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d�PPLICATIQ`"' FOR CON�TRUCTi'"�N PERIIAIT � <br /> TO BE COMPLETED IN BLACK INK—PLEASE PRINT <br /> I HEATING SYSTEM� i�GAS ❑ELECTRIC �I _ <br /> BUILDING DEPARTMENT <br /> 259-8810 <br /> ❑ DEMOLITfON I COMBINATION i�-BUILDING '-1 MECHANICAL i=' PLUMBING Ci SIGN <br /> OWNER IdAIL ADDRE55 dTV ZiP PHCAE <br /> Vo��n�-�S ��- ✓�M,a2�a4 ZB�oL ,6/��r,��l*1 Evr�2�r 9Pza 2�,'9- 3 � 9 / <br /> TENANT IAAILAGDRE55 CITY ZIP PM01JE <br /> APGHRECTOROESIGNER GIAILADDRESS CITV ZIP PHON[ ZS �" �J� � � <br /> TI��E D��/-F�v9nl.h✓1C[til�'��C //`✓ �� �� �Af.%J �� Gs�9�G� — <br /> GENEF4LWf:TBFC70R IAFILADDRE55 CITY ZIP FMON� STlSEUCENSEa <br /> �'��� I .C��—��21'�JC�O� )'� G � <br /> IdECHANICFL GONTPAGTOR MAIL AUOFE55 <br /> CITY 21P PHONE STATELICENSEtt <br /> P�MBINGCONT�OR�� CtA'�ILA���R SME�IY�Y7 <br /> R p�Ty 21P PHONE STATE LICENSE u <br /> �C IfUGK <br /> CONTRACT PRICE OF WGP�K ' <br /> � S?�D ///J/) ' �E5%� <br /> DESCRIBE WORK AN�S UFFE FOOTAGE INVOLVED GONiACT PERSON AND PHONE NO. S <br /> 2- s7i,Q�/ � , g8'o 2�� 3i � i <br /> I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br /> PPOPOSED USE OF Bl1IL�ING APPLICATION AND KNOW THE SAME 70 BE TRUE AND CORRECT.ALL <br /> '� �, ��`r� PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYP°OF <br /> LEGALOESCPIPTIONOFPROPERTV(SHOWNBELOWORATfAGHTWOCOPIES� WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br /> ��,T. r� NOT. THE GRANTING OF A PERMIT OOES NOT PRESUME TO GIVE <br /> �or� BLOCK� oF AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANV <br /> ��p O''HER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br /> C�C `�- pE:RFORM�NCE OF CONSTRUCTION.THAT I AM AUTHORIZED BY THE <br /> OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR 1'JHICH <br /> — APPLICATION IS MADE AND I COMPLY WITH THE ST�TE <br /> a.r.�ce�rnx i o.Nuuee�; CO ACTORS LAW 18.27 RCW AND 29620C WAC. <br /> / <br /> CONSTRUCTION LOFN LENDER.ADDRESS.TELEPHONE NUMBEF _ ^ J��L-� <br /> L <br /> ^ /}�/ �p 9GNAiU� , OAl[ <br /> PRO E TADDRESS L r w �� <br /> �� ci*.�usrt+css iicENsc�+o <br /> PLUMBING NECHANICAL <br /> FEE NO. TYPE OF E�UIPMENT FEE <br /> N0. TYPE OF FIXTURE OR EM � <br /> � WATER CLOSET(TOILET) � AIC—A/HNDLG UNITS—H.P. ' <br /> BATHTUB ' FORCED AIR SYSTEMS—B.T.U. M E.A. _ <br /> � � <br /> ; UNIT HEATERS—B.T.U. M � <br /> LAVATORY(WASH BASIN) , <br /> SHpWER ' CLCTHES DRYSRS <br /> KITCHEN SINK R DISP VE' �ILATION FAN _ <br /> DISHWASHER RANGE HOOD _ _ ' <br /> LAUNDRY TPAY ; WATER HEATER � <br /> CLOTHES VJASHER � WOOD STOVE ' <br /> � METAL FIREPLACE(WOOD BURNING) ' <br /> URINAL ; <br /> DRINKING FOUNTAIN FIREPLACE INSERT �— <br /> FLOOR DRAIN I� HEAT PUMP � <br /> BACKFLOW PREVENTERS ; GAS PIPING ', <br /> ROOF DRAINS—RAINLEADERS EXHAUST FAN ' <br /> SINK(SERVICE—BAR.ETC.) <br /> � <br /> � <br /> � <br /> SUB TOTAL S ; SUB TOTAL S <br /> — PERMIT S PERMIT 5 ' <br /> TOTAL FFE $ TOTAL FEE S ' <br /> FOR OFFICE USE ONLY: qEceiPrr+o <br /> PL4NGHECKNUIdBER FEE <br /> FB06TSETBAC PEARSETB4CK SIDESETBAGK /�C � n � � <br /> USE ZON LOT AREA VACANT SITE /y�/� Q/��� <br /> FEES VALUATION FEE <br /> � ��-� YES -� NO BUILDMG ��7�w'�-' —�Y� <br /> iYPEOFWtlSi. NO.OFSTOPIES etcuexwv rmov�wEurtlfm:ns <br /> cr uP ✓ PLUMBING ' <br /> � 3 B+ tiz � <br /> �SI,ZIE�OP BLDG. F.RE SPRINNLERS PEO'D BN MENT MECHANICAL � <br /> t�-� ��JD �F �L� �ES �NO � ) <br /> � -'• AD�ITIONAL PU1N CHECK <br /> OCCUPANCV LOA� FIRE ALARId REOD HEIGHT I�IM T�ZA7�N�'C`f � <br /> �y _�' <br /> '�,).Z� J� ��� OTHER <br /> REASON C ���� I <br /> � ���i STATE BUILDWG SURCHARGE <br /> ��/?h lll.t'�fz�l�`;�"; �//l/�l ; <br /> WIDKCBV PLANS�PPRO�EO�Y CITYOFEVERETT PUBLICWORKS � <br /> JM LOCALSALES �� L/ � C� <br /> on,e 3 <br /> � � _ TAX CODE IS 31U5 TOTAL � <br />