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APPLICQ410� F'OR CONSTRUCTI�N PERMIT � <br /> TO BE COMPLETED IN BLACK INK—PLEASE PRINT <br /> BUILDING DEPARTMENT HEATING SYSTEM: 'J GAS ! LECTRIC U <br /> 259-8810 <br /> ❑ DEMOLITION C] COMBINATION ( ! BUILDING �IECHANICAL - PLUMBING ❑ SIGN <br /> OWNER � MFILAO�PE55 GITY DP PHONE <br /> !-�w�-b�� �(��,ol���i'(t� — <br /> TENAIIT IdaIL n��RE55 GITV ZIP PHONE <br /> �4'-��.J�.�7 _ +J 1� CU/r..4-�:-YC � l�U- �i• ttl.��Etr <br /> AflCHII'ECiOR0E51GNER IANLACDRE55 CiTY ZIP PHONE <br /> GENEFLIGONTRACTOR MAILADL`RF.SS CITV ZIP PHONE STATELICENSEq <br /> IAECHAN'CALCONTRFGTOB lAFILqDGR�SS „p', D������LZ� PHONE SiFTELICENSEa <br /> � " � / <br /> L\XI "�)n�p-� �iu�IZ�ftlt�,liLi� S �i8'ITI�c o(n `��01=1°19����r�Z 1�}7M <br /> PWId61NGGONiRACTOR IdAILA0pRE55 CITY ZIP PHONE STATELICENSE< <br /> C NTOAG"PRICE OF W�RKO� <br /> �-fhG� 1� <br /> OESCRIBf_ ORKANDSOUAREFOOTAGBINVOLVED CONTACTPERSONANDPMONENO. <br /> � �—L'Ti4�. _?� �-1_=..�__Li✓nn� �c.- A-1�A, � \. ,.�.��-.7c "Ile1-"1�1`ls <br /> cNP-f�_����7— � ��iSat.��4�JL-17V�. - <br /> �✓ -N�� �-�'�^' VoISClk(nc T�iT��__ � HEREBY CERTIFV THAT I HAVE READ AND EXAMINED THIS <br /> rAovosEo use oF em_mNc APPLICATION AND KNOW THE SA1dE TO BE TRUE AND CORRECL ALL <br /> PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE JF <br /> LEGALOESCRIPTIO`lCFPflOPERTV�SMOWNBELOWORATTACHTWOf.OPIES) WORK WILL BE COMPLETED WITH WHETHEF S?ECIFIED HEREIN OR <br /> NOT. TNE GRANTING OF A PERMIT DOES NOT PAESUME TO GIVE <br /> LOT — BLOCK oF — AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br /> OTHER STATE OR IOCAL LAW REGULATING CONSTRUCTION OP THE <br /> - - PERFORMANCE OF CCNSTRUCTION.THAT I AM AUTHORIZED B'/THE <br /> OWNER OF THIS FROPERTY TO PERFORM THE WORK FOR �VHICH <br /> APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> PFRCEI TAX ID hUMBER CONTRACTORS LAW 1827 RCW AND 296200 WAC. <br /> GONSTRUCTION lOAN LENLEF.A��FEES.TELEPMONE NUlABER /,/ <br /> -� —�•—� <br /> PROJECT ADtlRESS scruru��c"�`�—� — �F�� <br /> /Dia SE C--� /.y,�// w �, �o�s�:��,���«�,s,�:� <br /> PLUMBING MECHANICAL <br /> NO. TYPE 01=FIXTURE OR ITEM FEE NO. TYPE OF EOUIPMENT FEE <br /> WATER CLOSET(TOILET) � AiC-ArHNDLG 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 CLOTHESDRVERS <br /> KITCHEN SINK 8 DSP VENTILATIDN FAN � <br /> —T— <br /> DISHWASHER RANGE HOOD <br /> LAUNDFiY TRAY WATER HEATEF <br /> CLOTHES WASHER � WOOD STOVE � <br /> URINAL ' META�FIREPLACE(WOOD BURNING) <br /> DRINKING FOUNTAIN FIREPLACE INSERT �_ <br /> FLOOR DRAIN HEAT PUMP ' <br /> BACKFLOW PREVENTERS GAS PIPING <br /> ROOF DRAINS-RAINLEADcqs i EXHAUST FAN <br /> SIIJK(SERVICE-BAH.ETC.) I <br /> � <br /> SUB TOTAL S SUFs TOTAL S D ; <br /> PERMIT $ PErIMIT S i <br /> TOTAL FEE S TOTAL FEE $ ' <br /> fOR OFFtCE USE ONLY: <br /> FRONTSETCA.^.K REAPSETDACK SIDESETB�CK PLANC4EC NUld�ER FEE RECEIPiNO. <br /> use zovE LOT AREA VACANT SIiE FEES VALUATION FEE <br /> ' YES ❑ NO g�JILDING <br /> TYPEOFCONSi � 'J.OFSTORIES occ�Pa�c ��Corw:Fw:Gu'�n5 ' <br /> �`0p° PLUMBING � <br /> SIZEOFBLDG. FIRESPRINNLGRSREOD BASEMENT MECHANICAL <br /> �._� YES � . NO -- <br /> OCCUPANCVLOAD FIREALANldREOD 11EIl:HTLIh11TATION ADDITIONALPLANCHECK � <br /> OTHEF <br /> REASON <br /> . STA7E BUILDING SUFiCHARGE <br /> INTAKEBY PLANSAFPROVEDBY CITYOFEVERETT PUf3lICWORKS i <br /> LQCAL SALES � <br /> onre TAn COUE IS 3105 TOTAL <br /> I _— <br />