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APPLICATI(`-'1 FOR CONSTRUCT �N PERMIT � <br /> TO BE COMPLETED IN BLACK INK—PLEASE PRINT <br /> BUILDING DEPARTMENT HEATING SYSTEM: f�GAS ❑ELECTRIC ❑ � <br /> 259•8810 <br /> ❑ DEMOLITION CI COMBINATION ❑ BUILDING '�'MECHANICAL ❑ PLUMBING �-I SIGN <br /> OWNER MPILADOFE55 CITV ZIP PHONE <br /> �� uc C��['NNE /3oa c mn,v.,✓E ✓i�� vR EYEiPf'TT 9a.7oi �7Se'+ .�903 <br /> TENANT MAILpDD1�E55 GTY 21P PHONE <br /> ARCHITECT OR DESIGNER MAIL ADORESS CIiY 21P PHONE <br /> GENEflAL CONTR4CTOR MAIL ADDRE55 CITV ZIP PHONE STATE LICENSE� <br /> MECHANICALCONTRAGTOR MAILADDRESS CITY 21P PHONE STATELICENSE+1 <br /> /99A�-b'/rsi/�vF.W . <br /> �Gt�v�. ENEXGY SYSrFYY/S S�✓n. iCY�✓NtvnO� 9f1o3G ?7s/-8d/S SO��-�'oGGTH <br /> PLUMBINGCONTBACTOR MRILAODRESS CIN ZIP PHONE ST�TELICENSEx <br /> CONTRACT PRI�E OF WORK S � � /) <br /> f �J <br /> OESCRIBE 1YORN ANO SOUARE FOOTAGE INVOLVED CONTACT PERSON AN�PMONE NO. <br /> / � <br /> (".qr !/ A /7 O Ze N ELSO�✓ <br /> i HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br /> PROPOSED USEOF BUILOING APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT.ALL <br /> PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br /> LEGALDESCRIPTIONOFPROPERTV(SHOWNBELOIVORATTACHTWOCOPIES� WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br /> NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br /> �ot BLOCK oF -- AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br /> OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br /> PERFORMANCE OF CONSTRUCTION.THAT I AM AUTHORIZED BY THE <br /> OWNER OF THIS PROPERTY TO PERFORM THE WORK FOF WHICH <br /> — APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> PARCELTA%ID.NUMBER CONTRACTORS LAW 18.27 RCW AND 296.200 WAC. <br /> _as - ao -000v <br /> CONSTRUCTION LOAN LENDER,ADDRESS,TELEPMONE NUMOER / <br /> �o-l.�.�,-� .��Jf.i.�i-e-� 9�0�95� <br /> PROJECTADDRESS � � sic etune Da7�s� oe�e <br /> �i�7 E. /llif�¢�NE iELaJ /JR • cirveusn+rssucr.vsEr+o <br /> PLUMBING MECHANICAL <br /> NO. TVPE OF FIXTURE OR ITEM FEE N0. TYPE OF E�UIPMENT PEE <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 ORYERS ' <br /> Y.ITCHEN SINK 8 DISP � VENTILATION FAN � <br /> DISHWASHER RANGE HOOD � <br /> LAUNDRYTRAY ; WATERHEATER ` <br /> CLOTHES WASHER � WOOD STOVE � <br /> URINAL ; METAL FIREPLACE(WOOD BURNING) � <br /> DRINKING FOUNTAIN I FIREPLACE INSERT � <br /> FLOOR DRAIN HEAT PUMP ' <br /> BACKFLOW PREVENTERS � a GAS PIPING <br /> ROOF DRAINS--RAINLEADERS � EXHAUST FAN <br /> SINK(SERVICE—BAR,ETC.) � <br /> � <br /> � <br /> � <br /> � � <br /> SUB TOTAL $ ' SUB TOTAL $ L1 ' <br /> PERMIT S PERMIT $ � <br /> TOTAL FEE 5 ' TOTAL FEE S <br /> FOR OFFICE USE ONLY: <br /> PRONT SETBACK REAF SETBACK SIDE SETBACK PLAN GMECN NIIMBER / � FEE RECEIPT NO. <br /> 15v <br /> USE20NE LOTAREA VACANTSITE FEES VALUATION FEE <br /> C' YES ❑ NO pUIL01NG � <br /> i <br /> TYPE OF CONSi. NO.OF STORIES atuveucv NO or mrEIUNGUvuS i <br /> �RWP PLUMBING i <br /> SREOFBLDG. FIRESPRINNLEFSREOD BASEMENT MECHANICAL � <br /> ❑ YES :� NO � <br /> OCWPANf,VLOAD FIREALARMREO'D HEIGMTLIAl1TAT1ON ADDITIONALPLANCHECK i <br /> i <br /> OTHER ' <br /> REASON <br /> ' STATE BUILDING SURCHARGE � <br /> INTANEBY PLANSAPPROVEDBY CITYOFEVERETT PUBLICWORKS � <br /> LOCAL SALES , <br /> oq,E TAX CODE IS 3105 TOTAL � <br />