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APPLICATIO' FOR CONSTRUCTI N PERMIT � <br /> TO BE COMPLETED IN BLACK INK-PLEASE PRINT `�� <br /> I HEATING SYSTEM: J 6AS J ELECTRIC J _ _JI <br /> BUILDING DEPARTMENT <br /> 259-8810 <br /> DEMOLITION COMBINATION ' BUILDING !MECHANICAL �! PLUMBING' _ _. SIGN <br /> OWMER tAA:I ADORE55 GtiY ZiP PnJL'E <br /> L)4LIP P�f-LC'yi�R /,Sa.�..,�oV% fvr(Z�l �A,�ol — <br /> iE���l1' MAILAD0255 r CiiV Z��' P'.!pGE <br /> nF�HRCCTOR�E5IGNEP h1I.ILFODRE55 G17Y 21P PHONE <br /> �ENERAL OhTf AGTOR ���'ILA�DFES� CITY ZIP PHph'E $TAi%UGENSE� <br /> ���i15..� �/i/ii�f �v /77�3 . <br /> :AECNANICALLONTRALTOR M ADDRE55 LITY 2�P PMONE STATEUCENSEk <br /> PWNBMGCONTRAGTJR MAILAD�RE55 CIN i4P PHONE STATELIGENSE• <br /> WNTFACT Pfl�GE OF WOPK L^/ /^ GO <br /> �UV� <br /> OESCRINE\VGRNANDSOI:APEP iA(' INV01.VE0 LON7ACTPER,rJF/NDPHONENO. <br /> _ U �—�OJf Cv/!'�/'�Z-�/Y/U�i.� __ <br /> i HEFEBY CERTIFV THAT I HAVE READ ANO EXAMINED THIS <br /> PROPOSED USE QF BUILOING APPLICA'i ION AND KNOW THE SAMF TO BE TRUE AND CORRECT. ALL <br /> PROVISIONS OF LAWS AND ORDINANCES GOVERNIN.THIS TYPE OF <br /> LEGRLDESCRIPTIONOFPROPENIV�SHOWNBELOWORATT�CHiWOCOPIE51 WORK VIILL BE COMPLETED WITH WHETHEh SPECIFIED NEREIN OR <br /> NOT. TFIE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br /> �ot BIOCN-- OF AUTHCRITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br /> OTHEF STATE OR LOCAL LAW REGULATING CONSTRUCTION 9F THE <br /> — PEF=ORMANCE OF CONSTRUCTION.THAT I AM AUTHOAIZED BY THE <br /> OW�ER OF THIS PROPERTY TO PERFORM THE WORN FOfl WHICH <br /> APPIICATION IS MADE AND I COMPLY WITH THE fiTATE <br /> vaRee�rnx i o.r+uMoea CCiVTRACTORS LAW 1827 RCW AND 296.200 WAC. <br /> LONSTPI1CtION LOAN LEN�ER.RDORESS,TELEPHONE NUMBER s� <br /> x- � wq ��9�' <br /> PROJECT ADDRESS L �"�F <br /> ���� �L � c�ivous�;issn� ;i �.c <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM FEE NO. TYPE OF EOUIPMENT FEE <br /> WATER CLOSET(TOILET) A�C—A:HNDLG UNITS—H.P. <br /> BATHTUB FORCED�IR SYSTEMS—B.T.U. M E.A. <br /> LAVATORV(WASH BASIN) _ UNIT HEATERS—B.T.U. M . <br /> SHOWER CLOTHESDRYERS <br /> KITCHEN SINK 8 DISP _ VENTILATION FAN <br /> DISIiWASHER _ RANGE HOOD <br /> LAUNDflY TRAY WATEF7 HEATER <br /> CLOTHES WASHER � _ WOOD STOVE <br /> URINAL METAL FIREPLACE(WOOD BURNING) <br /> DRINKING FOUNTAIN FIREPLACE INSERT <br /> FLOOR DRAIN HEAT PUMP _ <br /> BACh�L'�W FREVENTERS i GAS PIPING <br /> ROOF DHAINS—RAINLEADERS E%HAUST FAN <br /> SINK(SERVICE--BAR,ETC.) � <br /> —� <br /> � <br /> SUB TOTAL 5 �__ SUB TOTAL S <br /> PERMIT 5 PERMIT 5 _ <br /> TOTALFEE S TOIALFEE 5 <br /> FOR OFFICE USE ONLY: <br /> RCC[IPTNU <br /> FRONTSE:BACK FEARSETBAGR SiDESEiBACF PIONCN����C�F"� FE[ <br /> :� <br /> useZoue LOTAREA VFCANTSITE FEES VALUATION FEE _ <br /> [� YES I i NO BWLDING ��O _ �`� � ��U <br /> iYPEOFCONSi. NOAFSTORIES IXCuvwCr no0�nhmrvcCN'� — <br /> ccour PLU6IBING <br /> SIZE OF BLDG. FIRE SPRINKLERS REO'D BASEMENT MECHANICAL � <br /> �.—'. YES : ' NO ; <br /> OCCUPANCVIOAD iIFEAIARMREOD HEIGNTLiMIT�iION <br /> ADDI110NAL PLAN CHECK <br /> OTHER <br /> _ ' � <br /> R[ASON � ) <br /> STATE�UiL�INGSUFLHARGE __�_'�L <br /> ir�rnKEov ruNsnaPnoveoov f,ITYOFEVERETT auoucwor�Ks <br /> LOCALSALES �— <br /> onre TAX CO�E IS 310.` rorn� <br />