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APPLICATIC 1 FOR CONSTRIdC:T� 1N PEPaMIT � <br />TO BE COMPLETED IN BLACK INK—PLEASE PRINF �Tr <br />BUILDING DEPARTMENT HEATING SYSTEM: i�j GAS iJ ELECTRIC U l <br />259-887 0 <br />I_l DEMOUTION I� COMBINATION y\' BUILDING Jx!MECHANICAL �+PLUMBING f i SIGN <br />OWNEfl MAILADGRE55 � CITV ZIP PHOPiE <br />Bar'� 4 dahe i�wksf-�lis 77i� �.e�cr���la� L�drF�-(-1 r�.�o3 �OG-3S3-�/3/3 <br />TENANT . J MAILADDRE55 � CITY � ZIP PHONE <br />T�ames Inl��v,�� ��nQ ��.,� PI�,�I.Ja�f[,,,,,,LL•�l 9Rn�� �id-7ys-3aq�r <br />��GNITECi CP �E5IGNER <br />ZIP <br />GENEP�LLONTRnCTOR MMLA�DRESS CITY ZIP PHONE STATELICENSEN <br />51%}%E .�I� �//i,v.E/� _ <br />MECMANIGALCONTRFCTOR MAILAUDRE55 GTY ZIP PHONE STATELICENSEY <br />PLUMOING CONTRACiOR IAAIL ADORE55 ��T� ZIP PHONE STATE LICENSE k <br />AND <br />OF BUILDING <br />FOOTAGEINVOLVEO <br />LEGAL DESCRIPTION OF PROPERTY �SHOWN BELOW OR ATTACN TWO COPI�EJS� <br />LOT—�`--- BLOCN OF GFJJ�� /5/ <br />NO. <br />oF iNONnls,:i CG✓.vt� :vae.+i,✓6To,J. <br />TA%IO.NUMOER <br />hS'SO—Ufi�0—O37-0�0 <br />UCTiON �OAN LENDEF. ADURE55. TELEPHONE Nl `ADER <br />WATER CLOSET <br />BATHTU6 <br />LAVATORY (WA: <br />_� KITCHEN SINK & DI; <br />.i DISHWASHER <br />� LAUNDRYTRAY <br />-- CLOTHES WASHER <br />— URINAI. <br />OR ITEM <br />FLOOR DRAIN , <br />� BACKFLOW PREVENTEF � <br />i" ROOF DRAINS—RAINLEADERS <br />� SINK (SERVICE—BtiR, ETC.1 <br />FOR OFFICE USE ONLY: <br />� IV <br />OF �LDG <br />SUB TOTAL $ <br />PERMIT S <br />TOTAL FEE S <br />P ° SETIiACK SIDE SGT �ACK <br />� � � <br />LOTAREF VACANTSITE <br />�U 87C� � ❑ VES � NO <br />Ao.oFSTORtEs occovnxrr �.00!o��vElm�Gb'drs <br />FIPE SPRINKLERS REO'D <br />N� <br />FlRE AIARM REO'D <br />A�J <br />'VYES `.7 NO <br />HEIGHT LIMITA�ION <br />INTAKEBY PLANSAPPqoVEO�V CITYOFEVERETT <br />J � �" LOCAL SALES <br />on-e q�2y�� 3 TAX COOE IS 3105 <br />LON'ACT PERSON AND PMONE NO. <br />if �GG'�?S3 <br />3��-r�i3 <br />i HEREBY CERTIF`( THAT I HAVE RF.AD AND EXAMINED THIS <br />APPLICATION AND KNOW THE SAME TO BE TRUE AND CORFECT. ALL <br />PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br />WORK WILL BE COMPLETED WITH WHETHEF SPECIFIED HEREIN OR <br />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 LOCA� LAW REGULATING CONSTRUCTION OR THE <br />PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br />OWNER OF THIS PPOPERTY TO PERFORM THE WORK FOR WHICH <br />APPLICATION IS MADE AND 1 COMPLY WITH THE STATE <br />CONTRACTORS LAW 18.27 RCW AND 296.200 WAC. <br />X .�� //Ur/'�� JY '/% % -1 <br />sidrva*unE ' on*E <br />EQUIPMENT <br />A/C—A/HNDLG UNITS— <br />� FORCED AIR SYSTEM: <br />UNIT HEATERS—B.T.U. <br />— -CLOTHES DRYERS <br />) VENTILATION FAN <br />WATER HEAT[R <br />— WOOD STOVE <br />METAL FIREPLACE i <br />— FIREPLACE INSER' <br />� HEATPUMP <br />PLA�% CN NWA ER <br />� <br />BUILDING � ' <br />-�.J� <br />PLUMBING <br />M1fECHANICAL <br />ACDI7IONAL PLAN CHECK <br />O7HER <br />STATE �UILDING SURCHARGE <br />PUBLIC WORKS <br />70TAL <br />SUB TOTAL S <br />PERMIT § <br />TOTAL FEE 5 <br />� l�0 l� C� <br />FEe-� <br />G <br />No <br />� <br />R <br />� ' Or% <br />—i— <br />