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APPL�CA�'I�' -: FOR C�NS1rRUCT'l1Pi PERM14 � <br /> TU BE COMPLETED IN BLACK INK—PLEASE PRINT <br /> BUIL.DING DC-I'ARTMENT HEATING SYSTEM: ❑GAS J ELECTRIC CJ _ <br /> 259-8810 <br /> J DEMQLITION ] COMBINATION !�UILDING MECHANICAL :_' PLUMBING ' SIGN <br /> OVINEF C� b IL4DDRE55 LI`Y ZIP PHONE <br /> M��l+.o�t.� Scl„ieer� 2�'31 NwT A,�E Evt�eaT `7d7A 1 <br /> tF.NqNi MAiLADDRESS qTY PP PHONE � <br /> J <br /> ARCHITECTORDESIGNER MAILADDPESS CITY LP PHONE <br /> GENERALCOtlTRALTOF MAILFDDRE55 LITY 21P PHONE STATELICENSEe <br /> P �C; N nat �(1.�_�{��1./� �'��,Q�AA 9`���� ���� � �\�1 �tx7�( <br /> LtECNAMC4LCONTR<CTOF 7 IdFiLA0�flE55 CItY ZIP PHONE SiATEUCENSEa <br /> PIUMBINGCONTPFC�Oq M.41LAO.BE55 LITY ZIP PHONE STAT[UGENSEx <br /> CONTRACT PR�CE OF WORK <br /> �2500 <br /> DESCFIBE 1YORK AND 5 RE FOOTqGE INVOLVED � WNT CT PER N qND PH NE NO <br /> � ��t<-►.t 5�' Z"l�1 <br /> s�. t � � a,.� 3s -73zo _ <br /> . L <br /> �9��� W�'SV� 0 I HEREBY CERTIFY THAT i HAVE READ AND EXAMINED TH:a <br /> PROPOS SEOFBUILOING APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT.ALL <br /> ��.S1�G L PROVISIONS OF LAWS AND ORDINANCES GOVEFNING THIS TYPE O� <br /> iecaieescaianoru��c'aaoFearvisNownoe�owoanrTacNrvmcoaiesi WORK WILL BE COMPLETED WITH WHETHER SPEGFIED HEREW OR <br /> NOT. THE GRANTING OF A PERMIT 7CES NOT PRESUME TO GIVE <br /> ior — s�ocK — ^F — AUTHORITY TO VIOLATE OR CHNCEL THE PROVISIONS G" ANY <br /> OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION ON THE <br /> — PERFORI9ANCE OF CONSTRUCTION.THAT I AM AUTHORIZED 9Y THE <br /> OWNEA OF THIS PROPERTY TO PERFORM ?HE WORK FOR WHICH <br /> APPLIC�1-10N IS MADE AND I COMPLY WITH THE STATE <br /> ❑nace�Taz i.o.nrMaen CONTRACTORS LAW 18.27 RCV.�AKD 296.200 WAC, <br /> CONSTR�CTIONLOPNLENOER.ADDFlESS TELEPHONENUMBER <br /> PROJECTAUDRESS '` ^ sic�+nivae n�r 2 � <br /> ��3� n0�� i SvL cirrn�sin.. :�. r�o " <br /> FLUMBINr MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM FEE N0. TYPE OF EOUIPMENT FEE <br /> WATER CLOSET(TOILET) ArC—AIHNDLG UNITS—H.P. <br /> BATHTUB FORCED 11R SYSTEMS—B.T.U. M E.A. <br /> LAVATORV(WASH BASIfVj i UNIT HEATERS—B.T.U. M <br /> SHOWER CLOTHES DRYERS <br /> KITCHEN SINK&DISP VENTILATION FAN <br /> DISHVJASHER RANGE HOOD <br /> LAUNORYTRAY WATER HEATER �_ <br /> CLOTHES WASHER WCOD STOVE <br /> URIIJAL ; METAI FIREPLACE(WOOD BURNING) <br /> DRINKING FOUNTAIN � FIREPLACE INSERT <br /> FLOOR DRA:N HEAT PUMP <br /> BACNFLOW PREVEt:TERS GAS PIPING <br /> ROOF DRAINS—RHINLEdDEAS � EXHAUST FAN <br /> SINK(SERV�CEi—BAR,ETC.) ; <br /> _ � <br /> SUB TOTAL 5 SUB TOTAL 5 <br /> PERMIT $ PERMIT $ i <br /> TOTALFEE S TOTALFEE 5 <br /> FOR OFFICE USE ONLY: <br /> FRONTSET9ACN REAR SETBAGK SIpESETBACN PLANCNECK U R FEE R[CBP1N0 <br /> G ����� <br /> uSFrove LOTAREA vncar+isite FEES VALUATION FEE <br /> '^. YES �. NO BUILOING �f]�7 S � <br /> iY�EOiGON.i. NO.OFSTORIES acacnxa r,00�ev:nur�Lw;x — —�� <br /> cuour p�UMBING <br /> --i— <br /> SZCOFpLOG. FIRESPRINKLERSflE00 BASEMENi MECHANICAI. <br /> -� VES . � NO -- — <br /> OCCUPANCV LOAO FlRE nLAP1.1 REOD HEIGHT LIMITATION <br /> AD�ITIONAL PLAN CHECK � <br /> OTHER <br /> REASON T— <br /> STATE�UIL�ING SURCHAFlfiE Ly <br /> rt�TAKE01' PIANSAPPPOVE�BY CIT7'OFEVERETT PUBLICWORNS <br /> LOCAL SALES �— <br /> DATE TAX CODE IS 3105 TOTAL 5� � <br />