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APPLICATIO�•� FOR CONSTRUCTI N PER11AiT � <br /> TO BE COMPLETED IN BLACK INK—PLEASE PRINT <br /> BUILDING DEPARTMENT HEATING SYSTEM: ❑GAS ❑ELECTRIC ❑ _ <br /> 259-8810 <br /> I_I DEMOLITION i l COMBINATION ❑ BUILDING ❑MECHANICAL ❑ PLUMB!NG I c!GN <br /> O\YNEP `�� M(AILAD RES� �/ q �G11' � 7,w �� /�y�� � I� ��� / . <br /> 7 fw.�'K"�S I-C4^� `� f� / 1/YI )Ct Y l Z�4 v � <br /> TENFNT � �fAILADDFESS GTV ZIP PNONE <br /> ARCHITECTORDEGIGNER M�ILAOORESS CI1V ZIP PHONE <br /> . GENERAL�Y'C,O MFILAOORESS � �CITV N u�ZIP' I t � PHO� � Sin�LIC�a^� — <br /> / <br /> � �'C V —V <br /> MECHANICAICONTRA , R M AD�RESS CITY ZIP PHONE �TAiF,�J�CEy.Ep �, 9C�� <br /> �Z2�-Oz• �c:l<l•6� v <br /> PWMBINGGONTR4CTOR MAILADDRESS CiIY ZIP PHONE STATELICENSEp <br /> GONTRFjY�i PRICE OF WORH �� <br /> irn � — <br /> DESCRIBE WORK A' SOl1ARE FOOTFGE INVOLVED WNTACT PEFSON FNO PHONE NO. <br /> .�,.,,��� �'•�t n .� .� �ti �,��,...s �. -c��sov <br /> ��✓ - �^ ' C i HEREBY CERTIFY THAT I HAVE READ AND EXAPdINED THIS <br /> PROPOSE use oyem�o�.Nc APPLICATION AND KNOW THE SAME TO BE TRUE AND COFRECT.AL'_ <br /> PROVISIONS OF LAWS AND OFDINANCES GOVERNING THIS TYPE OF <br /> LFGALDESCRIPTIONOFP OPERTY�SMOVlNBELOWORAT(ACHiWOCOPIES� WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEP.EIN OR <br /> NO�i. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br /> �or— mock oF AUTHORITY TO VIOLATE OR CANCEI. THE PHOVISIONS OF APIY <br /> OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br /> PERFORMANCE OF CONSTRUCTION. THAT I hM AUTHOAIZED BY THE <br /> OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br /> APPLICATION IS MADE HND I COMPLY WITH THE S1�ATE <br /> PARCEL TA%I D NU�BER � CONTR TORS LAW 27 RCW AND 296200 WAC. <br /> t�3�f D �l l 0�7 �'��7v� � <br /> CONSTRUCTION LOAN LENOER.AODRE55.TELEPHONE NUMBEH . <br /> �r(�� <br /> PRO,IECT ADDRE S � �n*uae on*e <br /> ci*-ouswessuwnse no. � <br /> PLUMBING MECHANICAL <br /> N0. TYPc OF FIXTURE OH ITEM FEE NO. TYPE OF EOUIPMENT _ FEF <br /> WATEF CLOSET(TCILET) A/C-A/HNDLG UNITS-H.P. _ <br /> BATHT B FORCED AIR SYSTEMS-B.T.U. M E.A. _ <br /> LAVAfO (WASH BASINj � UNIT HEATERS-B.T.U. M __ <br /> SHOWER ' C OTHES DRYERS ___. <br /> KITCHEN SINI 8 DISP VE TILATION FAN � _ <br /> � DISHWASHER � RAN E HOOD <br /> LAUNDHYTRAY WATE HEATER ' _ <br /> CLOTHES WASHEfl —� WOOD S OVE <br /> URINAL ; METAL FIR PLACE(WOOD BURNING) _ ' <br /> DRINKING FOUNTAIN I FIREPLACE II ERT _ � , _ <br /> FLOOR DRAIN HEAT PUMP ' _ <br /> BACKFLOW PREVENTERS ; GAS PIPING __, _ <br /> ROOF DRAINS--RAWLEADERS � EXHAUST FAN _ <br /> SINK(SEFlVICE-BAR,ETC.) ; _ — <br /> � <br /> �- - <br /> — � <br /> � __ <br /> SUB TOTAL S ; SUB TOTAL $ ' <br /> PERA7IT $ � PERMIT $ _ <br /> TOTAL FEE 5 TOTAL FEE 5 _ <br /> FOR OFFICE USE ONLY: _ <br /> FRONTSETBACK REARSETBAf,K SIDESET84CK PLANCH KNUMBEH PEE REC@INTNO. <br /> t � /�Ci <br /> use zoue LOT AREA vncnNt site Ft ES VALUl�TIGN FEE <br /> ❑ YES ❑ NO BUILDING �� '(JU <br /> 7YPE OF COYS7. NO.OF SiOR'ES atuv:.uv h0 or pHFG�nc uYnS <br /> cem;c PLUMBING <br /> _ i— <br /> SIZEOFBLDG. FIRESPRINKLERSPEO'U BPS[MENT MECHANICAL � <br /> C��. YES '-1 NO - <br /> OCr,UPANGYLOAO FlRE�LARMfiEOD HEIGHTLIMITATION ADDITIONALPLANCHECK <br /> __ OTHER <br /> REASON <br /> S7ATE BUILOWG SURCHARGE --���_/"� <br /> INTFNEAV PLANSAPPROVEDBY CITYOfEVERETT pUBLICWORKS <br /> LACALSALES <br /> oATE TAX CODE IS 3105 TOTAL � 7'^ � <br />