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APPLICATIOI+�FOR CONSTRUCTInN PERMIT � <br /> TO BE COMPLETED IN BLACK INK—PLEASE PRINT <br /> BUILDING DEPARTMENT HEATING SYSTEM: GAS ❑ELECTRIC 0 <br /> 259-8810 <br /> ❑ DEMOUTION ❑ COMBINATION I BUILDING CHANICAL ❑PLUMBING O SIGN <br /> OW�yER , �IA��RE55 CITy � IP �� PM�03 �� '��� <br /> L "ve��� <br /> TENAN�T/\ ,p MAII D ESS CITY ZIP FMONE <br /> \ \\` � <br /> APCHjtECjORDESIGNER MAI�ADDRE55 CITY ZIP PHONE <br /> GE�R�OfJ�CTOR MAIIADDRE55 CITV ZIP PMONE STRTELICENSE� <br /> 1 <br /> � ME�ICALCONT�OP MAILAODflE55 CITV 21P PHONE iTATELIGENSEt <br /> 1V-J <br /> PjUMBINGCONTiUCTOfl /MIL�ODRESS CITY ZIP PHONE STATELICENSE� <br /> . ^ <br /> 1 ` <br /> COI{i�TPRIC�yi�pQfjK'��/1 <br /> �v1 �J v� \J <br /> DESCRIdE WORK AND SOU0.RE FOOTAGE INVOWED CONTACT PERSON AND PNONE NO <br /> �a1�G\\�n q rn <br /> � �' ~' I HEREBY CERTIFY THAT I NAVE READ AND EXAMINED THIS <br /> PROPOSF�u6��r+c APPLICATION AND KNOW TH£SAME TO BE TRUE AND CORRECT.AlL <br /> J PROVISIONS OF LAWS RND ORDINANCES GOVERNING 7HIS TYPE OF <br /> LEGALUESCP�FTIOHOFPPOPERTV�SHOWNBELOWORATTACNTWOLOPIESI WORic WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br /> NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br /> �a; � e�acK oF AU7HORITY TO V�OLATE OR CANCEL THE PROVISIONS OF ANY <br /> OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br /> PERFORMANCE OF CONSTRUCTION.THAT I AM AUTHORIZED BY THE <br /> OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br /> APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> P�RCEL TP%I.D.NUMBER CONTRACTORS LAW 18.2%ACW AND 296200 WAC. <br /> CONSTRUCTION LO�N LENDEF,�O�RE55.TELEPHONE NUMBEP � �.,/ �i � J� /' /'��XPIN/.L// � 1�7I93 <br /> x , i�c ii� <br /> l��KJ /�3c[i <br /> PRQIE SS (y 1 S�ONATUFE OQE � <br /> (+` -�� �Y CrtV9U5inE55L�CEn5FN0 <br /> PLUMBIN6 MECHANICAL <br /> N0. TYPE OF FIXTURE OR ITEM FEE N0. TYPE OF EOUIPMENT FEE <br /> WATER CLOSET(TOILET) AiC—A�HNDLG UNITS—H.P. <br /> � BATHTUB (°ORCED Alfi SYSTEMS—B.T.U. M E.A. <br /> LAVATORY(WASN BASIN) UNIT HEATERS—B.T.U. M T_ <br /> SHOWER CLOTHES DRYERS <br /> KITCHEN SINK 8 DISP � � VENTILATION FAN � <br /> DISHWASHER � RANGE HOOD <br /> LAUNDRYTRAY ' WATER HEATER ' <br /> CLOTHES WASHER WOODSTOVE <br /> URINAL METAL FIREPLACE(WOOD BURNING) <br /> DRINKING FOUNTAIN � FIREPLACE INSERT � <br /> fL00R DRAIN HEAT PUMP ' <br /> BACKFLOW PAEVENTERS � GAS PIPING � <br /> ROOF DRAINS—RAINLEADERS EXHAUST FAN � <br /> �SINK(SERVICE—BAR,ETC.) I <br /> � <br /> � <br /> i <br /> � <br /> , � <br /> - SUBTOTAL $ ; SUBTOTAL $ ' <br /> PERMIT 5 PEAMIT $ � <br /> TOTAL FEE $ TOTAL FEE $ <br /> FOR OFFICE USE ONLY: <br /> FRONTSETBACN REARSETBACK SIOESETBr1CK PLANGNIECNNUM9ER FEE HECEIPTNO. <br /> USEZCNE LOTAREA VACANTSITE FEES VALUATION FE'e �� <br /> ❑ YES ❑ NO BUILDING <br /> iYPEOF�ONST. NO.OFSTORIES acuvuxr iwaow[wxeuvns i <br /> �RWv PLUMBING i <br /> _ � <br /> SQEOFBIDG. FIRESPRINKLERSFEO'D BASEMENT MECHAHICAL � <br /> 7 YES = NO <br /> OCCUPANCY LO�D FIRE ALARM REO'D HEIGNT LIMITATION AODITIONAL PLAN CHECK i <br /> i <br /> OTHER • � <br /> REASON <br /> STATE BUILDING SURCHARGE i <br /> . � <br /> INTRKEBY PUNSAPPROVEOBY CITYOFEYERETT PUBLICWORKS � <br /> LOCAL SALES , <br /> ORTE TAX CGDE IS 31U5 � TOTA� ' <br />