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APPLICATIC� 1 FOR CONSTRUCT _ �N PERMIT � <br /> TO BE COMPLETED IN BLACK INK—PLEASE PRINT <br /> HEATING SVSTEM G �t�ECTRIC � � <br /> BUILDING DEPARTMENT <br /> 259-8810 <br /> ✓DEMOLITION �COMBINATION "BUILDING MECHANICAL �.'PLUMBING -1 SIGN <br /> OWNER 1.!AILADDRc55 CITY Z'P PtlONE <br /> pqU��c 6A�-�C�ES ��lC. 1(o C�4un[L De F�e�c7T Wn a�z�l 2s�- �3�� <br /> TENRNi MAR AODRE55 GITV ZIM PtiONE <br /> �t GITY ZIP V�104_ <br />� APCNIlECi0R0E51GNER MAILnDDBE55 <br /> PHONE STATE LILENSE� <br /> GENER5LCCNTRACTOA MAILADDFE55 ��� Z'P ����j� �g(cTN <br /> MECHAN�GAICONiqnCTOP MAILPDDRESS CITV DP PHONE STFTEL�CENSEY <br /> FHONE STPTELIGENSE� <br />' PWMBINGLONTqqpTOR IAAILADCRESS ��ry Z�P <br />� COHTRRCT PRICE OF WORK / zs/ �'3�� <br /> �/7 /-�Zn—_ ED G'�-scv`i <br /> OESCRIBE WORR nND Wl1ARE POOTAGE�NVOIVED CONTAGT PE�i50N AND PHONE NO <br />' ('v,vs7�wc7� fl�� /-�a�_r- �yDr�z h,us��n <br /> �ZQF7Z (�.�h,viyY�.O i HEFEBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br /> raoaoseo u .oF su��owc APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT.ALL <br /> �(��y_ PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br /> �EGALDESGRIPTlp40FPqOPEPTVISHONMBELOWOBRiTAGHTWOCOPIE51 N�R THELGRANT NG OP AD EfiMITJDOES NOT PR'ESUME TO GIOVE <br /> �ot eiocK oc AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br /> OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br /> PERFORMANCE OF CONSTRUCTION.THAT I AM AUTHONIZED BY THE <br />� �AppLICOION'SISRMADET A DPE COMP YH WIT�HKT ER STATE <br />� rnnce�Tax i n.Nurnaea CONTRACTORS LAW 1827 RCW AND 296.200 WAC. <br /> 5/�8-54Z-Gzs - pc�y <br />� CONST�iULTIONLOANlENOER.A�DRE55.T[L[PHONE N�MBEF _ / �+. <br /> /�F-?u�Kr 3�n�� /f9o2y�✓�c.cE �� � y/S/� <br /> PROJECT A "1RESS "c",�,�� — <br /> 1 � piVPOS�NC55'_�CF.NSEN� <br />, /� / _ / , <br />� PLUMBID MECHANICAI <br />'� TVPE OF EDUIP�IENT FEE <br /> NO. TYPE OF FIXTURE OR ITEM FEE NO. <br />� ,�, WA R CLOSET(TOILET) A�C—A�HNDLG UNITS—H.P. <br />�� BAT. 'IB / ; FORCED AIR SYSTEMS—B.T.U. M E.A. <br />. 2, LAVA� �V(WASH BASIN) / � S UNIT HEATER6—B.T.U. M �_ <br /> SHOWEN GLOTH[5 DRYERS <br /> / KITCHEN SINK 8 DISP VENTILATION FAN <br /> J DISHWASHER � � _L RANGE HOOD <br />� LAUNDRYTRAY � WATER HEATER <br /> CLOTHES WASHER � WOOD STOVE <br /> URINAI. � METAL FlfiEPLACE(WOOD BURNING) <br /> FIREPLACE INSERT <br /> DRINKING FOUNTAIN �i— <br /> FLOOR DAAIN � HEAT PUMP <br /> BACKFIOW PREVENTERS ; GAS PIPING _ <br /> ROnF DRAINS—RAINLEADERS EXHAUST FAN <br /> SINK(SERVICE—BAR.ETC.) <br /> __T_ <br /> ---i— <br />� SUB TOTAL S SUB TOTAL 5 /r�I ' — <br />� _ — PERMIT 5 <br /> PERMIT 5 TOTAL FEE 5 <br /> � TOTALFEE S <br /> FOR OFFICE USE ONLY: aec r r+o <br /> FRONTSETBACK RF.ARSETOACK SIOESETBA K/ NLANCHECy�(��,yM�CQ �EE� �� /) ^��r_ <br /> O � � � ' ( � � ` (/� <br /> ❑SE 20NE 1.07 ANFA VACA`1T Sli[ /� <br /> FEES VALUATION FEE <br /> � � i��. YES "�. NO � � �� '�Ci <br /> BUILDWG <br /> iVPEOfCONST NOAFSTOFIES oCNrvncr x004b�v[wbGu4i�s /�J <br /> 2 "00� I PLUIdBWG � � <br /> �-.v <br /> SIZEOFBL�F FIFFSPRINHLERSREO'0 BASEAIENT MECHANICAL <br /> ;i"i� �p i-�. YES �Z NO D �22 <br /> ADDITIONAL PLAN CHECK <br /> OCCUPANCVLO�D FIRE4L/RMREO'0 HEIGHTLIMITAT'ON //� i _ <br /> N/n �— �— � " _ <br /> �E��N ' J <br /> STATE Bl11LDING SURCHARGE <br /> INTANEBY PLANSAP!•�OVEDBV CITYOFEVERETT PUBLICWORKS �O � ' <br /> J LOCAL SALES �— <br /> oqTE 14 93 TAX COOE IS 3105 TOTAL � <br />