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APPLICATIO FOR CONSTRUCT( �N PERMIT � <br /> TO BE COMPLETED IN BLACK INK—PLEASE PRINT <br /> BUILDING DEPARTMENT HEATING SYSTEM: � GAS ❑ELECTRIC U <br /> 259•8810 <br /> DEMOLITION COMBINATION BUIL�ING f ECHANICAL PLUMBING SIGN <br /> r�owNIeR.�_.l12������nZ3�s(TU'Ji1lL[�( �! a��/ zia '�f'�//7�� <br /> nrvr h1AILADDRESS CITY ZIP PHONE <br /> ARCHITECTOROESIGNER MAILqDDRE55 CITY :IP PHONE <br /> GENERALCONTRACTOR l.IAI�qODRE55 CITV ZIP Pf10NE STATELICENSE� <br /> AIECHANICALCONTRACTOR MAILA��RESS CITY ZIP PNONE STATELICENSE+1 <br /> '���.7-�J�`fZ <br /> PLUMBING CONTF.�LTOR_� MAIL FOORE55 CITY 21P PHONE STATE UCENSE R <br /> GLASS Of N'ORK <br /> � � NEW � '�, ADDIPON ALTERATION �� AEPAIR . DEMOLITION WOODSTOVE/FRPL INSERT I f BUILDL IG RELOCATION <br /> CONTACTPERSON NOPNONENO. <br /> CONTRFCT PRICE OF WORK <br /> DESCRIBE WORK AND SOUA E FOOT�GE INV VED � <br /> FROPOSEDUSEOf8l11L01NG I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br /> APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT.ALL <br /> LEGAL DESCRIPTION OF PROPEIiTY�SHOWN UE�OW OR ATTACHFOURCOPIES� PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br /> WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br /> �oT BLOCK 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 REGULATINC CONSTRUCTION OR THE <br /> PERFORMANCE OF CONSTRUCTION.THAT I AM AUTHORIZED BY THE <br /> OWNER OF THIS PROPERTV TO PERFORM THE WORK FOR WHICH <br /> APPL�CATION IS MADE AND I COMPLY WITH THE STATE <br /> CONTRACTORS LAW 1827 RCW AND 296200 WAC. <br /> � � � X ���� <br /> PFQIEGTAO E55 SiG' uAE ��� �`ij/� OnfE <br /> CItVPU5�NE55liC NSE4p <br /> �b� <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM FEE NO. TYPE OF EOUIPMENT FEE <br /> WATER CLOSET(TOILET) � A/C—A/HNDLG UNITS—H.P. � <br /> BATHTUB ; FORCED AIR SYSTEMS—D.T.U. M E.A. <br /> LAVATORY(WASH BASIN) � UNIT HEATERS—B.T.U. M ; <br /> SHOWER ' CLOTHES DRYERS � <br /> KITCHEN SINK 8 DISP � VENTILATION FAN ; <br /> DISHWASHER � RANGE HOOD � <br /> LAUNDRY TRAY WATER HEATER ' <br /> CLOTHES WASHER � WOOD STOVE � <br /> URINAL METAL FIREPLACE&CHIMNEY - <br /> DRINKING FOUNTAIN FIREPLACE INSERT ; <br /> FLOOR DRAIN HEAT PUMP <br /> BACKFLOW PREVENTERS ; `)/ GAS PIPING ; <br /> ROOF DRAINS—RAINLEADEHS EXHAUST FAN � � <br /> SINK(SERVICE—BAR,ETC,) ; ' <br /> — <br /> � <br /> � <br /> SUB TOTAL S ; SUB TOTAL $ ! <br /> PERMIT 5 PERMIT 5 � <br /> TOTAL FEE $ ; TOTAL FEE 5 � <br /> FOR OFFICE USE ONLY: <br /> FRONi SETBACN REAR SETBACK SIDE SETBACK PLAN CHECK UMBER � FEE RECEIPT NO. <br /> 5 <br /> usezoNe LOTAqEA VACANTSITE FEES VALUATION FEE <br /> BUILDING i <br /> iYPEO(CONiSAILOWABLE TYPEOiCON5i.0.CilIAL atuvxr:tr fio0rnnuc�.6cuvu5 i <br /> teouv pLUMBING � <br /> SRE OF BIDG. NO.OF SiORIES BRSEAIENT MECHANICAL � <br /> OCCUPANGYLOF� FIRESPRNKLEHSfiEO'D MEIGHTUhVTATION ADDIPONALPLANCHECK i <br /> i <br /> SPRINKLER ' <br /> i <br /> REASON FON SPRINNLERS �— <br /> STATE BUILDING SURCHARGE <br /> INTAKE�Y PL�NSAPPROVEDUY CITYOFEVERETT PU�LICWONKS � <br /> LOCALSALES <br /> TAX CODE IS 3105 rora� � <br />