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AP�PLICATIO ' FOR CONSTRUCT�-`N PERMIT � <br /> TO F3E COMPLETED IN BLRCK INK—PLEASE PRINT <br /> BUILDING DEPARTMENT HEATING SYSTEM: �GAS ❑ELECTRIC ❑ <br /> 259-8810 <br /> ❑ DEMOLITION ❑ COMBINATION ❑ BUILDING k�MECHANICAL ❑ PLUMBING ❑ SIUN <br /> OWNER MAILADORE55 � ,� CITV 21P PHONE <br /> >%f��l���Aik s �/r5�p ��C�S��sc0 g=io l,t�nkux�� i'�03(i, <br /> TENANT MAILADDRE55 CITV ZIP PHONE <br /> ARCHITEC'ORDESIGNEP M�ILADDRESS CITV LP PHONE <br /> GENERALCONTfl�A/CTOR � MAILA��RESS CITY ZIP PNONE 3TATELICENSEp <br /> ��r"��Y' /YFJT- l '7fl� �C1 �rC ��. 1,Uc'Ilr._�� I�O�l��i ��-S�� �:1l��tCOo�f;rf'h� <br /> hfECHANICAL CONTRACTOR MAIL AODRESS CITV ZIP PHONE STATE UCENSE a <br /> PW4IBINGCONTRACTOR MAILAD�RESS dTV ZIP PMONE STATELICENSER <br /> CONTPACTPRICEOFWORK 1 ^� ,-��:�� <br /> )(/ <� <br /> DESCRIBE WORK AND S�UFRE FOOTAGE INVOLVED CONTACT PEPSON AND PHONE NO. <br /> ' 't'! �1 Z t,llf.l2 _ i'Ol� (-/f.t�/ F_(2 !� <br /> GCJ N v C ��exl�c..�Y SNUi� 1]p�p I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br /> PROPOSEO USE OF BUILDING p� APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT.ALL <br /> �J` / PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br /> IEGALDESCRIPTiONOFPROPERTV�SHOWNOELOWORATTACHTWOCOPIES� WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br /> �or BLOCK oF NOT. THE GRANTING OF A PERMIT DOES IJOT PRESUME TO GIVE <br /> AUTHORITY TO VIOLATE OR CANCEL 1'HE PROVISIONS OF ANY <br /> OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTIGN OR THE <br /> PERFORMANCE OF CONSTRUCTION.THAT I AM AUTHORIZED BY THE <br /> OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br /> APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> PAPLEL TA%I.D.NUMBER CONTRACTORS LAW 18.27 RCW AND 296200 WAC. <br /> CONSTRUCTION LOAN LENDER,AU�RE55,TELEPHONE NUI.�BER 1 j� <br /> � ,�/ lCT�I-- V'� �" � � <br /> PROJECTADDRESS sinn IIPE ,� DAIE <br /> ,���L ����K ci euswEssucEr+s�r+o <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM FEE NO. TYPE OF E�UIPMENT FEE <br /> WATER CLOSET(TOILET) � A/C—A/HNDLG UNITS—H.P. <br /> BATHTUB FORCED AIR SYSTEMS—B.T.U. M E.A. ' <br /> LAVATORY(WASH BASIN) UNIT HEATERS—B.T.U. M <br /> SHOWER CLOTHES DRYERS � <br /> KITCHEN SINK 8 DISP � VEMTILATION FAN <br /> DISHWASHER RANGE HOOD � <br /> LAUNDRYTRAY ; WATERHEATER ; <br /> CLOTHES WASHER � WOOD STOVE <br /> URINAL ; METAL FIREPLACE(WOOD BURNING) <br /> DRINKING FOUNTAIN � FIREPLACE INSERT � <br /> T <br /> FLOOR DRAIN HEAT PUMP ' <br /> BACKFLOW PREVENTERS ; GAS PIPING <br /> ROOF DRAINS—RAINLEADERS EXHAUST FAN <br /> SINK(SERVICE—BAR,ETC.) ; i -- <br /> - � <br /> � <br /> � � <br /> , � <br /> i � <br /> SUB TOTAL $ ; SUB TOTAL $ <br /> PERMIT $ � PERMIT S /.� � _ <br /> TOTAL FEE $ ; TOTAL FEE $ '^ <br /> FOR OFFICE USE ONLY: <br /> fRONTSETBACK REAf15ET8ACK SIOESET9ACN PLANCHECKNUMDER FEE flECEIPTNO. <br /> �^ <br /> � <br /> USEZONE �OTAREA VACANTSITE FEES VALUATION FEE <br /> ❑ YES G NO BUILDING <br /> i <br /> NPEOFWt15T. NO.OFSiCRiES ot[uPnNtr n0oroa�FlurvcUxirS -- i <br /> cnoua PLUMBING i <br /> SREOFPLDG. FIRESPRINKLERSREOD BASEMENT MECHANICAL � <br /> ❑ YES - NO — � <br /> OCCUPANCYLOAD FIREP�ABMRE�'D HEIGHTIIMITATION �+DOITIONALPLANCHECK — i <br /> i <br /> OTHER <br /> FlEASON �— <br /> STATE BUILDING SURCHARGE <br /> i <br /> MTAKF.�V PLANSAPPROVEOAY CITYOFEVERETT PUBLICWORKS � <br /> LOCALSALES <br /> onre TAX CODE IS 3105 TOTAL <br />