORDESIGNER MAILADDRESS CIiY ZIP PHONE <br /> GENERAL GONTRqCTOR MAIL AODRE55 GTV ZIP PHONE STATE IICENSE• <br /> MECHANICALCONTRAGTOR MAILADDRESS CITY ZIP PHONE STATEUCENSE� <br /> PLUMBING CONTRqCTOR MAI�pDDRESS CITV ZIP PHONE STATE�ICENSE t <br /> CONTRACT PRICE OP WORK � <br /> DESCR�I/BE WORK AND SOU�RE FOOTAGE INVOLVED �1 CONTACT PERSON AND PHONE NO. <br /> � /NS iA !_L 5/��AY ,F�t�i// <br /> AOP2r�iC aoov, ��-�7�,� <br /> :� - �t1ti�L <br /> I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br /> PROPOSE�USEOFBUILOING APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br /> � PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br /> LEGALDESCRIPTIONOFPROPEFTV!SNOWNBELOWORATTACNTWJCOPIES) WGRK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br /> NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br /> �or BLOCN oF — qUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS ^F qNY <br /> OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br /> PERFORMANCE OF CONSTAUCTION.THAT I AM AUTHORIZED BY THE <br /> OWNER OF THIS PROPERTV TO PERFORM THE WORK FOR WHICH <br /> � APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> PARCEL TA%I-0.NUMBER CONTRACTORS LAW 1827 RCW AND 296.200 WAC. <br /> CONSiRUCTION LOAN LENDER.ADDRESS,TELEPHONE NUMBER ',�� <br /> Rll./�.o�Gf/)'L- �Z ' z 7-%J� <br /> PROJECT ADDRESS sicrvr.rune a�re <br /> � .E✓E/�ET% ✓t- cnvousn+essuccH;erro - <br /> PLUMBING MECHANICAL <br /> N0. TYPE OF FIXTURE OR ITEM FEE NO. TYPE OF E�UIPMENT FEE <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 HEATEflS—B.T.U. M � <br /> SHOWER ' CLOTHES DRYERS � <br /> KITCHEN SINK&DISP � VENTILATION FAN ; <br /> DISHWASHER RANGE HOOD � <br /> LAUNDRYTRAY ; WATER HEATER ' <br /> CLOTHES WASHER � WOOD STOVE � <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—�BAfi,ETC.) � <br /> � <br /> , � <br /> � 1 <br /> SUB TOTAL 5 ; SUB TOTAL $ <br /> PG(iM1T $ PERMIT $ <br /> TOTALFEE S ' TOTALFEE $ <br /> FOR OFFICE USE ONLY: <br /> FRONTSETB�CK REARSETBACK SI�ESETB�LK PLANCHEGK MBEP FEE RECEIPTNO. <br /> 3�-� C <br /> usezor+e LOTAPEA VACANTSITE EES VALUATION FEE <br /> C YES ❑ NO BUILDING �� � � (� <br /> iVPEOFCONSi. NO.OFSTOFIES KCUPeNcv NoOfC�vuN6WUi5 i <br /> .�.� r 1 �P � PLUMBING i <br /> �L�v �" <br /> 52EOFBl.DG FIRFSPRINNIERSREO'D BASEMENT MECHANICAL � <br /> �g�� p y�c� i_i YES � NO � <br /> OCCUPANCY LOA� FNE AIAPM REO D MEIGNT LIMITATION <br /> ADDITIONAL PLAN CHECK ' �' ;��� <br /> � pTHER ' <br /> FEASON _ <br /> .��Mnn, �� fJ2 STATE BUIIDING SUACHARGE � � �1 <br /> al l�• T! <br /> INTAKEDV PIANSAPPROVED�Y CITYOFEVERETT PUBUCWORKS � <br /> � LOCAL SALES <br /> oATE 1y � 6�� TAX CODE IS 3105 TOTAL � <br />