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APPLICATlL N FOR CONSTF�UCti .ON PERMIT ���� <br /> TO BE COMPLETED IN BLACK INK—PLEASE PRINT <br /> HEATING SYSTEM: ❑GAS ❑E�ECTRIC ❑ <br /> BUILDIMG DEPARTMENT <br /> 259-8610 <br /> i DEMOLITION ' COMBINATION I ' BUILDING � MECHANICAL i I PL4MBING i I SIGN <br /> TENA��JE MAILADDRES CITY Z�P PHONE <br /> � 3.3v� (��/.�� ���� as 5 - ��o� <br /> MHILAODRES$ CITV 21P PNGNE <br /> ARGHRECTORDESIGNER MAILADDfl S CIN Z PHONE <br /> �tir d' �'���,v/� �ov �J ��i+�z�s o�, �„� %'�i�f �� -rl/�� <br /> GENERALCONTqACiOR M.'ILFUDRE55 CIiY ZIP PHONE STATE�ICENSEe <br /> Z/'�'��p ��--�n%`2�` Cf��JS�' <br /> MECHANICALCONTRAGTOR M4ILAODRE55 CITV ZIP PMONE 51ATELICENSEn <br /> PWMBINGCONTRACTGR MAIL,I�DRESS CITV ZIP PHONE SiATEUCENSEk <br /> CLASS OF WORY. <br /> f 1 NEW I-! ADDITION . J ALTERATION . '. REPAIR �, ! DEMOLITION '�. � WOODSTOV[IFRPL INSERT . I BUILDING RELOOATION <br /> LONTACT P AND PMCNE 0 <br /> 1� 7 <br /> CONTRFCTPRICEOFWORN I�� C� �v ' —�` �� _ <br /> OESCRIIIE WORK AND SQIIFRE FOOTAGE INVOLVEO <br /> PRo� �EGFBUILDING — I HEREBY CERTIFY THAT 1 HAVE READ AND EXAPAINED THIS <br /> � � �G�G� � �� O , AP?LICATION AND KNOW THE SAME TO BE TRUE AND CORRECT.ALL <br /> �__ <br /> LEGALDESCRIPTION OP PROPERTV�SNOWN BELOW OR ATTALH FOURCOPIES) PROVISIONS OF LAWS AND ORDIMANCES GOVERNING THIS TYrE OF <br /> WORK WILL BE COMPLETED WI'fH WHf_=THEF SPECIFIED HEREIN OR <br /> iot _ e�ocH _ oF . NOT. THE GRANTING OF A PERMIT DOES NOT PRGSUIdE TO GIVE <br /> AUTHORITY TO VIOLATE Ofl CANCEL THE PROVISIONS OF ANV <br /> OTHER STATE OR LOCAL LAW REGULATIN a�ONSTRUCTION OR THE <br /> PERFORMANCE OF CONSTRUCTION.THAT I AM AUTHORIZED BY 7HE <br /> OWNER OF THIS PPOPERTY �O PERFORM THG \VORK FOR WHICH <br /> -- APPLICATION IS MADE AND I COMPLY WRH THE STATE <br /> CONTRACTORS LAW 18.27 RCW AND 29620p WAC. <br /> I-��'-r�ri- � % ' �r�.Cn�. {+ � ,',[ .Y----- <br /> PRQIECTADDRESS/ • /� � S�Grvniuee O.aE��_�_�� <br /> (D/.33 /�� ��90/Gl.0 il. 1�� J� �2•L Q�a�/ ci.reusir+ess�icer+ser+e <br /> PLUMBING f MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM FEE NO. TYPE OF EOUIPMENT FEE <br /> WATER CLOSET(TOILET) NC—A;HNDLG UNITS—H.P. <br /> BATHTUB FORCED AIR SYSTEMS—B.T.U. M E.A. <br /> LAVATORY(WASH BASIN) UNIT HEATERS—B.T.U. M � <br /> SHOWGR CLOTHES DRYERS _ <br /> KI7CHEN SINK 8 DISP � VENTILATION FAN ' <br /> �— <br /> �ISHWASHER � RANGEHOOD <br /> LAUNDRY TRAY ; WATER HEATER <br /> CLOTHES WASHER � WOOD STOVE �_ <br /> - URINAL METAL FIHEPLr.CE&CHIMNEY _ <br /> DRINKING FOUNTAItJ i FIREPLACE INSEfiT _ <br /> ��LOOR DRAIN � HEAT PUMP <br /> BACKFLOW PREVENTERS ; GAS PIPING � <br /> ROOF DRAINS—RAINLEADERS � EXHAUST FP.N <br /> SINK(SERVICE—BAR,ETC.) <br /> � <br /> � <br /> SUB TOTAL $ ' SUB TOTAL 5 <br /> PERMIT 5 PERMIT $ <br /> TOTAL FEE $ ' TOTAL FEE $ ' _ <br /> FOR OFFICE USE ONLY: <br /> FRONTSE7BACK REARSETBACK SI�ESETOALN PLANCHEC,N��ER� FEE RELEIPiNO. <br /> 3% � <br /> USEZONE LOTAREA VACANTSITE FF_ES VALUATION FEE <br /> BUILDING ���JZ� � �) 'c� <br /> 7VPEOFCONTS.ALLOWABLE T�PEOFGONSTACIOPL acUv�mCr x00�owFun+LuhuS <br /> �A 1 � � saou � PLUMBING _ <br /> IV <br /> SI2EOFBLOG. NO.OFSTORieS BASEMENA 0 MECHANICAL ' <br /> �.�f� �. . Ili <br /> ✓L L. �,4�/� <br /> OCCUPANCYLJAD PIRESPRNK�EFSFEO'D HEIGHTLIMITATION tiDDITIONALPLANCNECK �� _u�- <br /> � N� SPRINKLER <br /> REASON FOR SPRINKLERS i <br /> STATE BUILDING SURCHARGE <br /> INTANEBV P�ANSAPPfiOVEDOY CITYOFEVERETT PUPL�CWORKS i <br /> LOCALSALES <br /> � Il �I Z �M TAX CODE IS 3105 70TAL L �j Q <br />