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yr /""' <br /> APPLIC�►'�IOrI FOR C�►NSTRUCT�vN PERMIT e�e�ett <br /> tn�e�-e�r,�ee� TO BE COMPLETED IN INK--PLEASE PRINT � <br /> CITV OF <br /> eve rett HEATING SYSTEM: ❑GAS ❑ELECTRIC ❑ _ <br /> BUILDiNG DEPARTMENT <br /> 259-8810 , <br /> DEMOLITIOP� COMBINATION BUILDING �AECHANICAL PLUMBING SIGN <br /> NER MAILApDRESS f� LITY ZIP PMONE <br /> �„ � S—�ri��r �SC�q�—.�ur�c����r�r�� 2(`(�— �� I�7 f� _ <br /> iENACNi�_ MAII.AD�RESS CITV ZIP PHONE <br /> —""�� CITV ZIP PHONE <br /> ARCHITELT OR DESIGNER MAIL A�DRESS <br /> GENERALGONTRPCTO MAILA�ORESS CITV ZIP PHONE LICENSEN <br /> � Z � �l)�Q. Q i ,r Z ,j 3�,I <br /> MECHANICAL ONTFACTOR MAILA�DRE55 CRV ZIP PMONE LICENSE> f/_G�r7 � <br /> O L <br /> PWMBING CONTFACTOR MML AD�RESS dTV ZIP PHONE LIGENSE 1 <br /> CLASS OF WORK -- <br /> �. .. NEW ���..�. AD�ITION �LTERATION �. ' REPAIR I , DEMOLITION �_.-. WOODSTOVE/FRPL INSERT ._�: BUILDING RELOCATION <br /> f CONTFCT PERSON AN�PHONE NO. <br /> CONTRACT PFICE OF WORK�/ � <br /> OESCRIBE WORKAND SOUARE FOOTPGE INVOLVED <br /> -Sv.�-E-a � � 'l(� <br /> PROPOSEDUSEUf9UI1.DING I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br /> ��� .O APPLICATION AND KNOW THE SAME TO BE TRUE AND COFRECT.ALL <br /> �-- PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br /> LEGALDESGRIPTIONOFPROPERTV�SHOWNBELOWORATTACNFOURCOPIE51 y,/ORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br /> ior eiocK oF NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br /> AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br /> OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OFi THE <br /> PERFORMANCE OF CONSTRUCTION.THAT I AM AUTHORIZED BY THE <br /> OWNER OF THIS PROPERTY TO PERFORM THE WOf',K FOR WHICH <br /> APPLICATION IS MADE AND I COMPIY WITH THE STATE <br /> CONTRACTORS LAW 1827 RCW AND 296200 WAC. <br /> � SIGNATURE OF CONTFACTOR OR AUiMOHREO AGENT DnTE <br /> X�".t i._1/ / l /�(ilK!(,��. <br /> PflOdELTADDRESS // A LIC�NTSCITVOUSINESSLICENSLIlO.ANDBUSM'e55IdF6fE <br /> o2�j� �Od�1 �i✓[[ <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTUFiE OR ITEM FEE NO. TYPE OF EQUIPMENT FEE <br /> WATER CLOSET(TOILET) � A/�NHNDLG UNITS—H.P. <br /> BATHTUB FORCED AIR S`.'STEMS—B.T.U. M E.A. ' <br /> LAVATORV(WASH BASIN) � UNIT HEATERS—B.T.U. M <br /> � <br /> SHOWER CLOTHES DRY�RS <br /> KITCHEN SINK 8 DISP � VENTILATION FAN <br /> DISHWASHER � RANC[HOOD � <br /> LAUNDRV TRAY ; WATER HEATER _ <br /> CLOTHES WASHER � WOOD STOVE ' _ <br /> UFWAL ; METAL FIREPLACE 8 CHIMNEY <br /> DRINKING FOUNTAIN FIREPLACE INSERT � <br /> FLOOR DRAIN � HEAT PUMP � <br /> BACKFLOW PREVENTERS ; GAS PIPING <br /> ii00F DRAINS—RAINLEADERS EXHAUST FAN <br /> SINK(SERVICE—BAR,ETCJ � <br /> � <br /> � <br /> SUB TOTAL $ SUB TOTAL S L <br /> PERMIT 5 PERMIT 5 �f <br /> TOTAL FEE 5 TOTAL FEE 3 ' —" <br /> FOR OFFICE USE ONLY: <br /> RECEIPT N0. <br /> FRONTSETBACK RGARSETBACK SIpESETB/.CK PLANLMECNNUMBER FEE <br /> USE20NE LOTAfiEA VFC�NTSITL FEES VALUATION FEE <br /> BUILUING _ <br /> TVPEOfGONiS.ALLOWRBIE TYPEOFGOIlSi.ACLUAL otLqanp[+ NO.O�UWf�L'xGuvrtS � <br /> PLUMBING _ <br /> i <br /> SIZE OF BL�G. NO.OF STORIES BASEMENT MECHANICAL �_ <br /> i <br /> OCCUPANCVLOA� FiRESPRNNLER5RE0'0 MEIGNTLIMITATION <br /> ADDITIONAL PLAN CHECK <br /> i <br /> OTHER <br /> T <br /> HEASON FOR SPRiNKLERS <br /> STATE BUILDING SUFiCHARGE <br /> urtrtHE[lY PLANSAPPFOYEDBV CITYOFEVERETT PU6LICWORK$ � <br /> LOCALSALES � <br /> TAX COUE IS 3105 Torn� <br />