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APPLICATIC l F'OR �ONSTRUCT'�1N P�RMIT � <br /> TO BE CO��PLETED IN BLACK IyK—PLEASE PRINT <br /> HEATWG SYSTEM:�I:GAS U ELECTRIC ❑ <br /> E3UILDING DEPARTMENT <br /> 259-8610 <br /> ❑ DEMOUTION CJ COMBINATION L' BUILDING i-i MECHANICAL iJ PLUMBING f_1 SIGN <br /> 0'NNER � � IAAILAD�RESS CITY ZIP PHONE <br /> � <br /> , 'I,_ �.1� , {-,� ,t� '"���Z � K • 1 , o-��:,< <i4'ac, � �-S2 � S'c.� <br /> TENANT IAAILAOORE55 CRY ZIP PHONE <br /> � �—�V�..� --__.__. . � — . <br /> AflCHRECTORDESIGNLR MAILADDRE55 LITY ZI� PHONE <br /> 7��r'�'� " . _ . .. _ _ _ <br /> GENERALGOI�TFACTOR MA�LADDRESS `____._---GTY iIP PHONE STATELICENSE4 <br /> S`���'�- <br /> IdECM<NICAL GONTFAGTOR MAIL ADDRE55 CITV ZIP PHONE STATE UCENSE b <br /> PWMBINGLONTFACTOR MAILAD�RESS Cltt ZIP PHONE STAIEUCENSE4 <br /> CONTRACT PfiICE OF WO�N '� � <br /> %3��.5 <br /> OESCRIBEWOFKANO50'JFREFOOTAGEINVOLVED CO�C`;RSONPNDPHONEti�; ` � 7S - <br /> J <br /> � ��\ . 0 �C^ ` <br /> (� __ <br /> ._�� 1 HEREBY CERTIFY THAT I HA�+E READ AND EXAMINED THIS <br /> aaovoseo use oF ew�nwc APPLIGATION AND KNOW THE SAME TO BE TRUE AND CORRECT.ALL <br /> L;V���, PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS T/PE OF <br /> LEGALDESCRIPTI�NOFP OPERTCY�S�HCOW' N6ELOWORATTAGHTW�1O1COPI ll WOflK WILL BE COMPLETED WITH WHETHER SPEGFIED HEREIN OR <br /> �o� �� e�ocK ,`�� — aF EV�cP " � � U I l NOT. THE GRANTING OF A PERMIT DOES NO7 PRESUME TO GIVE <br /> AUTHOHITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br /> �r ' �4 b �� OTHER SiA7F O,' LOCAL LAW REGULATING CONSTRUCTION OR THE <br /> 1!K — PERFORMANCE OF CONSTRUCTION.THAT I AM AUTHORI�ED BY THE <br /> OWNER OF �iHIS PROPERTY TO PERFORM THE WORK FOR WHICH <br /> APPLICATION IS MADE PND I COMPLV WITH THE STATE <br /> P�RCELTA%I D N111A�ER CONTRACTORS LAW 1827 RCW AND 296.200 WAC. <br /> �/ � � � ' ��2� — G/C� —C1C�0 <br /> CONS�RUCTION LONN LEIJ�LR.ADDRE55.7ELEPH�NE NUMDEF � � //� /�� <br /> PRO E� � �AiE <br /> OTADDRESS 1/� sisrva.uec , <br /> ;t,.� ',�-� ��(OVti� `� �lll(.� �1�'Y`s-' cirrnuswrssiicr.risErvo <br /> PLUMBING MECHANICAL <br /> N0. TYPE OF FIXTURE OR ITEM FEE NO. TVPE OF E�UIPMENT FEE <br /> WATER CLOSET(TOILET) AIC—A/HNDLG UNITS—H.P. � <br /> BATHTUB FORrFD AIR SYSTEIdS—B.T.U. M E.A. ' _ <br /> � LAVATORY(WASH BASIN) UNIT HEATERS—B.LU. PA �__ <br /> SHOWER CLOTHES DRVERS <br /> KITCHEN SINK 8 DISP VENTILATION FAN �._ <br /> DISHWASHER RANGE HOOD ' <br /> I.AUNDRY THAY WATER HEATER <br /> CLOTHES WASHER WOOD STOVE _T_ <br /> URINA�_ METAL FIREPLAGE(WOOD BURNING) <br /> FIREPLACEINSERT � <br /> DRINKING FOUNTAIN �— <br /> FLOOR DRAIN HEAT PLIMP <br /> BACKFLOW PREVENTERS ; GAS PIPING <br /> FOOF DRAINS—RAINLEADERS —� EXHAUST FAN <br /> SINK(SERVICE—BAR,ETC.) <br /> � <br /> SUB TOTAL S SUB TOTAL S <br /> PERMIT $ _ PERMIT $ <br /> — TOTALFEE 5 TOTALFEE S <br /> FOR OFFICE USE ONLY: Re iarno <br /> FEE �! <br /> FqONTSETBACN� REARSE�K/ SIOESETFIFjH PLFNCHECKNU�ER J <br /> � �� � � <br /> USEZONE IOTAREA <br /> vncnNrsrte FEES VALUATION FEE <br /> I ��� ��; YES �� pUILDING I� �� <br /> NO.OF TOPoFS acuvu.cv xoofbMwucuwis 2�T <br /> 7YaEOFCON57. eo�� ' PLUMBING � <br /> . <br /> SIZEOPOLDG FIRESPRINKLERSR[O'U BASEMENT MECHANICAL � <br /> 9 SQ FT D �' YES I�NO ; <br /> ADDITIO`1�L PLAN CHECK --� <br /> OCCUPANCY/A�ano FIREALARMRW'0 MEIGMTUh11TATiON __ i <br /> / <br /> N � OTHEfl � <br /> f1E�SON <br /> STATE BUILDING SURGHAFGE <br /> MTAKEBv PLANSnPPROv�OBY CITYOFEVERETT PUBUCWORKS � <br /> ���1 LOCALSALES �� 5 <br /> S/y�3 TAX CODE IS 310.�i TOTAL <br /> oaTe �. <br />