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APPLICAT14* FOR CONSTRUCTI 1N PERMIT <br />TO BE COMPLETED IN BLACK INK —PLEASE P�R�IN"1T� <br />(,visit <br />HEATING SYSTEM: U GAS •ELECTRIC ❑ _ __ __ _� <br />BUILDING DEPARTMENT <br />259-8810 <br />1I DEMOLITION Ll COMBINATION ?CBUILDING El MECHANICAL Li PLUMBING ❑ SICA <br />CHNER MALADDRE59 TF CITY ZIP FHDIF <br />r$rkT %3lOAi91r/ j17-2 u<SF �[ eke%l 81v i17-,tzz3 _ <br />TENANT MATLA0DRE55 CRY BE PHONE <br />7 - c.38 <br />PLUMBPq tpliRACt011 WLADDRESS CITY ZIP PHONE STATLIICENSE• <br />CONTRACT PRICE IY NWIX <br />DESCRBIE YNRK AND BIXMRE FOOtAGE IM'0.VED <br />/�jJ /, <br />Cp(TACT PERSON ANDPIENE NO. FanL rtUTAla2/C•K <br />HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br />APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT ALL <br />PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br />WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br />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 />PERFORMA14CE OF CONSTRUCTION, THAT I AM AUTHORIZED BY THE <br />OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br />APPLICATION IS M AND I COMPLY WITH THE STATE <br />CONTRAC ANCP99 200 WAC. <br />vlwrosEousE DF euaDNG <br />;P�GC� • <br />LEGAL DESCRIPTION OF PROPERTY BKOVIM SEEM OR AFFACN FAOC:PES <br />��/ '� .•p 4' / <br />LOTS- --Y_ BLOCK L- OF <br />T 4l a — <br />7 <br />PMCEE TAX I D. NUMI <br />7 - 947- 0/1 006o <br />CONSTRUCfKINL DER. ADD <br />SS. fELEPyONE NUMBER <br />1T'�VI!/`S••��C/�FiV' <br />PROJECT ADDRESS 3 u2/ IfSS�LCL <br />IL <br />rn.eus.asslcl vssw <br />PLUMBING <br />MECHANICAL <br />NO. <br />TYPE OF FIXTURE OR ITEM <br />FEE <br />NO. <br />TYPE OF EQUIPMENT <br />FEE <br />]' <br />WATER CLOSET (TOILET) <br />A'C-A�HNDLG UNITS-H.P. <br />BATHTUB <br />FORCED AIR SYSTEMS-B.T.U. M E.A. <br />LAVATORY (WASH BASIN) <br />UNIT HEATERS-B.T.U. M <br />--i— <br />SHOWER <br />CLOTHES DRYERS <br />KITCHEN SINK A DISP <br />VENTILATION FAN <br />DISHWASHER <br />RANGE HOOD <br />LAUNDRY TRAY <br />WATER HEATER <br />CLOTHES WASHER <br />WOOD STOVE <br />URINAL <br />METAL FIREPLACE (WOOD BURNING) <br />DRINKING FOUNTAIN <br />FIREPLACE INSERT <br />FLOOR DRAIN <br />HEAT PUMP <br />BACKFLOW PREVENTERS <br />GAS PIPING <br />_ <br />ROOF DRAINS-RAINLEADERS <br />EXHAUST FAN <br />SINK (SERVICE -BAR. ETC.) <br />SUBTOTAL S <br />SUBTOTAL S <br />PERMIT S <br />PERMIT S <br />-�— <br />TOTALFEE S <br />/03 <br />ITOTAL <br />FEE S <br />v"FEME USE ONLY: _JOp•Q% <br />FRONT SETBACK-w- <br />REARBETSALM A <br />Sam <br />PLAN LNELI(NIIMOER <br />EEE <br />(; L� <br />� CV <br />RECEIPifq <br />2-0 <br />d <br />USEZ <br />LOT AREAQ <br />YACANTSRE <br />FEES <br />VALUATION <br />BUILDING <br />PLUMBING <br />�7 <br />J/FEE <br />�n� i De) <br />— I <br />,1215L1� <br />fiYES ❑ NO <br />rvMa Mn <br />WOFSTORIES <br />QM_KT <br />avp040wn <br />3 <br />I <br />SIZE OF Bl00. <br />Sf <br />FIRE SPRINKLERS MOD <br />BASEMENT <br />"0 <br />MECHANICAL <br />22QE3 <br />ne <br />/u <br />❑ YES <br />ADDITIONAL PUN CHECK <br />J^ <br />3d iQei.. <br />OCCUPANCYLOADG <br />FIREAURMREOD <br />NE IOHTLIJMRaATq�' <br />OTHER <br />DOD <br />/0 <br />Iva✓� <br />� <br />REASON <br />STATE BUILDING SURCHARGE <br />INTAKEBY <br />PT N qPPRGYwoY <br />I9 <br />CITYOFEVERETT <br />LOCAL SALES <br />PUBLICWORKS <br />TOTAL <br />��a <br />DATE 617113 <br />TAX CODE IS 3105 <br />