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APPLICATIC�I FOR CONSTRUC-r''1N PERMIT � <br /> TO BE COMPLETED IN BLACK INK-PLEASE PRINT <br /> BUILDING DEPARTMENT HEATING SYSTEM:,�GAS 0 ELECTRIC 0_ I <br /> 259-8810 <br /> ❑ DEMOLITION ❑ COMBINATION ❑ BUILDING F�IECHANICAL ❑PLUMBING ❑ SIGN <br /> ON?!E MRIL ADDRESS CITV 21P PHONE <br /> �,e�l�a Cer�- ;��.� J ��rv_�5�, �'v� 9 ?1J�' � ��—�,3�� <br /> TENANT MAIL AD�FE55 CIT�' � �P PHONE <br /> ARCHITECTORDESIGNER MAILADDRESS CITV ZIP PHONE <br /> GENERALCONTNRCTOR MAILADDRES's CITV ZIP PHONE STATEUCENSE� - <br /> MEC ANICALCONTRACTOR MAILADORESS/� CIiY /,�^yn- ZIP / PHONE STpTEL E/NS�E/�� I ��/ <br /> . PLUMBIN6CONTRACTOfl �'(J�I�AD�RESS �� 1���`LII��IV�' ^�/ IiP !��J�V PM�����`�STA��,`Y/I/ 1T7r7���� <br /> . CONTMCTPRICEOFWORK (�� <br /> �/�/I VY <br /> OE 9E K ANO SIXIARE F00 OE INV VED CONTACT PEflSON AND PHONE N0. <br /> ,�'� r i c,�� �,�� {..�a.�k ,�- 7 73l <br /> � <br /> i HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br /> PROPOSEO USE OF BUILDING `�� APPLICATION AND KNOW THE SAME TO BE THUE AND CORRECT.ALL <br /> �7 PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TfPE OF <br /> LEOALDESCPIPTIONOFPROPENTV�SNOWNBELOWOR�TTACMTWOCOPIES) WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br /> NOT. THE GRANTiNG OF A PERMIT DOES NOT PRESUME TO GIVE <br /> �or s�ocrc oF AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br /> OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br /> PERFORMANCE OF CONSTRUCTION.THAT I AM AUTHORIZED B1 THE <br /> OWNER OF THIS PROPERTY TO PERFORM THE WORK FqR WHICH <br /> APPLICATION IS MADE AND I COMPIY WITH THE STATE <br /> PMCEL TiV(I.O.NUMBER CONTRACTORS LAW 18.27 FCW AND 296.200 WAC. <br /> CONSTHUCTION LO�N LENDER,ADDRE55,TEIEPHONE NUMBER /�/ <br /> PflOJECT ADDRE � s�cru?uae- i o�rt <br /> cin eus�rtss ucErvsE r�o. <br /> PLUM91N0 MECHAWICAL <br /> N0. TYPE OF FlXTUFIE OR ITEM FEE N0. TYPE OF EOUIPMENT FEE <br /> WATER CL0.SET(TOILET) � fVC—NHNDLG UNITS—H.P. � <br /> BATHTUB ' FORCED AIR SYSTEMS--B.T.U. M E.A. ' <br /> LAVATORY(WASH BASIN) � UNIT HEATERS—B.LU. M ; � <br /> SHOWER ' CLOTHES DRYEfiS � <br /> KITCHEN SINK 8 DISP � � VENTILATION FAN ; <br /> � DISHWASHER � RANGE HOOD � <br /> LAUNDRV TRAY ; WATER HEATER ` <br /> CLOTHES WASHEF � WOOD STOVE � <br /> URINAL METAL FIREPLACE(WOOD BURNING) � <br /> DRINKING FOUNTAIN � FIREPIACE INSERT � <br /> FLOOR DRAIN � HEAT PUMP � <br /> __` <br /> BACKFLOW PREVENTERS ; / GAS PIPING � <br /> ROOF DRAINS—RAINLEAUERS � EXHAUST FAN � <br /> SINK(SERVICE—BAR,ETC.) ; ' <br /> � � <br /> � � <br /> � i <br /> � � <br /> SUB'OTAL $ ; SUB TOTAL 5 <br /> PERMIT $ � PERMIT $ S � <br /> TOTAL FEE $ ' TOTAL FEE $ ' <br /> FOR OFFICE U3E ONLY: <br /> FRONT SE7&1CK REAR SETBACK SI�E SETBACK PLAN LHECK NUMBER FEE RECEIPT NO. <br /> U�E20NE LOT�RE� �ACANTSITE FEES VALUATION FEE <br /> ❑ YES ❑ NO gUIL�ING � <br /> TYPCOFCONST. r10.OFSiORIES otcUMMn HOarDW!WNGUNiA i <br /> tnwv p�UM81NG i <br /> SIZEOFBLDC. FIRESFRINKLERSFiEG'D B0.SEMENT MECHANICAL 1 <br /> ❑ YES ❑ NO <br /> ADDITIONAL PLAN CHECK � <br /> OCCUPANCV LOAD FIRE AURM REO'D HEIGHT LIMITATION � <br /> � <br /> OTHER ' <br /> i <br /> REA30N � <br /> STATE BUILOING SURCHARGE � <br /> INT�KEBY PUNSAPPROVEDBY CITYOFEVERETT PUBLICWORKS � <br /> LOCAL SALES � <br /> DATE TAX CODE IS 3105 T0TI1L � <br />