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APPLICATIO�' FOR CONSTRUCTY"'N PERMIT � <br /> TO BE COMPLETED IN BLACK INK—PLEASE PRINT <br /> yy��I�: <br /> HEATING SYSTEM: J GAS ❑ELECTRIC ❑ <br /> BUILDING DEPARTMENT <br /> 259-8810 <br /> ! DEMOLITION I i COMBINATION i BUILDING I i MECHANICAL PLUMBING I=] SIGN <br /> p�+�{ER MA1L FDD�E55 CITV ZIP PHONE <br /> I,C.V Hi,n+- Po Bor 3�5r Sn�k�M,sl 5'Y2`io �G� �l�i�t <br /> TENANT MAILA�DBESS CITv ZIP PNONE <br /> ARCNIIECTORDESIGRER MAILAODRESS GTY ZIP PNONE <br /> GENERdL CONTRA�TOR MAIL ADDFE55 CITV 21P PHON[ STATE UCENSE• <br /> c��e �I,.......f P� 13�� lu 5��,..�;s� �i �LSo S7�s�v�t C�,,�ce� o�s 3n <br /> MF GHANICRI CONI RAGTOR MAIL AD�FESS GTY ZIP PNONE STATE LICENSE/ <br /> . v��MBINGCONTRlC70N MAILpDORESS CITV ZIP PNONE STATELICENSE� <br /> CONTFAG7 PRICE OF WORK <br /> W <br /> S—¢,a� <br /> DESCFIBE WORK RND fOUnRE FOOTAGE INVOWED CONTpCT SOk AND PHONE NO. <br /> Ui � C�t�� <br /> � Jl�t �X / ��-� �� — �� lg _ <br /> � �C�U ` I— r:J= 5���1 I HEREBY CERTIFV THAT I HAVE READ AND EXAMINED THIS <br /> PROPOSEDUSF.OFBUIIDING APPLICATION AYD KNOW THE SAME TO BE TRUE AND CORRECT.ALL <br /> PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br /> LEGALDESGPIPTIONOFPROPERTYISHOWNBE}pwOpATTACNTWOCOPIES� WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br /> �Z� /yd° NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TG GIVE <br /> �or �� BLOCN —t"— oF AUTHORITY TO VIOLATE OR CP,NCEL THE PROVISIONS OF ANY <br /> — ���� Q� ,�UG�e� OTHER STATE OR IOCAL LAW REGULATING CONSTRUCTION OR THE <br /> PERFORMANCE OF CONSTRUCTION.THAT I AM AUTHORIZED BY THE <br /> OWNER OF THIS PRCPERTY TO PERFORM THE WORK FOR WHICH <br />, ' APPLICATION IS MADE AND I COMPLY W�TH ?HE STA7E <br /> � � PAflCEL TA%�.�.NUMBEF CONTRACTORS LAW 78.27 RCW AND 296200 WAC. <br /> �l3�11 - 43� - otl- boo ? <br /> I CONSTRUCTION LOAN LENDE .ADDPESS.TELPHONE NUMBER <br /> ' 21 � 2 �/z 7�.a.., .P .Ru / �-Zs- 95' <br /> 'f PROJECTADDRESS (.� s'�""'u . a��� <br /> v qTY 90SR.ESS liClNS[NO <br /> PLUMBING MECMAP�ICAL _ <br /> I Np, TYPE OF FO(TURE OR ITEM FEE NO. TVPE OF EOUIPMENT FEE <br />� � WATER CLOSET(TOILET) � A/�A/HNDLG 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 8 DISP VENTILATION FAN __� <br /> ' � DISHWASHER � RANGE HOOD ' <br /> . . LAUNDRY TRAY ; WATER HEATEfl ' <br /> - � CLOTHES WASHER WOOD STOVE � <br /> � URINAI. METAL FIREPLACE(WOOD BURNING) ' <br /> DRINKING FOUNTAIN � FIREPLACE I�SERT � <br /> FLOOR DRAIN HEAT PUMP ' <br /> BACKFLOW PRE'JENTERS ; GAS PIPING � <br /> ROOF DRAINS—RAINLEADERS � EXHAUST FAN � <br /> SINK(SERVICE—BAF.ETC.) � �- <br /> � _ <br /> � <br /> _ __T <br /> SUB TOTAL $ ' SU9 TOTAL $ <br /> PEFMIT $ PERMIT $ � <br /> TOTAL FEE $ TOTAL FEE $ <br /> FOR OFFICE USE ONLY: <br /> FRONT SETBACK REPR SETBRCK SIDE SETBACK PLAN CNECN NUMBER FEE RECEIPI NO. <br /> USE 20NE LOT AREA VRCANT SITE FEES VALUATION FEE <br /> ,-i yES :7: No ouilowG ; ` <br /> iYPE OP WVSi. NO OF STORIES ocCuvex[v uo o�o-NFun�,uHnS � <br /> cnoav pLUMBING � <br /> SIZE O('BLLC. FNE SPRINKlERS REO'D BASEMENi MECHANICAL <br /> f, YES C-: NO — <br /> OCCUPANCVLOAD FIREAURMFEOD HEIGNTLIMRPTION <br /> ADDITIONAL PLAN CHECK � <br /> i <br /> �_ rHER i <br /> REASON � � <br /> S7ATE OUILDING SURCHARGE <br /> INTANEBY PLANSAPPROVcD�V CITYOFEVERETT PUBLICWORKS � i <br /> LOCAL SALES � � <br /> DATE <br /> TAX CODE IS 3105 rora� ' �— <br />