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APPLICATIO"' FOR CONSTRUCTf�N PERMIT � <br /> TO BE COMPLET�D IN BLACK INK—PLEASE PRINT <br /> BUILDING DEPARTMENT HEATING SYS7EM: �GAS 0 ELECTRIC ❑ <br /> 253-8870 <br /> ❑ DEMOLITION ❑ COMBINATION i l BUILDING IIQMECHANICAL �PLUMBING L7 SIGN <br /> OWNER MpILADDRE55 CITY ZIP PNONE <br /> �C'D?T �Dt�E ��io� �i�tl EU�E1T G�A S'�2a� a��7-U� 2 � <br /> TENpNT MAILAODRE55 CIiV ZIP PHONE <br /> ARCHITECTORDESIGNER MRILADDRE55 CITY ZIP PHONE <br /> GENERALCONTRACTOR MRILADDRESS CITY ZIP PHONE STATELICENSE� <br /> MECHANICALCONTPACTOfl MAILADDRESS CITV 21P PMONE STATEUCENSE� �i�� <br /> KAL/¢F-'S Sr'R�ieF /�1�J3i /3.-wnST�i� �/[L.cGn,v �3'"z� �9i-�Ls�.s' �I[�!�',eio!D�IJ <br /> PLUMBING CONTPACTOR M�IL ADDRE55 CITY ZIP PHONE STATE LICENSE/ <br /> F'� �vCf i v / -,ur �RL�cG.Tiv �sa3 GS/-7uT F <br /> CONTRACT PNILC OF WORK <br /> � � � i- �L ur <br /> DESCRIBE WORK ANO SOUARE FOOTAGE INVOLVED CONTACT PERSON AND PMONE NO. <br /> �A.��E �LG a r,/1 re To �.4 <br /> !.� TE /� = Tc/� <br /> � ! f"Lt7l�c.RE G/JS D � I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br /> PROPOSED USE OF BU, OING APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT.ALL <br /> � �A L PROVISIONS OF LAWS AND ORDINANCES GOVERNIN6 THIS TYPE OF <br /> LEWLOESCRIPTIONOFPROPERN(SHOWNBELOWORATfACMTWOCOPIES� WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br /> �ot BLOCK oF NOT. THE GflANTING OF A PERMIT DOES NOT PRESUME TO GIVE � <br /> AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br /> OTHER STATE OR LOCAL LAW REGUUITING 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 COMPLY WITH THE STATE <br /> ! PARCEL TPX I.D.NUMBER CONTRACTORS LAW 18.27 RCW AND 296.200 WAC. <br /> i <br /> � CIXJSTRUCTION LOAN LENDER.ADDRESS,TELEPHONE NUMBER <br /> � �?l'. L ��.�- s-a a -9 � <br /> � PROJE DR SS 5 A P OATE <br /> � eirv eusrt�ss uccuse�+o <br /> PLUMBIN(i MECHANICAL <br /> � N0. TYPE OF FlXTUHE Op ITEM FEE NO. TVPE OP EGUIPMENT FEE <br /> � + WATEF CLOSET(TOILE� � A/C—,NHNDLG UNITS—H.P. � <br /> t BATHTUB ; FORCED AIR SYSTEMS—B.T.U. � <br /> � LAVATORY(WASH BASIN) � UNIT HEATERS—B.T.U. M ; <br /> t SHOWER � CLOTHES DRYERS � <br /> t KITCHEN SINK 8 DISP ; VENTILATION FAN ; <br /> j DISHWASHER � RANGE HOOD � <br /> i LAUNDRY TRAY ; WATER HEATER D/ Ec'�' I��N r ' <br /> iCLOTHES WASHER � WOODSTOVE � <br /> URINAL ; METAL FIREPLACE(WOOD BURNING) � <br /> � DRINKING FOUNTAIN I FIREPLACE INSERT ' <br /> � � <br /> � FLOOR DHAIN � HEAT PUMP � <br /> � BACKFLOW PREVENTERS ; GAS PIPING ; <br /> l ROOF ORAINS—RAINLEADERS � EXHAUST FAN � <br /> � SINK(SERVICE—BAR,ETC.) ; � <br /> I - � <br /> , , <br /> , <br /> , <br /> , <br /> � SUBTOTAL $ ; SUBTOTAL $ ' <br /> i PERMIT $ PERMIT S i <br /> � � TOTALFEE $ ' TOTALFEE $ � <br /> � FOR OFFICE USE ONLY: <br /> i FRONT SETB�CN RE�R SEiBACK SIDE SETBACN PLAN CHECN NUMBER FEE RECEIPT NO. <br /> USEZONE LOTAREA VRCANTSITE FEES VALUATON FEE <br /> ❑ YES ❑ N� BUILDING � <br /> � TVPEOFLONST. NO.OFSTORIES occuvexcr Noo�owEluNGUxrtS � <br /> �A0°v pLUMBING � <br /> SIZE OF BLOG. FIRE SPRINKLERS REO'D BASEMENT MECHANICAL � <br /> ❑ YES C NO <br /> OCCUPANCY LOA� FIRE ALARM REO'D HEIGHT LIMITATION ADDITIONAL PLAN CHECK � <br /> OTHER � <br /> REn50N <br /> STATE BUILDING SURCHqRGE i <br /> INTAKEBY PLANSAPPFOVEDBY CITYOFEVERETT PUBLICWORNS � <br /> LOCALSALES � <br /> onre TAX CODE IS 3105 TOTAL � <br />