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APPLICATIG_J FOR CaNSTRUC`�_ ,Pl PERMIT � r <br /> TO BE COMPLETED IN BLACK INK—PLEASE PRINT <br /> HEATING SYSTEM: GAS O ELECTRIC !J � <br /> BUILDING DEPAFtTMENT <br /> - 259-8810 <br /> DEMOLITION COMBINATION �BUILDING MECHANICAL PLUMBING SIGN <br /> � OWN R MAILAOOFE55 CITY ZIP �P,� � ^ � <br /> � O <br /> �.�OG n <�Uf��7�" �,.'�,`/ /5i-�i�y 9 T3" D5� <br /> TENANt MA�LADDRE55 CITV ?IP PHONE I <br /> 59�11e <br /> AqGHRECtOFDESiGNER tAAILRDDflE55 CiTV ZIF PHONE �I <br /> ��� , �A,tl lti2Rruc F•vG trn fi>r4:,�r �C'� �'A�u�nA GDr/ s33 - 5'77/ � <br /> GEN[RRLCONTfl CTOR MAILADOFE55 CITY ZIP PHONE STATELICENSE� <br /> ,o�x y% T � . ��"/��u �G:uc�+/a� 9Xazo ��'S-/(G5o T�C1tJ�/3��1Z � <br /> � /srnii�no.c� �7/.�05 1 <br /> ayy �dECMANICALWNTRAGTOR 1dAtLA�DRE55 CITV ZiP PHONE STAiELIGENSE> � <br /> H ��' � <br /> y 7H PWM�INGCONTRACtOR MMLADDRESS CrtV ZIP PHO"�E dTATEIICENS[t � <br /> FG y� i <br /> '�i1 H'i1 <br /> GLPSS OF WORK <br /> y V1� � NEW XADDITION . '� ALTERATION REPAIR DEMOLITION WOODSTOVE/FRPL INSERT EUILDING FELOCATION <br /> Z f,ONt�CT P 501!AND PHOUE NO. � <br /> \ .��/�� 7 C c— <br /> � yd CONTPACTPRiGEOFWOBN � �1J1 (�O_� /� � � ��—/�JO <br /> O �"� OESCRiBE WOFN AN�SOUARE FOOtAGE INV06'ED � . <br /> � �,g a�z ,k ; <br /> �" n raoaoseous or uaowc I HEREBY CeRTIFY THAT 1 HAVE READ AND EXAMINED THIS , <br /> � y� APPLICATION AND KNOW THE SAtdE TO BE TRUE AND CORRECT.ALL , <br /> x �eea�oEscaiPnoNOFPaoaearr�sNo�+r�oe�owoanrtacHFouacoaies� PROVISIONSOFLAWSANDOFDINANCESGOVERNINGTHISTVPEOf <br /> WORK WILL BE COPdPLETED WITH WHETHER SPECIFIED HCREIN OR <br /> � y y �o. , -} etocK Z oF NOL THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE . <br /> H AUTHORITY TO VIGLATE OF CANCEL THE PROVISIONS OF AN'/ ' <br /> nCC5��''' d y OTHEF STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE � <br /> �j PERFORMANCE OF CONSTiiUCT10N.THAT I AM AUTHORIZED BY"THE <br /> z �y OWNER OF THIS PROPERTY TO PERFORM THE WORK POR WH1CH <br /> y py APPLICATION IS NADE AND I COMPLY WITH THE ST.1TE <br /> CONTRACTORS LAW iB27 FCW AND 296200 WAC. i <br /> ) I <br /> � / ' 1 t <br /> X—��LL Lv GGLliY�O 71 '/�� � <br /> ,�o.wr� oar[ <br /> �— ; <br /> pROJECTF�D7DRE55 "7�� ��y� �) � <br /> ' (���� ID� ��//ie� �?� uivoe•��•.is:�.ic��:sFr:n — . <br /> PLUMBING MECHANICAL �, <br /> .��� NO. TYPE OF FIXTURE OR ITEM FEE NO. TYPE OF EOUIPMENT FEE <br /> I ' WATER CLOSET(TOILET) A�C—A/HNDLG UNITS—H.P. _�_ � <br /> '� FORCED AIR SVSTEM1IS—B.T.U. M E.A. <br /> BATHTUB —1— . <br /> L4VATORY(WASH BASIN) UNIT HEATERS—B.T.U. M � <br /> r— <br /> �� SHOWER CLOTHESDRYERS ' � <br /> !�' KITCHEN SINK 8 DISP VENTILATION FAN __�_ � <br /> DISHWASHER � PANGE HOOD ' � <br /> LAUNDRYTRAY ' WATERHEATER i_ ' <br /> o— CLOTHES WASHER WOOD STOVE <br /> URINAL METAL FIREPLACE 8 CHIMNEY _ <br /> DRINKINCi FOUNTAIN FIREPLACE INSERT _ <br /> FLOOR DRAIN HEAT PUMP <br /> �s BACKFLOW PREVENTERS GAS PIPING <br /> ROOF DRAINS—RAINLEADERS EXHAUST FAN <br /> ��.i,,,� SINK(SERVICE—BAR,ETC.) _�, <br /> ♦ � <br /> .���� <br /> 0 <br /> � <br /> 't.; SUB TOTAL S SUB TOTAL S <br /> PERMIT S PERMIT 5 <br /> TOTALFEE S TOTALFEE $ <br /> FOR OFFICE USE ONLY: <br /> .'POYi SETBALK REAR SETOAGK SiOE SETDACN PLAN n-CH NU�JMOER FE �[C{EI�Pt NO. <br /> Z�� '� , O/ /�(� �� �� /���� <br /> usr.zc ioranen vacarursire FEES VALUATION FEE . <br /> �`I '�- Z O� /�a euaowc � <br /> iYCE(FCONiS.FLLOWAOLE iYPEOFLOtl51 FGIOAL O[Lvru¢r u0 OfoJiiw"Gm:nS ��0.� �� <br /> �"0pP PLUMOING <br /> 9zLOP�LDG. NOArSTORIES BASFMF.NT� �!E�HANICAL <br /> f�J�L ��k Z k k ADDITIONAL PLAN CHECK <br /> CCCUPANGYLOAD FIR::SPFNNLERSREOD HLIGHTIIA TALON <br /> � �/� SPRINKLER i <br /> PEASON FOR SPRINNLERS � <br /> STATE DUILDING SURCHARGE <br /> INTAKEOY PL�NSAPPROVEDBV CITYOFEVERETT PUBLICWORKS �� <br /> LOCAL SALES � <br /> JrI 3 q2 TAX CO�JE IS 3105 TOTAL '�9 �Q <br />