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APPLICATIO` FOR CONSTRUCTY"`N PERMIT � <br /> TO BE COMPLETED IN BLACK INK—PLEASE PRINT <br /> BUILDING DEPARTMENT HEATING SYSTEM: i]GAS ❑ELECTRIC ❑ <br /> 259-8810 <br /> ❑ DEMOLITION I_1 COMBINATION I] BUILDING Ll MECHANICAL �PLUMBING ❑ SIGN <br /> OWNEfl MAILADORESS CITY ZIP PMONE <br /> �i5 9 L.v^�ZE, urkaS�r� �,'lOt� - I�O�TOn1 F\J EJ����T� wA �iS2ol 252- 7oGl <br /> 1ENANT MAILADDRESS GIiV Z�p PHONE <br /> ARCHITECTORDESIGNER MAILADDf1E55 GiV ZIP PHONE <br /> GENERRLCONTRACTOR MAILAD�RESS CITY ZIP PNONE STATELIGENSE• � <br /> MECNANICAICONTRALTOP MAILADORE55 LITY ZIP PHONE STATELICENSE� <br /> PLUM CONTRACTOR MAILADDqE55 CITY ZIP PNONE STATEIICENSEI <br /> i <br /> CONTRACf PRICE OF WORK <br /> DESCRIBE WORK AND SOUARE FOOTAGE INVOLVED CONTACT PERSON ANO PHONE N0. <br /> ��a��L �.�.� , ./LoD�arp,�-�" <br /> �— <br /> I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br /> PROPOSEDUSEOFBUILUING APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT.ALL <br /> � � PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br /> LEGRLDESCRIPTIONOFPROPERTY�SHOWNBELOWOPATTACNTWOCOPIES� WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br /> �or BLOCN oF NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br /> AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br /> OTHER STATE OR LOCAL LAW qEGULATING CONSTRUCTION OR THE <br /> PERFORMANCE OF CONSTRUCTION.THAT I AM AUTHORRED BY THE <br /> OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br /> APPLICATION IS MADE AND I COMPLV WITH THE STATE <br /> P�RGEL TA%I.D.N11A19ER CONTR,�CTORS I,�4W 18.27 RCW AND 296.200 WAC. <br /> CONSTRUCTION LORN LENDER.ADOPESS.TELEPHONE NUMBER X ��� `� �� � �I �I n� <br /> � <br /> PROJECT ADDRESS s�cr�a,�ne �`1 <br /> �'�J '�/n/ o+rc <br /> /D o//7 �` LIiY01151NC55lIC[NS[Ip <br /> PLUMBING � MECHANICAL <br /> N0. TYPE OF FIXTURE OR ITEM FEE NO. 7VPE OF E�UIPMENT FEE <br /> WATER CLOSE7(TOILET) A/C—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 DRVERS � <br /> KITCHEN SINK 8 DISP V'cNTILATION 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—RAINLEADEflS � EXHAUST FAN � <br /> SINK(SERVICE—BAR,ETC.) ; <br /> � <br /> � , <br /> � ; <br /> �— <br /> SUB TOTAL 5 ; SUB TOTAL $ ' <br /> PERMIT 5 PERMIT $ <br /> TOTA�FEE � TOTAL FEE S � <br /> FOR OFFICE USE ONLY: <br /> FRONT SETBAGK REAR SETflACK SIDE SETUAGN PLFN GHEG'NUpMBER FEE RECEIPT NO. <br /> �J� <br /> usr:zoNe ior nnen vacnn.src FE3S VALUATION FEE <br /> i� YES i� NO BUIL�ING i <br /> TYPEOFLONSi. NO.OFSTORIES xtur�y[v NoOvoWi�uxLUNaS -- � <br /> CP0°c PLUMBING <br /> i <br /> SIZEOFBLW. FIRESPPINKLERSREOD B�SEMENT MECHANICAL i <br /> I' YES ��l NO <br /> OCCUPRNCY�O�D FIREALARMPEOD HEIGNiLIMITATION ADOITIONALPLANCHECK � <br /> � <br /> OTHER � <br /> REASON � <br /> S7ATE BUILOING SURCHARGE i <br /> INTAKEBY PL�NSAPPROVED�V CITYOFEVERETT PUBLICWORKS ' <br /> LOCAL SALES <br /> oa,E TAX CODE IS 31U5 rorn� � <br />