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APPLICATI�! FOR CONSTRUC'T�4N PERMIT � <br /> TO BE COMPLETED IN BLACK INK—PLEASE PRINT <br /> HEATING SYSTEM: ❑GAS ❑ELECTRIC ❑ <br /> BUILDING DEPARTMENT <br /> 259-8810 <br /> O DEMOLITION ❑ COMBINATION ❑ BUILDING �'MECHANICAL ❑PLUMBING Cl SIGN <br /> pydNEH MAIL ADDRESS CITV t ZIP PHONE Q 1�� <br /> 50 ►.ti-rv ��so�� 12.z� t,aa�� �w�F E,��*- ���� � 339 — � <br /> TENANT M�',ILPDDRE55 CITY ZIP PMONE <br /> ARCHITECTORDE5�16NER MAILADDRE55 CIN ZIP PHONE <br /> �� <br /> GENERA�CONTRACTOR MAILADDRESS CITY ZIP PHONE STATELICENSE� <br /> �� <br /> MECHANICALCONTRACTOR MAILPODRE55 CITY 21P PHONE STATEIICENSE� ���4�� <br /> 9ePE,�a�B�e Ns.t� �A-C- �f4wz �oy�rN� F—reas,rr 4��3 ��i— y9�P� Q�'c_N <br /> PIUMBING CONTRACTOP MAII ADDRESS CITV 21P PHOYE STATE IICENSE t <br /> C�TR�CT;PIC;OF WORK � � � ^_i/Q/� <br /> V v d—' Js-�•-� I��EzS IJ � � �� r <br /> DESCRIBE WORK AND SOUARE FOOTAG2INVOW ED CONULT PERSGN AHD PHONE N0. <br /> LNS1-Az� Grks P,t'. kJh�T'.,-R ;t6fit"g� k <br /> (�-hj' �S-�LN� I HEFEBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br /> PROPOSED USEOF BUILDING APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT.ALL <br /> PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br /> LEGALDESCRIPTIONOFPROPERTV�SMOYMBELOWORATfACNTWOCOPIES) WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HERE�N OR <br /> NOT. THE GPANTING OF A PERMIT DOES NOT PRESUME lii GI`.�F <br /> �or e�xK oF AUTHORITY TO VIOLATE OR GANCEL THE PRO"ISIONS 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 COMPLV WITH THE STATE <br /> PARCELT�%I.D.NUMBEF CONTRACTORS LAW iB.27 RCW AND 296.200 WAC. <br /> CONSTRUCTION LOAN LENDER.AUDRESH,IELEPNONE NUUBER �^ � � �a/ ' I� � <br /> g / <br /> PROJECTADORE I'" up` °"T� <br /> USiNE55liC[NSE NO <br /> PLUMBIN6 MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM FEE NO. TYPE OF E�UIPMENT FEE <br /> WATER CLOSET(TOILET) � N�AIHNDLG 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 /> KITCHEN SINK 8 DISP � VENTILATION FAN � <br /> DISHWASHER RANGE HOOD ' <br /> LAUNDRY TRAY WATER HEATER � <br /> CLOTHES WASHER � WOOD STOVE � <br /> URINAL ' METAL FIREPLACE(WOOD BURNING) ' <br /> DRINKING FOUNTAIN � FIREPLACE INSERT � <br /> FLOOR DRAIN � HEAT PUMP : _ <br /> BACKFLOW PREVENTERS ; GAS PIPING � <br /> ROOF DRAINS—RAINLEADERS � EXHAUST FAN ' <br /> SINK(SERVICE—BAR,ETC.) I F�E PL�"�E , <br /> � — <br /> � <br /> SUB TOTAL $ 1 SUB TOTAL $ —� <br /> PERMIT $ � PERMIT 3 ,5 <br /> TOTAL FEE S ' TOTAL FEE S � <br /> FOR OFFICE USE ONLY: <br /> FRONTSETBACK REpRSETBACK SI�ESETBACK PLANCHECNNUMBEfI FEE FECEIPTNO. <br /> USEZONE LOTAREA V�CANTSITE FEES VALUATION FEE <br /> 'J YES �� NO gUaDiNG <br /> 7VPEOFLONST. NO.OFSTORIES occuP/nrv NoO�sNFwNGUNrtS ' <br /> caouo PLUMBING <br /> SRE OF BLDG. FIFE SP^.INNlERS REO'D BASEMENT MECHANICAL <br /> ❑ YES G NO ' <br /> OCWPANCV LOAD FIRE F.AFM PEOD HEIGNT LIMITATION AD�ITIONAL PLAN CHECK � _ <br /> OTHER <br /> flEA50N � <br /> STATE BUILDING SU(iCHARGE <br /> INTAKEB� PLANSAPPFOVEDBY CITYOFEVERETT PUBLICWORKS i <br /> LOCALSALES <br /> DATE TAX CODE IS 3105 rorn� <br />