1931 GRAND AVE 2016-01-01 MF Import

APPLICATIQ�II FOR CONSTRUCT'"�N PERMIT � TO BE COMPLETED IN BLACK INK—PLEASE PRINT BUILDING DEPARTMENT HEATING SYSTEM: ❑GAS ❑ELECTRIC O 259-8810 ❑ DEMOLITION ❑ COMBINATION ❑ BUILDING �MECHANICAL ❑PLUMBING ❑ SIGN OWNER �/ ff' ILRDDf ESS CITV ZIP PHONE % �' ,'� Y 'G/�'7�s�o TENANT MAIL ADDPESS CITY 21P PHpNE �qCH1TECTOR DESIGNER MAIL ADDRE55 CITV 2�p PHONE GENEHALCONTiUCTOR MAILAODFE55 CITY ZIP PHONE STATELICENSE/ MECM�yIQA�TR�pTpR��M�ADDRESS dTY ZIP PHONE STATELICENSE• CJ �(� PLUMBINGCONTFUCTOP ADDPESS CITY ZIP PHONE STATELICENSEI CONTMCT PRICE OF M/ORK DESCRIBE WORK AND SOUARE FOOTAGE INVOLVEO CONTACT PERSON MID PHONE NO. �/�Z G� f.-�.g �C.� i HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS PROPOSED USE OF BUILDIN6 APPLICAT�ON AND KNOW THE SAME TO BE TRUE AND CORRECT.ALL PROVISIONS OF LqWS AND ORDINANCES GOVERNING THIS TYPE OF IEIULDESCflIPTIONOFPqOPERTY�SHOWNBELOWORATTRCHTWOCOPIES� WORK WILL BE COMPLETED WITH WHETHER SPECIFIEO HEREIN OR �or e�ocK oF — NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE AUTHORITV TO VIOLATE OR CANCEL THE PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION.THAT 1 AM AUTHORIZED HY THE OWNER OF THIS PROPERTY TO PERFORM THE W7RK FOR WHICH V�pCEITA%I.D.NUMBER APPLICATION IS MADE AND I COMPLV WITH THE STATE CONT RS LAW 18. W AND 296.24 'NAC. CONSTRUCTION LOAN LENUER.ADDRE55.7ELEPHONE Nl1MBER ' PROJECT ADDNESS Y 9 a-,�3 ' /��/ � ^w �� SiG1UTURF O�iE � � CITVBOSMESSLKENSENO. PLUMBIN(i MECHANICAL N0. TYPE OF FlXTURE OR ITEM FEE NO. TVPE OF EOUIPMENT FEE WATER CLOSET(TOILE� � A/�A/HNDLG UNITS—H.P. � BATHTUB ; FORCED AIR SYSTEMS--B.T.U. M E.A. � LAVATORY(WASH BASIN) � UNIT HEATERS—B.T.U. M ; i SHOWER CLOTHES DRYERS ' KITCHEN SINK 8 DISP � � VENTILATION FAN ; � DISHWASHER � RANGE HOOD � , LAUNDRYTRAY ; WATER HEATER ' � CLOTHES WASHER � WOODSTOVE I URINAL ' (p METAL FIREPLACE(WOOD BURNING) � Qp � DRINKING FOUNTAIN � FIREPLACE INSERT ; FLOOR DRAIN � HEAT PUMP � BACKFLOW PREVENTERS ; GAS PIPING ; ROOF DRAINS—RAINLEADEflS � EXHAUST FAN � SIMK(SERVICE—BAR,ETC.) ; ' � 3 aJS � r� � .�' � � � � � ' � � SUB TOTAL $ ; SUB TOTAL $ / PERMIT $ � PERMIT $ � �UD —�— TOTALFEE $ ' TOTALFEE $ ' FOR OFFICE USE ONLY: FRONTSETBACK REARSEiBACK SIDESETBACN PUNCHECKNUMBER FEE AECEIPTNO. USEZONE LOTAREA VRCANTSITE FEES VALUATION FEE ❑ YES ❑ NO BUILDING i TYPEOFCON51'. NOAFSTORIES ocaru�tv Noaow[uixcuxrt5 � GR0°r PLUMBING � SIZE OF BLDG. FIRE SPPINKLERS REO'D BASEMENT MECHANICAL � ❑ YES Cl NO � OCCUPANCVLOAD FIREALARMflE00 HEIGHTLIMITATION ADDITIONALPLANCHECK i i OTHER i REASON STATE BUILDING SURCHARGE i i INTAK[OY PUNSAPPROVEDBV CITYOFEVERETT PUBLICWORKS � LOCALSALES , onre TAX CODE IS 3105 TaTA� ;