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APPLICATIOI_ FOR CONSTRUCTI� N PERMIT �� <br /> TO BE COMPLETED IN BLACK INK-PLEASE PRINT <br /> BUILDING DEPARTMENT HEATING SYS7EM: ❑GAS i ELEC7RIC O <br /> 259-8810 <br /> DEMOLITION COMBINATION BUILDING MECHANICAL PLUMBING SIGN <br /> � OWNER MqIL AO�RE55 CITV ZIP PHONE <br /> �wa `�E I�o�cs3�6 Lc�.�fF q°v2o6 ZSZ-27Z� <br /> TENANT MAILAODFESS CITY ,IP PHONE <br /> ARCHITECTORDESIGNER IdAILADDRESS CITV ZIP PHONE <br /> GENERAL�ONTRACTOR MAILADOFESS CITY TIP PHONE STATELICENSE> <br /> '' � Sc--�F <br /> MECHANICALCONTRACTOF MRILADORESS dTY IIP PHONE STATELICENSEa <br /> ♦ <br /> PLUMBING CO4TRACTOR MAIL A��RESS CITV ZIP PHONE STqTE LICENSL a <br /> CLASS OP WORN <br /> ' � NEW I '. ADDITION �LTERATION `r(REPAIR _ � DEMOLITION WOODSTOVEiFqPL INSERT BUILDING RELOCATION <br /> GONTACT PERSON AND PFONE NO. <br /> CONTRACT PflICE OF WOFK ,�p��p� <br /> DESCRIBE\VORK FNO SOUARE F iAGE INlOLVE�o— <br /> PROPOS DJSEOFBUILDING 1 HEREBY CERTIFY THAT I HAVE FEAD AND EXAMINED THIS <br /> ,�p��r� APPLICATION AND KNOW THE SAME TC BE TRUE AND CORRECT.ALL <br /> r PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br /> LEGAL ESCRIPiIONOFPFOPEflNISNOWNBELOWORATfACNFOURCOPIES) <br /> WOI�K WILL BE (:OMPLETED WITH WHETHER SPECIFIED HEREIN OR <br /> tor eiocK oF _ NOl". THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br /> AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br /> _ OTHER STATE OR LOCAL LAW flEGULATING CONSTRUCTION OR THE <br /> PER°ORM1tANCE OF CONSTRUCTION.THAT I AM AUTHORIZED BY THE <br /> �j�,�,�P�,� � L�d„e� S���k, � OWMER OP THIS FROPERTY TO PERFORM THE WOFK FOR WHICH <br /> C—� APP�ICATION IS MADE AND I COMPLY WITH THE STATE <br /> � �.,-�s �' sub�'L�r r�� �fa�'I� CONiR l"O SLAW18.27RCWAND296.200WAC. <br /> PROJECTFD�R� �� X�+ar�ne V onr[ l�l� <br /> � � CIiv90!ANESSlICf15CN0 <br /> PLUMBING MEChIANICAL <br /> NO. TYPE OF FIXTURE OR ITEM FG:E NO. TYPc OF EOUIPMENT FEE <br /> WATER CLOSET(TOILET) �� �� A,'C—NHNDLG UNITS—H.P. <br /> BATHTUB �;' ;� FORCEDAIRSYSTEMS—B.T.U. Id E.A. <br /> LAVATORY(WASH BASIN) �"I— UNIT HEATERS—B.T.U. M ; <br /> SHOWER �CLOTHES DRYERS <br /> KITCHEN SINK 8 DISP " I— 'JENTILATION FAN <br /> DISHWASHER RANC��E HOOD <br /> LA�NDRY TRAY 1NATER HEATER <br /> CLOTHES WASHEA �VOODSTOVE ; <br /> URINAL A4ETAL FIREPLACE&CHIMNEY <br /> DRINKING FOUNTAIN � FIREPLACE INSERT <br /> FLOOR DRAIN HEAT PUMP <br /> BACKFLOW PREVENTERS I GAS?IPING <br /> ROOF DRAINS—RAINLEADERS � EXHAUST FAN <br /> SINK(SERVICE—BAR,ETC.) ; ' <br /> i <br /> � <br /> — <br /> i <br /> SUB TOTHL S r� SUB TOTAL 5 ' <br /> PERMIT S PERMIT $ <br /> TOTAL FEE S ,-Jd ' — TOTAL FEE 5 /I ' <br /> FOR OFFICE USE ONLY: <br /> FRONTSETBACK REARSETBAGK SIDESETBACN PLANCHECKNlIM6ER F[E RECEIPTNO. <br /> ��a `�/ <br /> USEZONE �OTAREA VPGANTSITE FEES VALUATION FEE <br /> BUILDING �� :OU <br /> TYPEOFCONiS.AiLOWABIE TYPEOit@ISi.ALiUAL ot[uvnxcv No arowFLUNGUuus <br /> cxouv � <br /> PLUMBING rJ0 ; OU <br /> SIZEOFBLDG. NO.OFSTORIES BASEMENT MECHANICAL � 00 <br /> AD�ITIONAL PLAN CHECK ' <br /> OCCUPANCY LOAD iIRE SPRNKLERS REO'0 MEIGHi LIMITATION � <br /> � SPRINKLEfl � <br /> REaSON FOR SPRINNLEF$ <br /> STATE 6UILDING SURCHARGE ; Sp <br /> i_ <br /> INTANEBV PLANSAPPROVEDBY CITYOFEVERETT PU6�ICWORKS � <br /> LOCAL SALES <br /> TAX CODE IS 3105 TOTAL , ;S G <br />