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__ _ � — --.� - - -� <br /> I�PPi.�CL'►TIQ�°°� FOR �ONSTRUCTMM►N PERMIT � <br /> TO BE COMPLETED IN BLACK INK—PLEASE PRINT <br /> HEATING SYSTEM: ❑GAS ❑ELECTRIC ❑_ —� <br /> BUILDING DEPARTMENT <br /> 259-8810 <br /> ❑ DEIAOLITION Ci COMBINATION ❑ BUIL'JING ❑MECHANICAL _�LUMBING � SIGPI <br /> OWNER IAAILAD�RE55 CIiV ZIP PHONE <br /> t-� 9:2Mo N d- ,�SS. <br /> TENANT MFIL ADDFE S , CITY ZIP PMONE <br /> /'(�//� 7 M� �E�J,c ef -- <br /> ARCHITECTORDESIGNER MaILFDDRE55 CITv ZIP dON[ <br /> GENERAL CONTnRAC70R MAIL AD�RE55 GITV ZIP PHONG S7ATE L�.^.ENSE a <br /> / TO CJ U <br /> MECHANICAL CONTRFCTOR IdAIL ADDRESS CITY ZIP PHONE STATE LICENSii p <br /> ?oG GG8�3��J - <br /> PLUMBINGGONTRACTOR MAILA�DFESS CITY 21P P40NE STATELICENSEN <br /> � (� S��,n�l� ��J'S���`-i iR�.� CVIVCIYC 4 ,i� Sti�O. r,� `' ..Z96 ���.SdP/�CJS7l�oz _ <br /> CONTRACT PRICE OF WORK <br /> OESCFICE WORK AND SOUARE FOOTAGE INVOWED CONiAGT PERSON AND PHONE N0. <br /> �1�,�,1�� �� ,S iN f <br /> i HEREBY CERTIFY -PHAT I HAVE READ AND EXAMINED THIS <br /> PROP05=0 USE OF BUiI�ING APPLICATION AND KNOW THE SAME TO BE TRUE AND CORREC7.A:L <br /> � PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE CF <br /> LEGPLDESCRIPTIONOFPROPERTVISHOWNBELOWORATTACHiWOCOPIcS) WORK 1VILL BE COMPLETED WITH WHETHER SPECIFIED HFREIN OR <br /> NOT. 'fHE GRANTIWG OF A PERMIT DOES NOT PFESUME TO GIV[ <br /> �pT e�ock oF AUTHJRITY 'f0 VIOLATE OR CANCEL THE PROVISIONS OF ANY <br /> 07HER STAfE OR LOCAL LAW REGULATItdG CONSTRUCTION OR i HE <br /> PERFORMAh^E OF CONSTRUCTION.THAT I AM AUTHORIZED BY TH[ <br /> OWNER OF THIS PFOPERTI' TO PERFORM THE WORK fOR VJHICH <br /> APPLICATION IS MADE AND I COMPI.Y WITH THe STA7� <br /> rance�Tnx i.o.Nun+eEa CONTRACTORS LAW 1827 RCW AND��5.20U WAC. <br /> CONSTRUCTION LOAN LENDER.FUDPF55,TELEPHONE 9UMBER �,.e (�„ /j� (,� <br /> X� � ,ryN Q- l, 7- -- <br /> S�GNAiURE ��lE <br /> PROJECT ADDRESS -- <br /> /�/o �C= Fuenc-7I'�9// G�� ��,.A�s���s�,��E��E�o _ <br /> PLUMBING MECHANICAL <br /> N0. TYPE OF FIXTURE OR ITEM PEE N0. TYPE OF E�UIPMENT FEE <br /> WATER CLOSET(TOILET) � AIC—A/HNDLG 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 DRYEFS _ <br /> KITCHEN SINK&DISP I VENTILATION FAN —_ <br /> DISHWASHER � RANGE HOOU _ _ <br /> LAUNDRY T�AY ' WATER HEATER � <br /> CLOTHES WA£iiER � WOOD STOVE ' <br /> URIMAL ' METAL FIREPIACE(WOOD BURNING) � ____ <br /> � <br /> DRINK'�JG FOUNTAIN <br /> ; FIREPLACE INSERT � <br /> FLOOR DRAW HEAT PUMP -- <br /> BACKFLOW PREVENTERS ; GAS PIPING — <br /> ROOF DRAINS—RAINLEADERS EXHAUST FAN <br /> SINK(SERVICE—BAR,ETC.) � <br /> — � — <br /> SUB TOTAL 5 ' SUB TOTAL $ <br /> PERMIT f � PERMIT S <br /> — TOTAL FEE 5 ' TOTAL FEE S <br /> FOR OFFICE USE ONLY: Receivr Ho <br /> PLANCM KNUMBER FEE <br /> FFONT SETBACK REAR SETOFLK SIDE SETBACK �� <br /> USE 20NE L0T AREA <br /> vncnNrsiTe FEES VALUATION FEE <br /> � YES ' �� N� BUILOING <br /> iYPEOiCONST NOOF370RIE5 aCcu><va tAo�o�ARutcu4n5 <br /> ,aoua PLUMBING .._— <br /> SIZEOF�LDG. FIRESPRINKLEfl5RE0'D BASElAENT MECHANICAL ._ <br /> ❑ YES 7 NO <br /> ADDITIONAL PLAN CHECK <br /> OCCUPANCYLOAD FIREALARMREO'D NEIGHTLIN:TATION - <br /> OTHEF _ <br /> REnSON STATE BUILDING SURCHARGE <br /> INTANEBV PLA1lSAPPPOVGOBY CITYOFEVERETT PUBLICWORKS <br /> LOCAL SALES <br /> OFTE <br /> TAX CODE IS 3105 TOTAL <br />