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' ' � APPLICATI�'`� FOR CONSTRUCT"'1�� <br /> TO BE COPJIPLETED IN BLACK INK—PLEASE PRINT U�� AUG - <br /> 8 1994 <br /> HEATING SYSTEM: [�"GAS ❑ELECTRIC J�� �����""' <br /> • ......... <br /> ...... , <br /> BUILDING DEPARTMENT p�b��� <br /> 259-8810 Works Dept, <br /> L] DEMOLITION LJ COMBINATION i BUILDING C�MECHANICAL L1 PLUMBING I ! SIGN <br /> O� NeR MAILAOOPE55 � CITV ZIP PHONE <br /> �—{��' �/ 1– ��Fr� � �r. �- >� �.c`i ��� i��� c � ii1�� f r,c � c '� 1 � 5,��� � �� ;- i � i �� <br /> 1IT\ WFE NT� Id41LADDRESS CITV ZIP PHONE <br /> A CH�TORDESIGNER MFILA]DRE55 CITY ZIP PHONE <br /> ��;\ <br /> G ERfpLCONTRACTOR IdAILADDRE55 CITY ZIP PMONE S7ATEUCENSEx <br /> 1�� I-1 <br /> !dE MN II,A�_CONiflFCTOR IAAILADDRES$ CITY ZIP PHONE STATELICENSEa <br /> � y�_ � <br /> .. � t � r � Yi � �r't `� i � �C 1__�� -(��I J I ��� �� �S�( � � v �l � 1�(�n /�iJ'il/11��ir� (+ C';j %itl('_. <br /> PLIY MG t ONTRACTOR MAIL A�OBESS GTV ZIP PMONE STATE Uf.ENSE p <br /> c.�Cl V � \ C� <br /> CONTRACT PRCC f P W IRI�I �� <br /> )I � <br /> c�c l <br /> DESGRIBE WORK ANO SOUAPE fOOT�GE IIJVOLVEO GONTFQ PER80N AN�PHONE N0. <br /> lC� � <br /> � "7�'L � ('^ �.T C•� � •-�,'�-I � " � C/ C� l.J <br /> \ _I` <br /> ��I . i 1' �`��`� I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br /> PROPOSED USE OF BUILOING � APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT.ALL <br /> ��'� ' r (�=> PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br /> LEGNLOESCRIPiIONOFPROPERTY�SHOWNBELOWORATTFCNTVJOGOPIESI WORK WILL BE COMPLETED lh'iTFI WHETHER SPEGFIED HERC-IN OR <br /> NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br /> �oT BLOGN oF AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br /> OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br /> PERFORMANCE OF CONSTRUCTION.THAT I AM AUTHORI2ED BY THE <br /> OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br /> APPLICATION IS MADE AND I COMPLY WITIi THE STATE <br /> anncE�Tnxi.o NUMeen , CONTRACTORS LAW 18.27 RCW AND 296200 WAC. <br /> —� � b •-� � �J� r ��'� •-{ � �'�,� � . <br /> GONSTRUf�TION LOAN LENOER.ADDRESS.TELEPHONE NUMBER c <br /> �'� L.`C L� L�C'_ J.���I� �� � <br /> sicrvnruae f onie <br /> p �EC,j1.1DDR`SS ," , ( .�P . L=��C•���(• - <br /> V� � \ � CITYptIS�N[SStICF�'SE 0 <br /> PLUMBING MECHANICAL <br /> NO. TVPE OF FIXTURE OR ITEM FEE NO. TYPE OF EOUIPMENT FEE <br /> WATER CLOSET(TCILET) A/C—AiHNDLG UNITS—H.R ��� <br /> BATHTUB FORCED AIR SYSTEMS—B.T.U.7� E.A. <br /> LAVATORY(WASH BASIN) UNI'HEATERS—B.T.U. M � <br /> —� <br /> SHOWFR ' CLOTHES�RYERS ' <br /> KITCHEN SINK 8 DISP � VENTILATION FAN <br /> DISH'NPSHER RANGE HOOD ' <br /> LAUNDRY l'RAY WATER HEATER ' <br /> CIOTHES WASHER � WOOD STOVE <br /> URINAL METAL FIREPLACE(WOOD BURNING) <br /> DRINKING FOUNTAIN FIREPLACE INSERT <br /> FLOOR DRAIN � HEAT PUMP ' <br /> BACKFLOW PREVENTERS I GAS PIPWG � <br /> ROOF DRAINS—RAINLEADERS � EXHAUST FAN ' <br /> SINK(SERVICE—BAR,ETC.) � <br /> � <br /> � <br /> SUB TOTAL S ' SUB TOTAL S ' <br /> � PGRMIT $ PERMIT 5 � <br /> TOTAL FEE S ' TOTAL FEE S (.� � r � <br /> FOR OFFICE USE ONLY: <br /> PRONT SETBACK REFR SETBACK SIDE SETBACK P�AN GH K NUMB'EF/ FEE RECEIPi NO. <br /> r���`1 <br /> usezoNe �otnaen vncnNTstre FEES VALUATION FEE <br /> �^i YES '�J NO BUILDING <br /> TVPEOFCONSL NO-OFSTORIES actUVAr.cv uooroWEluNGUNuS � <br /> i <br /> cao�:v PLUMBING � <br /> SIZEOFBLOG. FIRESPRINKLERSPEO'D BASEIdENT MECHANICAL <br /> ❑ YES �.i NO � <br /> OCCUPANCV LOAD FIRE ALARM REO'D HEIGHT LIMITATIGN ADDITIONAL PLAN CHECK � <br /> i <br /> � <br /> OTHER <br /> T <br /> RE�SON � <br /> STATE BUILDING SURCHARGE � <br /> INiFKEBV PL�NSAPPROVEDBV CITYOFEVERETT PUBLICWORK.i <br /> LOCAL SALES � <br /> onre TAX COUE IS 3105 TOTAL ; , <br /> � , �/ <br />