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APPLICATIC"1 FOR CONSTRUCT'-1N PERMIT �✓�" <br /> TO BE COMPLETED IN BLACK 1�1K—PLEASE PRINT <br /> BUILDING DEPARTMENT I HEATING SYSTEM: J GAS J ELECTRIC ,1 _ t �z�� ��- <br /> 259-8810 -- - - <br /> DEMOLITION 1 COMBINATION " BUILDING MECHANIC4L pLUMBING . SIGN <br /> OWNER MAILAp::nESS CiTY Z�P P�,���, <br /> Y f!� r/Gsfanl 28 �9 �1s��.�a `G�c, L`i�i;�'fl �b =vi "�S�i-�s�� <br /> TEIJANT IAAILADDRE55 pTY ZiP <br /> F�011E <br /> ARCHITECi OF OESIGNER MnIL ADUFh55 GTY ZIP PHCNE <br /> GENERALGONTRACTOR MnILADDRE55 CITY � 7ia — � <br /> PHONE STATE lIG'cNSE e <br /> ML�L�f,[hN"IC�AL`W�NTR�AGTO� MAiLqDORE55 GtV 2iP �L� �J P40�IE // STATEr�ENSE• <br /> 1U�K� � JZ�Le s 1-ri 4 � or� 190�� G��'' /7ve �7[: l��l'�-� ,�daa-� <br /> PLLMBIRG CONiRACTOF MAII ADDRE55 CITY ZIP PHONE ST�TE LICENSE� <br /> _ ��1 J=S 7-A' �j'Ln/,,i <br /> CONTRACT PRICE OF V;ORK <br /> DESGRIBE WOFN FND SW/AE 1°OpTAGE INvp�VED CONTAGT PE�"A4 AND PNONE NO. <br /> Jn't .1LG.�A' � <br /> � .1L <br /> i HEREBV CERTIFV THAT I HAVE REAU AND EXAMINED THIS <br /> aaoroseo us�oF euaoiNc APPLICATION AND KNOW THE SAME 70 BE TRUE AND CORRECT ALL <br /> C�� _ PROVISIONS OF lAWS AND ORDINANCES GOVERNING THIS TYPE OF <br /> �ecn�oescaianor+ovvaoPearvisMowmeuowoanrTacNTwocovies� WORK WILL BE COMPL[TED WITH WHE7HER SPECIFIED HEFEIN OR <br /> NOT. THE GRAtJTING OF A PERI.!IT DOES NOT PRESUME TO GIVE <br /> �oT—� eiocK oF qUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANV <br /> OTHER STATE OR LOCAL LAW REGULA7ING CONSTRUCTION OR THE <br /> PERFORA7ANCE OF CONSTRUCTION.THA'I AM AUTHORI2ED BY THE <br /> OWNER OF THIS PROPERTY TO PERFOFl�,7 THE WOfiK FOfi WHICH <br /> - APPLICAlION IS MADE AND t COMPLY WiTH THE STATE <br /> vnnce�rnz i o Nuuoen CONTRACiORS LAW 1827 RCW AND 29E200 WAC. <br /> � <br /> CONSTRUCiIONLO�NLEN0EP.4DDRE55.TEL[PHONE NUMBBR <br /> PROJECT ADDRESS /` s�cvnY�n x��� �/�� �p I� �� <br /> 2 � IJL�,�� �� u�rz <br /> cm nusw�ss nn rvs�.+o <br /> PLUMBING MECHANICAL <br /> N0. TYPE OF FIXIURE OR ITEM FEE NO. TYPE OF EQUIPMENT FEE <br /> WATER CLOSET(TOILFT) A%�A�'HNDLG UNITS—H.P. <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 S!NK 8 DISP VENTILATION FAN <br /> DISHWASHER qANGE HOOD <br /> LAUNDRV TRAV WATER HEATER <br /> CLOTHES WASHER WOOD STOVE <br /> UFINAL METAL FIREPLACE(WOOD BURNING) ��70 <br /> DRINKING FOUNTAIN FIREPLACE INSERT ; <br /> FLOOR DRAIN HFAT PUMP <br /> BACKFLOW PREVENTERS GAS PIPING <br /> ROOF DRAINS—RAINLEADERS EXfiAUST FAN ; <br /> SINK(SERVICE—BAR,ETC.) � <br /> � <br /> T <br /> I � <br /> SU8 TOTAI. S SUB TOTA! 5 Q_� <br /> PERMIT 5 � PERMIT $ <br /> TOTAL FEE 5 TOTAL FEE $ <br /> FOR OFFICE USE ONLY: <br /> fRONiSETBACK REARSETpACN SIDES[i84CK PLANCN[CNNUMBLR FEE PEGEIPTNO. <br /> �� ._� <br /> USCZONE iornaen vncaNrsrcE FEES VALUATION FEE <br /> ���. YES _7 NO BUII.DING ; <br /> ivVEO�CON57. NO-OFSTORIES occuo>y�r uoornw¢i�v.u�ins <br /> L9p�� pLUMOING <br /> i <br /> SREOFPLDG. FIRESPRiNNL[RS'1L'O'D PASEA'.bl MECHANICAL <br /> .l YES �_! NO — <br /> OCCUPaNCY LonO FlUE n•,nFl.'REOJ HEIGHi UMIT�*ION ADUI fIONAL i''LAN CHECK <br /> OTHEF <br />� REASON -- -- <br /> STATG BUILDING SURCHARGE <br /> INTANEBV PlANSAPPGOV[�BY CiTfOFEVERETT PUBLICWOfiN$ <br /> LOCAL SIILES <br /> o�.e TAX CODE IS 3105 TOTAL <br />