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APPLICAY'IOI: FOR CONSTRUCT,'lN PERNlIT � <br /> TO BF_COMPLETED IN BLACK INK—PLEASE PRINT <br /> HEATING SYSTEM� ❑GAS �LECTRIC ❑_ <br /> BUILDING DEPARTMENT — <br /> 259-8910 <br /> ❑ DEMOLITION i� COMBINATION :di'BUILDING ❑MECHANICAL ❑ PLUMBING ❑ SIGN <br /> OWNER MAILADDPESS CITY-/- �, ZI' PHONE��_�/�� <br /> � A�� l ►^� 1�+-a�Ft I E IcI '�� i st l�K�._i�✓ '�'tr'ao�� <br /> TENANT AtAILADDRE55 CIT' ZIF PHONE <br /> C.�.nA�: — - — <br /> ARCHITECTORDESIGNER N4ILPDORESS CITY ZIP PHONE <br /> i>u � ��,�E — lA NE _ 35"3-C� � I <br /> GENEP�LCO TRACTOB MAILRDORE55 CRV ZIP PMONE STATEL'CENSE• <br /> �ll )►��2 <br /> MECHANICM CONTRACTOR MAIL�DDRESS CIN 21P PHONE STATE LICENSE II <br /> PLUMBING CONTRAGTOR MAIL ADDRE55 CITY ZIP PNONE STATE LICENSE Y <br /> CONTRxT PRILE OF ORK ^� /� <br /> �� a '�j� <br /> DESCRIDE WORK AND SOWRE F AGE INVOLVE • CC CT PER50 ��ONE . S S I .�) <br /> c � <br /> �r�l�—7 <br /> I HEREBY CERTIFV THAT I HAVE READ .OND EXAMINED THIS <br /> PROPOSEO USE OF BUILDINC APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT.ALL <br /> PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br /> LEGALDESCRIPTIONOFPROPEPTV(SHOWNBELOWO ATTACHTYOCOPIES) WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br /> T ,k n 1 �I l� NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br /> �or-1-� e�ocK� °F AUTHORITV TO VIOLATE OR CANCEL I HE PROVISIONS OF ANY <br /> � OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br /> PERFORMANCE OF CONSTRUCTION.THAT I AM AUTHORIZED BV THE <br /> ��' OWNER OF THIS PROPEflTY TO PERFORM THE WORK FOR WHICH <br /> APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> PARCEL PU(I.D.NUMBEH CONTRACTORS LAW 18.27 RCW AND 296.200 WAC. <br /> � CONSTFUCTIONLO�NLENDER.ADDRESS,TELEPMONENUMBER x /n A' /�/ /�J��y� f'� ,. 7- q �3 <br /> ! / ,�ryiC j (�.(.G.f <br /> � � � � 5 N�iURE O�TE <br /> PRWECTADDRESS LC /iyd%UI.Lt.�- /v � <br /> CIiY 9USME55 UCENSE NO <br /> PLUMBING MECMANICAL <br /> FEE NO. TYPE OF EDUIPMENT FEE <br /> Np, TYPE OF flXTURE OR REM � <br /> WATER CLOSET(TOILET) � A/C—lVHNDLG 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 SINK&DISP � ; VENTILATION FAN � <br /> DISHWASHER � FANGE HOOD � <br /> LAUNDRYTRAY ; WATER HEATER <br /> CLOTHES WASHER � OOD STOVE ' <br /> � METAL FIREPLACE(WOOD BURNING) ' J _ <br /> URINAL ; ' <br /> DRINKING FOUNTAIN FIREPLACE INSERT ' <br /> FLOOR DRAIN � HEAT PUMP � <br /> BACKFLOW PREVENTERS ; GAS PIPING ' , <br /> � ROOF DRAINS—RAINLEADERS _ � EXHAUST FAN ' �I <br /> SINK(SERVICE—BAR,ETC.) � � <br /> _ <br /> 7J <br /> � <br /> � SUB TOTAL $ I <br /> SUB TOTAL $ � — <br /> PERMIT $ � PERMIT $ ' <br /> TOTALFEE S ' TOTALFEE S ' <br /> FOR OFFICE USE ONLY: ' `O� <br /> Pll�NCME KNUMBER FEE PECEJ�TNO <br /> FRONTSETBACK/ RERRSETBA�K / SIOESETBACI( / /��� �/�0,/� (/J/�S <br /> /) �1/\ .Ju� O / <br /> 5' %'S s•-�./ <br /> LOTARER VACANTSITE FEBS VALUATION FEE <br /> USEZONE �I, NO n <br /> ... <br /> ❑ YES BUILDING �� 7Z �Oo� ' S v <br /> 11PEOFLONST. NC.OFS:JRIES aaDaNtv NaoroxiluxGUNns / � �� <br /> ♦ ' � enour pLUMBING <br /> SIZE OF BLqG'v FIRE SPRINNLERS PEO'� BASEMENT MECHANICAL I 0 � V�� <br /> 22GGa SF�" N� ❑ YES [[?�N� � <br /> 7SB S � _ ADDITIONAL PLAN CHECK '�� <br /> OCCUPANLV LOAD FIRE AURM REO'D MEIGHT LIMITATION � <br /> N/A NO �, OTHER �' /.�C�i�. v ' ,�, <br /> REnSON STATE BUILDING SUFiCHARGE "J O <br /> MTAKEBY PLANSA['F�OVEDBY CITYOFEYERETT PUBLICWOFiKS ��UiG���7 <br /> J LOCAL SALES �p� I J�,,Z <br /> DATE �j Z q3 TAX COUE IS 3105 T�TA� <br />