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APPLICATIC'f FOR C���NSTRUCTS"'')N PERMIT � <br />TO BE COMPLETED IN BL ACK INK—PLEASE PRINT <br />BUILDING DEPARTMENT HEATING SYSl"EM: ❑ G�S ❑ ELECTRfC O_ <br />259-8810 <br />❑ DEMOLITION ❑ COMBINATION � <br />OWNER A:AIL�ODFE55 <br />�NAGa� l�r��CY-' ��'0�. !.(/ /�i <br />TENANT MFILADORE55 <br />MAIL AODflE55 <br />BUILDING C] MECHANICAL ❑ PLUMBING ❑ SIGN <br />CITY 21P (HONE <br />PHONE <br />CITV 21P PHONE <br />1�1 l)Y1F'C� <br />GENERALCONTRACTOR lAAILAD�PE55 CRY ZIP PHONE STA7ELICENSE/ <br />MECHqNICALCONTRACTOR MFILAOOflE55 CITV ZIP PHONE STATELICENSEt <br />MAIL A��RESS <br />CONTqACTPRICEOFWORK ,�„ n <br />��"����n ��� <br />]ESGR�BE WOR AND SOUARE FOOTAGE INVOLVEO <br />PROPOSED USE OF <br />LEGAL DESCPIPTICY OF PqOPEKtt �SMOWN BEIOW OR ARACH <br />�/� -�� ) <br />LOT-JL�_ BLOCK OF /L/��: <br />� . ,. -� _ _. , � I _ � <br />/olGU-U�JU �/ 1 <br />'T'�ION� ]LOAN LENOEfl, AD�PE55y. T�E/L�EPH( <br />LGL y` � 1 I 1('A <br />fADDRESS <br />BING <br />TVPE OF FIXTURE OR I <br />WATER CLOSET (l�OILET) <br />BATHTUB <br />LAVATORY(WASH 9ASIN) <br />SHCWER <br />KITCl1EN SINK 8 DISP <br />DISHWASHER <br />LAUNDRYTRAY <br />CLOTHES WASHER <br />URINAL <br />DRINKING FOUNTAIN <br />FLOOR DRAIN <br />BACKFLOW PREVcNTERS <br />ROOF DRAINS—RAINLEADERS <br />SUB TOTAL <br />PERMIT <br />Y�CA OFhiCc USE ONLY: <br />FN�NTSETB�CK � REAflSETBA�K <br />� O >"'°"� 5 <br />lI5EZ0N�V � �pTAREA <br />Q ' Z � <br />nreorcoxsr NOAFSTORIES <br />_�� � <br />512EOFBLDG. FIRESPqINNLEPSREO'U <br />A <br />REASON <br />an <br />Z �� <br />FEE <br />$IOE SETO �CK � �, <br />'� J l O M, r <br />VACFNTSRE / <br />n res �No <br />occurR�ucr �rocrrnv[u,ricuru�s <br />� G YES iVNO <br />FIRE ALARM RCOD HEIGHT LIMITATION <br />/V � 21 ' <br />INiAI(EBV P�ANSAPP OVF.DBV � CITYGFEVERETT <br />LOCAL SALES <br />DFTE�]��/A �c�2 I TAR CODE IS 3105 <br />PHONE STATE UCENSE t <br />/ � C'/!r?.� /�/r`�%! � J J.s � �//Z <br />GONTACi PEfl$ON FND PHONc NO. <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br />APPLICATION AND KNOW THE SAME TO BE TFUE AND C6RRECT. ALL <br />PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br />WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br />NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br />AUTHORITY TO VIOLATE OR CANCEL THE PNOVISIONS OF ANY <br />OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br />PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br />OVJNER OF THIS PROPF.RTY TO PERFORM THE WORK FOR WHICH <br />APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />CO TRACTOR ' W �8' 7 RCW�4Np 296200 WAC. <br />� � � <br />' i n � <br />., . ,CC". � � � 9 �, . <br />sw aiunE o4r[ <br />CIiY BOSME55 �i :6NSE NO <br />MECNANICAL <br />NO. TYPE Or EOUIPMENT FEE <br />FORCED AIR SYSTEMS—B.T.U. M F.A. <br />UNIT HEATERS—B.T.U. M <br />CLOTHESDRYERS <br />VENTILATION FAN <br />RANGEHOOD <br />WATER HEATER <br />FIREPLACE INSERT <br />HEAT PUMP <br />GAS PIPING <br />EXHAUSTFAN <br />SUB TOTAL 5 <br />PERMIT 5 <br />TOTAL�EE $ <br />���. i y�>. ys � i���,3� <br />B:1ILDING <br />TLUMBWG <br />MECHANICAL <br />ADDITIONAL PLAN CHEGK <br />OTHER <br />STATE BUILDING SURCIIARGE <br />PUBLIC WORKS <br />TOTAL <br />� <br />