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APPLICATIC�"'1 FOR CONSTRUCT�IN PERMIT � <br /> TO BE COMPLETED IN BLACK INK—PLEASE PRINT <br /> HEATING SYSTEM: ! GAS ❑ELECTRIC ❑ <br /> BUILDING DEP.4RTMENT <br /> 259-8610 <br /> DEMOUTION l i GCMBINATION �BUILDING NJ�MECHANICAL i��PLUM8ING i_! SIGN <br /> 0\VNER MAILACDRE55 CITY ZIP n Q PHONE <br /> {��Lvnv C�1r�ZMzr� /c7LU � /6l^_ si � ii�� bn /�G ZSf}' �•^_,// <br /> TEN4NT MMLADDRESS CITY �P PMO4E <br /> 4FCMITECTOP�e_+3!e�R' b�4RA0DRE55 CITV 21P PHONE <br /> �/c,� �;;n.ikce� �,t �4//-� /z�u-s 3•�"'.�� v�-' , c've� fl Gs'ra `I�'�zuq 745 zyo� <br /> GEN LLONiRACTOR MAIL���RE55 GT ZIP PHONE STATELICENS k <br /> �'/7 Q� � <br /> MECH�NIGALCONTR�GTOR h1AIL�DDRE55 CITY ZiP PHONE STATEL�CENSEs <br /> PW'dBINGCONTPACTOR MAILADDRESS CIiV ZIP PHONE STRELICENSE+ <br /> CONTRACT PRICE OF WORK <br /> 2 ZC� ^ <br /> DESCRIBE WORK AND SOUARE FOOTAGE INVOLVED CONTACT PERSON AN�PMONE NO. i�l, /1,tL�<J�•✓ � <br /> i•— r <br /> � L'o 2 S��! � . :� �on 2. '�j- Z"�`Gv <br /> �a ���, .r• � � — " /W i HEREBY CERTIFY THAT I HAVE READ AND EXAMWED THIS <br /> PROPOSED U OF BUIL�ING APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT.ALL <br /> � PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br /> LEG�LDESCRIPTIONOFPROPEFTY�SNOWNBELOWOFATTACHT.4000PIES� WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br /> �q� n1� �on NOT. THE GRANTING OF A PERMIT DOES NOi� PRESUME TO GIVE <br /> �or BLOCH-f-� oF �����•� N�� AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br /> � OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br /> �� � PERFORAIANCE OF CONSTRUCTION.THAT I AM AUTHORIZED BY THE <br /> OWNER OF THIS PROPERTY TO PERFORM THE WORK FOfl WHICH <br /> APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> PARCE TA%ID NUh1BER CONTRAC ORS A 8.27 RCN'AND 296.200 WAC. <br /> �+-1- � Z - 6%�"O� D O 9 v� <br /> CONSiRUCTIONLOANLENOEF,�ODRE5S.IELEPXONENUMBER L / , ��' �� <br /> l <br /> S�GN�t ;iC D�l[ <br /> PROJECT ADDRES ^^ " - <br /> C,' // ' CiIY USMESS��CFtbLkO <br /> PLUMBING MECNANICAL <br /> NO. TYPE OF FIXTURE OR ITEM FEE NO. TYPE OF EOUIPMENT FEE <br /> � WATER CLOSET(TOILET) � A/C-A�HNDLG UNITS-H.P. � <br /> ( BATHTUB ' FORCED AIR SYSTEMS-B.T.U. M E.A. <br /> LAVATOAY(WASH BASIN) � UNIT HEATERS-B.T.U. M � <br /> SHOWER ' CLOTHES DRYERS ' <br /> KITCHEN SINK&DISP VENTILATION FAN � <br /> DISHWASHER � RANGE HOOD ' <br /> LAUNDRY TRAY WATER HEATER <br /> CLOTHES WASHER � WOOD STOVE ' <br /> METAL FIREPLACE(W000 BURNING) ' <br /> URINAI � ' <br /> ORINKING FOUNTAIN � FIREPLACE INSERT � <br /> HEAT PUMP <br /> FLOOR DRAIN � � <br /> BACKFLOW PREVENTERS ; GAS PIPING � <br /> ROOF DRAINS-RAINLEADERS � EXHAUST FAN ' <br /> SINK(SERVICE-BAR,ETC.) � <br /> ' <br /> SUB TOTAL 5 ; SUB TOTAL 5 � <br /> PERMIT S PERMIT S � <br /> TOTAL FEE S ' TOTAL FEE 5 ' <br /> FOR OFFICE USE ONLY: � 7�2 – CN"� � <br /> REAR SETBAGK SIDE SETBAGK / FLAN CHECK NUMBE� FEE _ <br /> � /� PEGEIPT O. <br /> FRONTSETOACK / � J ^ � —� <br /> '"� S FEES VALUATION FEE <br /> USE 20NE LOT AREA VACANT S�TE f� —7 <br /> �p � �J Z _ YES � '� N� BUILDING V � 2 / '� � <br /> ��—• f <br /> 7YPEOFLOH51. N0.0'rSTORIES oCtuvcur k�cicr.ul'�,u'.ns /J/ � <br /> Z �,P-3 PLUMBING G ' . <br /> SIZ[OF BLDG FIRE SPRINKLERS FEO'D BASEMENT ��� MECHANICAL J <br /> C��b SF nnvN � ,=i YES .✓N� � <br /> �..�y2 SG PUR�-!� ADDITIONAL PLAN CHECK 'f <br /> OGGUPANCY LO�� FIRE FLARhI REO'D HEIGHT 1�6�1T4T101� � <br /> J Z8 ' ' <br /> q OTHER _� <br /> REASON '� L� <br /> S7ATE BUILDING SURCHAFiGE <br /> INT�KEBY PLANSAPPRC�VEDBY CI7YOFEVERETT PUBLICWORNS y <br /> J�•� LOCAL SALES ��� �n�i` <br /> � TAX CODE IS 3105 TOTAL <br /> onre q <br />