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__ -APPLICATIC _J FOR CONSTRUCT _ �N PERMIT � <br /> TO BE COMPLETED IN BLACK INK—PLEASE PRINT <br /> HEATING SYSTEM: U GAS O ELECTRIC ❑ <br /> BUILDING DEPARTMENT <br /> 259•8810 <br /> I I DEMOLITION I COMBINATION BUILDING I I MECHANICAL ! I PLUM�lNG i i SIGN <br /> OW9ER MAILADDREdS CITY ZIP PHONE <br /> LAwSo►J KF� 233q I I"R� A�e e SeA�il.� WFr 48"� � <br /> TE�:ANT MAILA�DRESS CITV ZIP PHONE <br /> �- r�esQ ow�aus aaa► c.�en��' ►�e t�nei i _ <br /> /RCHITECTORDES�GNER MAILADDRESS CITY 21P PHONE T ^� <br /> GENEPAL�ON�O�►R� MAILOADDRESS ��� �� �CI��� P��V�O STATE�NSEa � <br /> MECHANICALCOH RA'CT�R MPI�AUDRE55 CITV ZIP PNONE STA7ELICENSEs <br /> PLUAIBINGCO�ITRACTOR MAILADDRE55 CITV 21P 7NONE STATELICENSE� <br /> �4! IJ 82- <br /> CLASS OF WORN <br /> I i NEW '�� I ADDITION I ! ALTERATION � ��. REPAIR i �� DEMOLITION '�. I WOODSTOVFJ?RPL INSERT . . BUILDING RELOCATION <br /> CONTACT PERSON AND PHONE NO. <br /> CONTRACiPRICEOFWOPN ✓' �� ��^� <br /> DESCRIBE WORK AND SOUARE FOOTAGE INVOLVE <br /> S U6� �uh�� S1�11�- 0 <br /> PROPOSEDUSEOFBUILO G I HEREBY C�RTIFY THAT 1 HAVE READ AND EXAMINED THIS <br /> AA..1 S �I O APPLICATION AND KNOW THE SAME TO DE TRUE AND CORRECT.ALL <br /> LEGAL�ESCRIPTIONOFPROPERTY�SH04YNBELOWOHATfACHFOURCOPIES) PROVISIONSOFLAWSANDORDINANCESGOVERNINGTHISTYPEOF <br /> 'o /,� _ 2J L�sh�S 3 WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br /> �or�U BLOCN �Q� oF NOT. THE GRANTING OF A PERMIT �O[S NOT PRESUME TO GIVE <br /> / AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br /> �O � lO� TN G OF �L OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br /> PERFORMANCE OF CUNSTRUCTION.THAT I AM AUTHORIZED BY THE <br /> OWNER OF THIS PROPERTY TO PERFORM THE WORK FUR WHICH <br /> APPLICATION IS MADE AND I COh".PLY WITH THE STATE <br /> CONTRACTORS LAW 18.27 RCW AND 296.200 WAC. <br /> x �, ..�.�5.� g "04--92� <br /> PRMEC7 AU�RESS sicruruAe �� o^�� <br /> 2'ZZ — cirreus��+cssucErvsEr+o <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM FEE 0. TYPE OF E�UIPMENT FEE <br /> WATER CLOSET(TOILET) � AIC-NHNDLG UNITS-H.P. � <br /> BATHTUB , FORCEC Alfl SYSTEMS-B.T.U. M E.A. ' <br /> LAVATORY(WASH BASIN) UNIT HEATERS-B.T.U. M � <br /> SHOWER ' CLOTHESOR'fERS ! <br /> ITCHEN SINK 8 D�SP � VENTILATION FP^J _� <br /> DI WASHER � RANGEHOOD <br /> LAUN TRAY ; WATER HEATER ' <br /> CLOTHES SHER WOOD STOVE � <br /> URINAL ' METAL FIREPLACE 8 CHIMNEY ' <br /> DRINKING FOUNTA � FIRtPLACE INSERT �_ <br /> FLOOR DRAIN ' HEAT PUMP ' <br /> BACKFLOW EVENTERS ; GAS PIPING � <br /> ROOF INS-RAINLEADER � EXHAUST FAN <br /> SIN SERVICE-BAR,ETC.) � <br /> � <br /> � ' <br /> SUB TOTAL 8 ' SUB TOTAI $ I <br /> PERMIT $ PEFlMIT S <br /> TOTALFEE 5 ' TOTALFEE S <br /> FOR OFFICE USE ONLY: <br /> FRONTSETBACK REARSETBACK SIDESETBACK PLANCHE�NUM ER F�5� RECEIPTNO. <br /> / ,�b• �� �`7 <br /> USfZONE LOTAREA VACANTSITE FEES VALUATION FEE <br /> e � � <br /> '^ 1 BUILDING /,��U ' _ <br /> iYPEO-FrC�ONi5.ALL4WABlE 1YPEOFCONA.ACIUAL uCCurdNa NOOrDwtu:ucumns � <br /> y.N N °p2 ��� PLUMBING ---� <br /> SIZEOFOL�G. NO.OFSTOPIES BASEMENT MECHANICAL T` <br /> �2ao � T►. z Y�� �� ;�— <br /> OCCUPANCY LOAD FIRE SPRNNLERS REO'� HEIGHT LIMITATION ADDITIONAL PLAN CHECK <br /> /� � � <br /> `i' IN TI• NQ SO SPRINKLER <br /> �� <br /> - REASON FOR SPRINKLERS � /� <br /> CMyt /,�-buJa� t�� �.� STATEBNLDINGSURCHARGE � <br /> IRTf� %GI�`•n � . <br /> INTAKEBV PLANSAPPROVEDBY CITYOFEVERETT PUBLICWORKS T <br /> LOCAL SALES /�,2 ;�� <br /> 10 ;��3L JM TAX CODE IS 310[ Torn� <br />