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f <br /> APPLICATIO�"` FOR CONSTRUCTt"`N PERMIT � <br /> TO BE COMPLETED IN BLACK INK—PLEASE PRINT <br /> ��'�1 BUILDING DEPARTMENT �EATING SYS7EM: IJ GAS ❑ELECTRIC I]_ � <br /> y 259-8810 <br /> 9 y . �( DEMOLITION I I COMBINATION Ix BUILDING I 1 MECHANICAL !7 PLUMBING Cl SIGN <br /> ty OWNER _J ANILADDRESS CITY Z�P PHONE <br /> y � �(Ja�ra i �a����'I 1�z�5 �✓P r���l ��,/ �a25�5 a�y -- <br /> M�' (] TENANT � AILADOqE55 CITV 'iP PHONE <br /> ��� �-��� �lyec�s ,�va--�l �l�a� <br /> y ARCMITE TORpE51GNE MA�LADDRESS GItV 21P VNONE <br /> y .�,�—�aa l G��rs F��r���r` �a��i a�59-.�3��� --�- <br /> O: <br /> [�� GENEPALCONTHACTOF RIpILF0�FE55 GIiV Z�P PNONE STATEUCENSEt <br /> H <br /> ��� AtEGNANIGAI CONTRPCTOq MAIL ADDRE55 CITY ZiP �NONE ST4TE IICENSE v <br /> (y�]Y (] <br /> L:H PWMBINGCONTRACTOR MAI�ADDRESS CIN 21P PIIONE SiATELICENSE� <br /> � <br /> H CONIRACTPPICEOFIYORK <br /> � <br /> N <br /> O�W O�SGR1C0E W�P AN �]UF,[1E FO��r��NaVOlVEO � � V� CONTAGt PERSON ANO PHONE NO. <br /> �V LL � � <br /> '�y uc� /� � . �� ,� . v� , / . <br /> ' I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br /> PROPOSEO USE OFBWLOING APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT.ALL <br /> PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br /> �ecn�oes NIPTIONOPPflOPEF�TY��7SH�O�WNBELOWORATT(q�CNTYOCO/PJ1�_s WORK WILL BE COMPLETED WITH JJHETHER SPEGFIED HEREIN OR <br /> �oT e�ocK—�—�— oF ��"��' �TJ� • 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 REGULATING 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 /> Pnece�rax i.o.Nuueea CONTRACTORS LAW 1027 RCW AND 296200 WAC. <br /> i <br /> CONSTFUCTiONLOANIENpER.ADORE55.TELEPHONENUh1�ER 1 <br /> ;'. , , � . <�cvti� 5 y � <br /> PflOJECTAUDRE ssr+'u�r � wic ' <br /> `. ��� 2Z ' q <:rver.s:.iessucc,isevo ; _ <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FI%TURE OR ITEM FEE N0. TYPE OF EOUIPMENT FEE <br /> 1�' WATER CLOSET(TOILET� NC—A�HNDLG UNITS—H.P. <br /> '�1 BATHTUB FORCED AIR SVSTEMS—B.T.U. M E.A. <br /> L�VATORV(WASH BASIN) UNIT HEATERS—B.T.U. M <br /> 1 ' SHOI'JER CLOTHES DRYERS <br /> � KITC4EN SINK 8 DISP VENTILATION FAN <br /> 1 DISHWASHER � RANGE HOOD <br /> LAUN�RY TRAY ; WATER HEATER <br /> ' CLOTHES WASHER WOOD STOVE � _ <br /> URINAI METAL FIREPLACE(WOJD BURNING) � <br /> i� DRINKING FOUNTAIN FIREPLACE INSERT <br /> �' FLOOR DRAIN HEAT PUMP <br /> � BACKFLOW PREVENTERS G�S PIPING <br /> ROOF ORAINS—RAINLEADERS EXHAUST FAN <br /> '�' SINK(SERVICE—BAR,ETC.) ; <br /> 1�' — <br /> � <br /> ��1 SUB TOTAL 5 SUB TOTAL S <br /> �I PERMIT 5 PERMIT S <br /> -- - TOTALFEE S TOTALFEE 5 <br /> FOR OFFICE USE ONLY: <br /> FPONTSETB�CN FEARSEtpACK SI�ESEiBAIX PLANCMECNNOM�ER FEE REL[iPTNO. <br /> usezor+e IOTARER VRCRN�SITE FEES VALUATION FEE <br /> � YES Ci N� BUILC��:� <br /> tYPEOFtON51. NOAPSTORiES rccuoxva xoacn[wvunns <br /> °4aP pLUMBING <br /> SIZEOFBLOG. FIRESPPINNLERSREOD BASEMENT MECHANICAL <br /> ��- YES CS NO <br /> OCCUPANCY LOAD FiHE ALAFM REOD MEIGNT LiAlIt4TI0N AODITIONAL PLAN CNECK <br /> OTHER <br /> REASON � <br /> STATE BUIL�ING SURCHARGE <br /> :NtnrcEBV PlANSAPPFOVEDBY CITYOFEVERETT PUBIICWORN$ <br /> LOCALSALES <br /> oa,e TAX CODE IS 37U5 rorn� <br />