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APPLICATI�'`I FOR CONSTRUCT'�`1N PERMIT � <br /> TO BE COMPLETED IN BLACK INK—PLEASE PRINT <br /> BUILDING DEPARTMENT HEA7ING SYSTEM: �GAS ❑ELEC7RIC ❑ <br /> 259•8810 <br /> [J DEMOLITION IJ COM8INATION I:%!6UILDING ❑ MECHANICAL IrPLUMBING ❑ SIGN <br /> OWNER MRILADURESS CITY Z�P PMONE <br /> T: E�i � /�oi/'K�N � /J23 GR-KF� fkJF-tdt7�r�u/A - Zs� -�YF) <br /> TENANT AIAILADCRE55 CITY ZIP PHONE � (,� <br /> ����,N� ,-��¢C�oc , s-��-� sT�i9-r� ST. I�tt�r�c�.11 w.q• �a2>c, 337�� <br /> pRCHITECTORDE5IGNEP MAILRDDRESS CI7V ZIP PMpNE ��53_S�I, <br /> �(p C�.�ss A . �fla� �r��/� �•uys�,l�e ��4 • �j�a�o <br /> GENERAI,COyTRACTOfl MAILADDRESS CITY ZI HONE STATEIICENSE• <br /> � �� ��'Ud'n✓L <br /> MECHAyICAICONTRRCTOB MAILADDRE55 CITY iIP PHONE STATELICENSEt <br /> � <br /> PLUMBI�CONTRRCTOR MAILAUDRESS CITV ZIP PHONE STATELICENSE� <br /> CONTRRCT PRICE OF WOqK <br /> DESCRIBE WORK AND SOUARE FOOTAGE INVOLVED CONTACT PER AND PMONE NG <br /> C <br /> aa`�i�o,w ��d•� - 3 s � ��srr,.«� � �� � <br /> z.s-s�. 7Y�7 <br /> I HEREBV CERTIFY THAT 1 HAVE READ AND EXAMINED THIS <br /> PROPOSED USE OF BUILUING /� APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT.ALL <br /> S iC.i PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br /> LEG�LDESCRIPTIONOFPflOPERTY�SHOWNBELOWOHATTACHTWOCOPIES) WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br /> NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br /> -�( �or BLOCK — 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 1 AM AUTHORIZED BY THE <br /> OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br /> APPLICATION IS MAQE AND I COMPLY WITH THE STATE <br /> �( PARC TA%I.D.Nl1MBE CONTRACTORS LAW 78 27 RCW AND 296200 WAC. <br /> �� oC� � D � <br /> CONSTRUCTION LOAN LE4DER.PDDRE55,TELEPHONE NUMBER <br /> x /� '��-� 3 <br /> XPAQIECT ADDRESS /3 a� �Jv� SK.NATURE o.te <br /> N pITYBUSMESSIICENSEN� <br /> PLUMBIN6 MECHANICAL <br /> NO. TYPE OF FIXTUAE OR ITEM FEE NO. TYPE OF EGUIPMENT FEE <br /> / WATER CLOSET(TOILET) � fVC—lVHNDLG UNITS—H.R � <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 /> KITCHEN SINK 8 DISP � VENTIUITION FAN ; <br /> DISHWASHER � RANGE HOOD � <br /> LAUNDRVTRAY ; WATFR HEATER <br /> CLOTHES WASHER � WOODSTOVE � <br /> URINAL ' METAL FIREPLACE(WOOD BURNING) � <br /> DRINKING FOUNTAIN � FIREPLACE INSERT . ; <br /> FLOOR DRAIN � HEAT PUMP � <br /> BACKFLOW PHEVENTERS ; GAS PIPING ; <br /> ROOF DRAINS—RAINLEADERS � EXHAUST FAN � <br /> SINK(SERVICE—BAR,ETC.) ; ' <br /> � � <br /> � <br /> � <br /> i � <br /> SUB TOTAL $ ; SUB TOTAL $ ; <br /> PERMIT $ PERMIT $ i <br /> TOTALFEE $ ' TOTALFEE $ ' <br /> FOR OFFICE USE ONLY: (S c ,5'InoK� OE�C7o2S � 2.�o u BG <br /> FRONT SETBRCK REAR SETBACK SIDE SETBRCK PLAN CHE K NUMB FEE PECEIPT NO. <br /> 2E,• � �' 30 .S� � / <br /> USEZON LOTAREA VACP!JTSIiE FCES VALUATION FEE <br /> �� � 9� �! YES '� NO BUILDING 'L � i <br /> TVPEOFLONST NO.OFSTOFIES OcruvAncv HOofOw¢uNGUNrts <br /> -/J Z <br /> f9p ' PLUMBING <br /> SIZE OF BLDG ` FIRE SPPINKLERS REO'0 BASEAIENT '� <br /> � 13LSr MECHANICAL � � <br /> A��'4 p p ❑ YES ❑ NO � <br /> OCCUPANCY ORD FIRE 4LARM REO'� NEIGNT LIMIT�ION ADDITIONAL PLAN CHECK <br /> � I <br /> OTHER <br /> REASON <br /> � STAiE BUILDING SURCHARGE L/ � ~ . <br /> INTAKEBY P�ANSAPP OyEDO� CITYOFEVERETT PUBLICWOFlKS _y <br /> ��Q IOCAL SALES <br /> OATE � sr � TAX CODE IS 3105 TOTAL ��'� <br />