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APPLICATIO�FOR CONSTRUCTI��1 PERMIT �� <br /> TO BE COMPLETED IN BLACK INK�PLEASE PRINT <br /> � <br /> BUILDING DEPARTMENT HEATING SYSTEM: GAS �cLECT ❑ <br /> 259-6810 <br /> � I DEMC�LITION COMBINATION BUILDING ECHANICAL PLUMBING SIGN <br /> ONRiER MAIL ADORE ITY ZIP PHONE <br /> � <br /> ��� �A�cA�rfw - //�����s ,�f� �i���r�r 9��L�l zs7��&y/�..s�-z�z-8�. <br /> . TEN�NT �y� M4ILACD ESS C�Y-� P � PHONE / <br /> � �Cj7�'7!. <br /> .. ARCHITECTORDESIGNER MAILAUDRE55 GTY ZIP PMONE <br /> GENERA�CONTRACTOR MAIL AUDRESS GITY ZIP PHONL STATE LICENSE t <br /> ME C�LCONTRACTOR// M�ILADDRE55 ITY >IP PN E STATELICENSEA <br /> i���r-� H�►rr�l� /`�.Si1 /`�l�-r-l�i �c. G� ��Z' 9��r�3 i�i.�f{,�'/fb,�f"I <br /> PLUMBINGCONTRRCTOR M�ILAD 55 C � PMONE STATELIGENSE• <br /> � CLASSOFWORK / <br /> , � i NEW I ' ADDITION i . LTERATION �, REPAIR DEMOLff10N WOODSTOVFJfRPL INSERT BUILDING RELOCATION <br /> � �� � CONTACT PERSON AND PHONE NO. <br /> CANTRACT PRICF OF WJRN � • ? <br /> � DESCRIBE WORK A! SOU E FOOTAG41NVOlVED �y <br /> e q� b (o-�,%R� <br /> .� v.KS Lfc , - i lU va.t_1J <br /> PNOPOSCOUSEOFBUILDING i HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br /> APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT.ALL <br /> LEGALDESCRIPTIONOF PROI�, RiV 15HONN BELOW OF RTTACH FWN COPR51 PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br /> ! WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br /> LOT_ BLOGN oF NOT. THE GRANTING OF A PERMIT DOES NOT PF.�SUME TO GIVE <br /> , �X����n'-�/� h�//_�J"\ hUTHqRITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br /> � / �"/ (J �` (.�--�.(J OTHER STATE OR LOCAL LAW REGULATING CON��HUCTION OR THE <br /> � PERFORMANCE OF CONSTRUCTION.THAT I AM�;t: 40RIZE0 BY THE <br /> � OWNER OF THIS PROPER;Y TO PERFORM THE WORK FOR WHICH <br /> . APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> � CONTRACTCRS LAW�827 RCW AND 296.200 WAC. <br /> T z 1 /�!CL�ilYl.d^�+' llH�//f77YI�� <br /> ' "F.xIELTADDRE55 s�c *ua�� or.rei_, � i�� <br /> dA +� � ��i' <br /> 3� /le b�vpUSM[55 VGENSE NO <br /> PLUMlINO MECNANICAI <br /> � N0. TVPE OF FIXTURE�R ITEM FEE NO. TYPE OF EOUIPMENT FEE <br /> � WATER CLOSET(701LET) !UC—A'HNDLG UNITS—H.R I <br /> ; BATHTUB FORCED AIR SYSTEM M E.A. � <br /> � UVATORY(WASH BASIN) UN�T HEATEi�S—B.T.U. <br /> - SHOWL'R CLOTHES DRVERS <br /> KITCHEN S�hK 8 DISP VENTILATION FAN <br /> O�SHWASHER RANGE HOGD �— <br /> � LAUNDRYTHAY WATER HEATER <br /> � CLO1'HES WASHEF WOODSTOVE <br /> URINAL METAL FIREPLACE 8 CHIMNEY � <br /> DRINKING FOUNi'AIN � FI EPLACE INSEHT ; <br /> FLOOR DRAIN EAT PUMP � <br /> i BACKFLOW PREVENTERS GAS PIPWG ; <br /> � ROOF DRAINS—RAINLEADERS E%HAUST FAN <br /> - SINK(SERVICE—BAR,ETC.) <br /> T— <br /> � � <br /> — T— <br /> SUB TOTAL 5 SUB TOTAL $ / <br /> PERMIT $ � PERMIT $ �� <br /> TOTALFEE $ TOTALFEE S <br /> FOR OFFICE USE ONLY: <br /> FRpNTSEiBACN REAFSE78ACN SIOESETBRCN PLFNCHE K . F fEE RECEIPiNO. <br /> useza+e �oTnnea vnenNrsiTe FEES VALUATION FEE <br /> BUILDING i <br /> 1YVE OF CJNiS.ALLOWABLE 1vPE OF CONSi AGiUAI Occuc�xtr va or uw¢urv�uxns <br /> eaoav PLUM�ING <br /> SIZE OF BIDG. NO.OF STORIES BAS[MENT MECHANICAL � <br /> ' OCCUPANCVLOAU FIRESFRNKLERSBEO'0 HEIGMTLIMITATION ADDITIONALPLANCHECK i <br /> SPRINKLER � <br /> i <br /> , REASONFORSPRINKLERR <br /> STATE BUILOING SURCHARGE i <br /> INTAHEBV PLANSAPPROVEOBV CITYOFEVERETT PUBLICWORKS � <br /> LOCAL SALES � <br /> TAX CODEIS 3105 TOTAL <br />