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� ARPLICATII'l� FOR CONSTRUCT�IN PERMIT � <br /> TO BE I;OMPLETED fN BLACK INK—PLEASE PRINT <br /> BUILDING DEPPRTMENT C HEATING SYSTEM: J GAS ❑ELECTRIC ❑ —� <br /> 259-88 i 0 ' / <br /> I_7 DEMOLITION i ] COA681NATION !:/,�BUILDING !J MECHANICAL f_; PLUMBING i7 SIG�I <br /> OWNEF MFILA�DFESS CITV ZIP PHONE <br /> s' � �,�sr /s��,� 9"L,�� S i�r,��,"v!-.�.� F,�P�}c(ldi �j�s-Ga�s_ <br /> TENANT IdAILAODRESS �I ZIP I / PHpNE <br /> ARG TECTOROESIGNEF MAILAOORESS CITV� � 21P PHONE <br /> /' r 1 ;�0, �iU� � �3Y��9 7 <br /> �J�fvC�<�7 �r'Sig�/ /,-�S��f �7�� '.a'Cr;c, � '�IDYHr-s <br /> GENERFLCONTFACTOF�� iLq�DRESS CITV � P PH NE /��f STAiELICENSEx <br /> 1��G�Gv��� /�e�dsf y6`// ��,lvovfi� La�ve , G��eve}� �>l��uos t�,�c� �C l O� <br /> M1�CHANICAL CONTRACTOF MAIL ADDFESL CIT� Z ' PHONt STATE LICENSE a <br /> P�UMBING�C/ONTPACTOR IAAILAOpRESS CITV ZIP PNONE STATE�ICENSEa <br /> �,/Tf�j�l� ��!/i�J'I�/A/S �P E� /,!/� S/ — 3 <br /> CONTRFCT PRIGE OF WORK jJ^�m` <br /> �/ /` <br /> DESCRIBE WORK AND SOUARE FOOTAGE INVOLVED /���� CONiACT PEPSON AND PHONE NO. <br /> � �r�„' s _ �� .�37-GE'a� <br /> I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br /> PROPOSED USE OF BUIL�ING �� ^ AppLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT.ALL <br /> ���-- PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br /> LEGAlDESCRIPT10NOfCAOPERry�SNOWNBELOWOP TTACHiWOCOPIE WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br /> �� �� NOT. THE GRANTING OF A PERMIT DOES MOT PRESUME TO GIVE <br /> �oi BLOCN oF AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br /> Sy�uG°`'L�L�S� OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTiON OR THE <br /> — PERFORMANCE OF CONSI�RUCTION.THAT I AM AUTHORRED BY THE <br /> �/�-� �� � (� OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br /> � � APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> anRce�rnx t.o.Nuraeea CONTRACTORS LAW 18.27 RC D 296200 WAC. <br /> CONSIIIUCTICN�LOAN LEN�ER ADDRE55.TELEPHONE NUMBE�3�_�3�� <br /> �U //P/" !� ��� <br /> PROJECT ADDRESS �a�u o.*e <br /> �M � c i,siHessu 5u+o — <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM FEF. N0. TYPE OF E�UIPMENT FEE <br /> WATER CLOSET(TOILET) Ai�—A/HNDLG UNITS—H.P. <br /> BATHTUB ; FORCED AIR SYSTEMS—B.T.U. M E.A. <br /> Z LAVATORY(WASH BASIN) UNIT HEATERS—B.T.U. M �— <br /> SHOWER CLOTHESDRYERS <br /> KITCHEN SINK 8 DISP VENTILATION FAN ; <br /> DISHWASHER RANGE HOOD <br /> LAUNDF'!TRAY ; WATER HEATER <br /> CLOTHES WASHER WOOD STOVE <br /> URINAL METAL FIREPLACE(WOOD BURNING) <br /> DRINKING FOUNTAIN FIREPLACE INSERT ; <br /> FLODR DRAIN � HEAT PUMP <br /> BACKFLOW PREVENTERS ; GAS PIPING <br /> ROOF DRAINS—RAINLEADERS EXHAUST FAN <br /> SINK(SERVICE—BAR,ETC.) <br /> � <br /> SUB TOTAL S SUB TOTAL 5 <br /> � PERMIT $ PERMIT S <br /> TOTALFEE $ TOTALFEE S <br /> FOR OFFICE USE ONLY: <br /> FRONTSET�ACK REARSETOACH SIDESET9ACN PIANCHECKNUMOE�+ F[ FECEIPTNU <br /> Zo s o3// 3o g(� ?i <br /> usezo �ornr+en vncnNTsiTe FEES VALUATION FEE <br /> �,� �'� OeO � . i YES f7 NO BUILDING <br /> rvrEorcoNsr r+o.oFsruaiEs acuP<tic. xoeoy�.��N��m�s S �7 5!J � �O <br /> —IT'IJ `fl0s�° / PWMDING ���� � �j <br /> -Y- <br /> SIii02P9LD�j� t FIRESPNINNLERSiiE00 �AS[MENi � MECHANICAL � � �f(J <br /> $4 �SP A /O ❑ YES Z�NO , <br /> OCGUPANCVLOFD fIREALARMREOD MEIGHTLIIAIT4TION ADDITIONALPLANCHECK � <br /> ,Q O � OTHER Q � <br /> REASON <br /> STATE BUIL�ING SURCHARGE � ; L� <br /> INTAKEBY PLANSAPPFOVEDO\' CITYOFEVERETT PU�LICWOFlKS <br /> �J�� LOCAL SALES �� � <br /> ���� 5�6�93 TAX CODE IS 3105 TOTAL (��� , �;-. <br />