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APPLICATIC�' FOR CONSTRUCTf,N PERMIT � <br /> TO BE COMPLETED IN BLACK INK-PLEASE PRINT <br /> HEATING SYSTEM: ❑GAS ❑ELECTRIC 'J <br /> BUILDING DEPARTMENT <br /> 259-8810 <br /> ' DEMOUTION C� COMBINATION � ] BUILDING i I MECHANICAL i :PLUMBING i ; SIGN <br /> OWNEF MAILADOReSS CITY ZIP PMONE <br /> _��1�—/F�G�iz�C P,a, ,1.31.,�,�-��l�.zs� l��7��yop . <br /> TENANT MA�L ADDRESS Cltt IIP PHONE <br /> 4RCNITECTORDESIGNER MAiLADDRE55 CITY IIP PHONE <br /> GENERALLO�N*+FACTOR MAILADORE55 CITY ZIP PHONE STATELICENSE� <br /> �/�/7 �i��//ls�'`� � � ` l < < � �'�CLCS �'3.S/�" � <br /> IAECMANICAL CONTFACTOR MAI:ApORESS CITY ZIP PNONE SiATE IICENSE• <br /> PWMBINGCONTRAGTOR MAILADDRE55 CITV ZIP PHpNE STATELICENSE• <br /> CONiRACT PRICE OP WOflK <br /> DESCNIBE WORK AN�SOUARE FOOTAGE INVOLVED CONTAGT PERSON AND PNONE N0. <br /> I HEREBI� CERTIFY THAT I HAVE FiEAD AND EXAMINED THIS <br /> PROPOSEOUSEOF BUILDING APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT.ALL . <br /> PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br /> LEGALDESCRIPTIONOFPROPERTY�SNOWNBEIOWORATTRGNTWOCOPIES� WORIC WILL BE COMPLETEO WITH WHETHER SPECIFIED HEREIN OR <br /> NOT THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br /> ior a�aK oF AUTHORITY TO VIOLATE OR CANCEI THE PROVISIONS OF ANY <br /> O7HER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br /> PERFOR67ANCE OF CONSTqUCTION.THAT I AM AUTHORIZED BY THE <br /> OWNER Of THIS PROPERTV TO PERFORM THE WORK FOR WHICH <br /> APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> PARCELTA%ID.NUMBER CONTRACTORS AND 296200 WAC. <br /> LONSTRUCTIONIOANIENDER.ADDR[SS.TELEPHONENUMBER <br /> X `z�Zy S'Y <br /> PROJEQT��ESS scHAroAE � o�rc � <br /> at CIiYPUSiN[SSI�Cf:NSE NO <br /> PLUMBING MECHANICAL <br /> N0. TYPE OF FIKTURE OR ITEM FEE NO. TYPE OF EOUIPMENT FEE <br /> WATER CLOSET(TOILET) � A�C—A%HNDIG UNITS—H.P. . <br /> BATHTUB ; FORCED AIR SYSTEMS—B.T.U. M E.A. <br /> LAVATONY 1WASH BASIN) � UNIT HEATERS—B.T.U. M <br /> SHOWER ' CLOTHES DRVERS � <br /> KITCHEN SINK&DISP ; VENTILATION FAN ; <br /> DISHWASHER � RANGE HOOD <br /> LAUNDRVTRAV ; WATER HEATER <br /> CLOTHES WASHER � WOODSTOVE <br /> URINAL ' METAL FIREPLACE(WOOD BURNING) <br /> DRINKING FOUNTAIN � FIREPLACE INSERT <br /> FLOOR DRAIN � HEAT PUMP �— <br /> BACKFLOW PREVENTERS GAS PIPING ; <br /> ROOF DqAINS—RAINLEADERS � EXHAUST FAN <br /> SINK(SERVICE—BAR,ETC.) ; <br /> i <br /> � <br /> -- —T <br /> SUB TOTAL $ SUB TOTAL $ <br /> PERMIT $ PERMIT $ <br /> TOTAL FEE $ TOTAL FEE $ <br /> FOR OFFICE US[ONLY: <br /> FFON�SETBACK REARSETBACK SIDESETOACN PLANp�EGKNUMBEF f[E REGEIPTNO. <br /> use zone �oT nAen vncnNr srte FEES VALUATION FEE <br /> .l: YES � �: NO BUILDIN^, <br /> iYPEOFCONSi. NOAFSTOPIES atuceNp NaormvFwNeuNrts � <br /> caouv PLUMBING <br /> SIZEOFBLDG. FlRESPRINNLERSRE�'D BASEMENT MECHANICAL <br /> � I YES �-. NO - — – <br /> OCCUPANCY LOFD FIRE ALAfiM RW U HEIGNT LIMITATION ADDITIONAL PLAN CHECK <br /> OTHEfl � <br /> REASON �— <br /> STATE BUILDING SURCH�FGE ; <br /> INTANEBY PLANSAPPROVEOBV CITYOFEVERETT PUBLICWORNS ' <br /> LOCAL SALES <br /> �A,E TAX COOE IS 3105 TOTAL <br />