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��ea�i .__� _. . ,_. . _ <br /> APPLICATIO.N FOR �ONSTRUCTI�IN PERMIT � <br /> TO BE CVrvIPLETED IN BLACK INK—PLEASE PRINT <br /> BUILDING DEPARTMENT HEATING SYSTEM: �GAS J ELECTRIC J _ __. � <br /> 259-8810 <br /> ❑ DEMOLITION ❑ COMBINATION ' I BUILDING �MECHANICAL C PLUMBING = SIGN <br /> uui �OOPF.Sc rRY ZIP PNONE � <br /> TO�N�Y ��MAIL t3���1 I V �`l ZI'-_� rnuNE���� � <br /> •_� <br /> ARCHITEC�OB DESIGNER MRIL ADDRESS CITI ZIP PHONE <br /> �O, TV1�IL�JR \1�6�jY�lQ(i�¢I �IIO`�}� 'I CITY ? C2� �_ PHONE � STATEL�SEI <br /> 1—tU F�,- 59-5 3 3 1�b2T W�I 10:� 2a <br /> MECHMIICAL CONTMCTOR MAIL ADORESS CITV ZIP PMONE STATE 1�CENSE• <br /> P�IN���TOR� MAIL�DDRESS CITV liP PHONE STATE LICENSE v <br /> � <br /> CONiR!�C_T P_RICE OF WORK <br /> ��Y 1� <br /> �65CP�BE WORK AND SOU�flE OqTAGE I_NV�(1LVED _ CONTACT PERSON AND PHONE NO. � <br /> �'�Q��� ���Y�Y`� ' . <br /> , ,—�,r�,...� _ � aE��.� ��`��l"5�� <br /> � S�� I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br /> PROPOSEDUSEOFBUILDING � APPLICATION AND KNOW THE SAME 70 BE TRUE AND CORRECT.ALL <br /> PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br /> LE4ALDESCRIPTIONOFPROPERTV�SHOWNBEIOWORATTACHT4000PIES� WORK WILL BE COMPLETE�WITH WHETHER SPECIFIED HEREIN OR � <br /> NOT. THE GRANTING OF A PEflMIT DOES NOT PRESUME TO GIVE <br /> �oT etocK oF AUTHORITY TO VIOIATE OR CANCEL THE PROVISIONS OF ANY <br /> OTHER STATE OR IOCAL LAW REGULATING CONSTRUCTION OR THE <br /> ' PERFORAIANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br /> �/ _� /�'�/V\ _I�1�I OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br /> Lp l��l-��J SJ APPLICATION IS MADE AND � COMPLY WITH THE STATE <br /> FCELTA%I.D.NUMBER CONTRACTORS LAW 1827 RCW AND 296.200 WAC. <br /> CUN Ti1UCT L H,#fy/�QURESS,TEL PHMJ$�(IOMB�RO ��• O � <br /> US�ius '��ri� <br /> � oness � � D�iE i ��� <br /> CiivqU5�M1E55UC[15f AO <br /> PLUMBINO MECHANICAL � <br /> NO. TYPE OF FIXTURE OR ITEM FEE N0. TYPE OF E�UIPMENT FEE <br /> . WATER CLOSET(TOILET) NC—A/HNDLG UNITS—H.P. <br /> BATHTUB ; FORCED AIR SYSTEMS—B.T.U. M E.A. ; I <br /> LAVATORY(WASHBASIN) � � UNIT HEATERS—B.T.U. M � <br /> —T <br /> SHOWER CLOTHES ORYERS <br /> KITCHEN SINK 8 DISP VENTILATION FAN <br /> DISHWASHER RANGE HOOD i <br /> LAUNDRY TRAY ; WATER HEATER ' <br /> CLOTHES WASHER � WOOD STOVE <br /> URINAL ' METAL PIREPLACE(WOOD BURNING) I <br /> DRINKING FOUNTAIN � FIREPLACE INSERT � <br /> FLOOR DRAIN HEAT PUMP <br /> BACKFLOW PREVENTERS GAS PIPING ; <br /> ROOF DRAINS—RAINLEADERS EXHAUST FAN � I <br /> SINK(SERVI,E—BAR,ETC.) <br /> � <br /> � I <br /> � <br /> � <br /> i <br /> SUB TOTAL 5 SUB TOTAL S �V.---�' �-- <br /> PERMIT 5 PERMIT S �J � <br /> TOTAL FEE 5 TOTAL FEE S '' <br /> FOR OFFICE USE ONLY: I <br /> FPONTSElBACN HEARSETBACN SIDESETBALK PLANCHECKNUMBER FEE RECEIPTNO <br /> �U���� � <br /> use zorve LOT Ai1EA VRGANT SiTE FEES VALUATION FEE <br /> YES NO BUILDING <br /> ivPEOiCOkSi NOOFSTORiES IACdo•utr u0wm�nusG�M1nS -- � <br /> cewa PWh7BING • <br /> SIZE OF B�IX'i. FIRE SPRINKLERS REO'D B�SEMENT MECHANICAL � <br /> o ves ❑ No ; <br /> OCCUPANC°LORD FIREAIARMREOL HEIGHTlIMI7ATION ADDITIUNALPLANCHECK <br /> OTHER <br /> REASON <br /> STATE BUILOING SURCMARGc <br /> INT�KEBY PLRNSAPPROVEDBY CITYOFEVERETT PUBLICWOflKS ' <br /> LOCAL SIILES ' <br /> o„TE TAX CODE IS 3105 . ror�� � <br />