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APPLICATIC"rl FOR CONSTRUCT�N PERMIT � <br /> TO BE COMPLETED IN BLACK INK—PLEASE PRINT <br /> BUILDING DEPARTMENT HEATING SYSTEM: ❑GAS ❑ELECTRIC D <br /> 259-�810 <br /> DEMOLITION COMBINATiON ! 1 BUIIDING f MECHANICAL CI PLUMBING I_J �'iGN <br /> �SK PAr�'ners�i�p MA14�c85 "vct,u:�oo� �e:��W+ Zi� � 8�31-09J� �s�=2�3-3 <br /> TENANT MAILA�DRE55 CITY ZIP PNONE <br /> ARCNITECtORDESIGNER MAILAU6RE55 j���<J�rj CITY ZIP PMONE <br /> (1'I �7N�h' PqeT: 9�4ttivi u:A�' SiaTie 113A `�$IDI ��3'-7�� <br /> GENERALCONiAALTOR MAILIIDDRESS CITY 21P PMONE STATELICENSEII <br /> IJ�wl�,d ('o�sT Bdx9SB E�E�..CTr u:�a ��zc� zs9 -�i�l <br /> MECMANICALCONTR�CTOR MAILADDRE55 GTV ZIP PHONE ST�TELICENSEII <br /> PLUMBMG CONTRACiOR MAR�DDRE55 CITV 21P PHONE STATE LICENSE t <br /> CLASS OF WORK <br /> ' : NEW ! ' ADDITION `- � ALTERATION I I REPAIR . ��� DEMOLITION ��: i WOODSTOVE/FRPL INSERT L] BUILDING RELOCATION <br /> CONT�CT PERSON AND PHONE NO <br /> CONTR�CTPRICEOF WORK � � I /��� d✓ancc'� FiQ ��OTQ ionl •OG�t K�3 <br /> DE$CRIBEWOqK11NDSIXIAREFOpT�GEINVOLVED ZC(� L�,j-� <br /> F�QE���AKI,E�.sYSTEY�'19 21;loU �' �nrll�e l✓ &7Z C1i�r/es ��isr�orn� <br /> PROPOSEDUSEOFBUILDMG i HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br /> I�PR2TYYIE�� - L�Ji 13C��IJ 1 T�3 APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT.ALL <br /> LEGAL OESCHIPTION OF PROPERTY�SHOWN BEIOW OR ATTRCN FOUR LOPIES� PROVISIONS OF LAWS AND ORDINANCES 60VERNINO THIS TYPE OF <br /> �ot 12.- l4 e�oac 37�o oF D'�� WORK WILL BE COMPLETED WITM WHETHEH SPECIFIED HEREIN OR <br /> NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO QIVE <br /> c %� AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANV <br /> �(�R T d� �C-VCIeE T T—y��� � , OTHER STATE Ofl LOCAL LAW RECaULATIN6 CONSTRUCTION OR THE <br /> PERFORMANCE OF CONSTRUCTION.THAT 1 AM AUTHORIZED BV TME <br /> � OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br /> APPLICATION IS MADE AN� I COMPLV WITH THE STATE <br /> CONTRACy�RS L(tW�27 RC AND 296200 WAC. <br /> /1 / / / <br /> x �t'14i�i 'f s-s-y z <br /> PpOJECT ES+ eqMAtuqE O� Q�D 3 WtE <br /> LRv 8�14ME65�iCENSE MO <br /> pLUMSNIO MECHANICAL <br /> N0. TrPE OF FlXTURE OR ITEM FEE NO. TYPE OF EGUIPMENT FEE <br /> WATER CLOSET(TOILE� � N�A/FINDLG 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 /> SHOWER ' CLOTHES DRYERS � <br /> K�TCHEN SINK 6 DISP � VENTILATION FAN ; <br /> �� DISHWASHER � RANGE HOOD � <br /> LAUNDRYTHAY ; WATERHEATER ' <br /> CLOTHES WASfiER i WOOD STOVE � <br /> � URINAL ' MFTAL FIREPLACE 8 CHIMNEY � <br /> DRINKING FOUNTAIN � FIREPLACE INSERT ; <br /> —�— <br /> FLOOR DRAIN � HEAT PUMP � <br /> I BACKFLOW PHEVENTERS ; GAS PIPING ; <br /> - ROOF DRAINS--RAINLEADEHS EXHAUST FAN � � <br /> . SINK(SERVICE—BAR,ETC.) ; ' <br /> � � <br /> � � <br /> SUB TOTAL $ ; SUB TOTAL S ' <br /> PERMIT $ � PERMIT E � <br /> TOTAL FEE $ ' TOTAL FEE S ' <br /> FOR OFFlCE USE ONLY: <br /> PqpNTSETBACK RE�FSETBACK SIDESETdRCK PUNCHELKNUMBER FEE RECEIPTNO. <br /> USEZONE LOTAFEA vnc�r+rsire FEES VALUATION FEE <br /> BUILDING � � <br /> flPE 0�CONTS.ALLOW�BLE TVPE OF CONST.ACTUAI occuveHcv No.a Dw[wHG Uxrts i <br /> _ � _� cnwo pLUMBING � i <br /> \ <br /> SRF OF BLOG. NO.OF STORIES BRSEMENT � <br /> � ` I�_� MECHANICAL ' <br /> �CU�CY LOAD FlRE SP�/R�N;KLERS REO'D NEIGHT LIMIT,AGTION ADDITIONAL PLAN CHECK �/ i� <br /> 7Z `�y SPRINKLER �•�y�� <br /> REASON FOR SPRINKLERS <br /> STATE BUILDING SURCHARGE i <br /> INT�KEdY PLANSAPPPOVEDBY CITYOFEVERETT PUBLICWORKS � <br /> LOCAL SALES ,� <br /> �y y� TAY CODE IS 3105 TOT�L ��.j ;7,.� <br />