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� APPLICATIC"`7 FOR CONSTRUCT'�1N PERMIT <br /> TO BE COMPLETED IN BLACK INK—PLEASE PRINT �n <br />� HEATING SYSTEM: '.J GAS �QELECTRIC U --� <br /> BUII_DING DEPARTMENT <br /> 259-8810 <br /> ! DEMOLITION i � COMBINATION Y. BUILDING � MECHANICAL PLUMBING i l SIGN <br />� OWNER ��qILA00RE55 CITY ZIP PHONE <br /> I <br /> Ronn�c E f�ol �.Ilq .c/„�(e sT �vere?f' 98�3°I .�s^�- IYob <br /> TEN�NT h1AiLADDRESS CITY ZIP PHONE <br />' ARCHITECTOAOESIGNER MMLAD�RESS CITY ZIP PMONE <br /> GE�L CONTRACTO MFIL ADOPESS CITY ZIP PMONE STATE LIGENSE n <br /> I/Y`-l i <br /> l�.� <br /> MECHANiCALCONTRACiOR MML��ORESS CITY ZIP PMONE STATELICENSEa <br /> PLUMBINGCONTRACIOR M�ILADOPESS CITY 21P PHOPIE STATELICENSE� <br /> � CONTRACTPRIGEOFWO4jK� �� <br /> /S <br /> d <br />' DESC(iIBE WORH AND SOl1LFL FOOTAG INVOLVED CONTACT PERSON AND PHONE NO. n �b! <br /> /Ca, L�ec,I 1s J-- ( �o <br /> o�d ., �'�.�o ��rco.» o�+c �a^F <br /> I HEFEBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br /> PROPOSED USE OF�UILDING APPLICATION AND KNOW THE SAME TO BE TRUE ANO CORRECL ALL � <br /> PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF ', <br /> LEG4LDESCRIPTIONOFPROPERTY�SHOWNDELOWOFATTAGIITWOCOPIE51 WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR I <br /> NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br /> �oT �� �3 e�xK�-� oF AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY �I <br /> OTHER STATE Ofl LOCAL LAW REGULATING CONSTRUCTION OR THE <br />' PERFOfiA1ANCE O°CONSTRUCTION.THAT I AM AUTHORIZED BY THE i <br /> i� L� � OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH I <br /> APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> PARCEL TAn I D N1IMBER CONTRACTORS LAW 18.27 RCW AND 296200 WAC. ' <br /> o yos— t—oc3— �c <br /> CONSTRUCTION IOAN LENDER.�fJDFE55.TELEPNONL NUMBER <br /> � x G�_ �' G..� .� �/ -j <br />' PROJECT ADDRESS ^ scrvmm�e ue�e <br /> /��� �( ��yp�� S'�" FVP/'C� urrnusirv�ssiic[�vs�no <br />. PLUMBING MECHANICAL <br /> NO. TVPE OF FIXTURE OR ITEM FEE NO. TVPE OF E�UIPMENT FEE <br /> WATEF CLOSET(TOIIET) � NC—FvHNDLG UNITS—H.P. <br /> BA"fHTUB ; FORCED AIR SYSTEMS—B.T.U. M E.A. � <br /> LAVATORY(WASH BASIN) i UNIT HEATERS—B.T.U. M � <br /> SHOWER ' CLOTHES DRYERS <br /> KITCHEN SINK 8 DISP � VENTILATION FAN ; <br /> DISHWASHER � RANGE HOOD � <br /> LAUNDRYTRAY WATER HEATER <br /> CLOTHES WASHER WOO[JSTOVE I <br /> URINAL M�TAL FIREPLACE(WOOD BURNING) � <br /> DRINKING FOUNTAIN � R�:FPLACE INSERT I <br />� FLOOR DRAIN � HEAT PU41P <br />� BACKFLOW PREVENTERS ; GAS PIPING ; <br /> ROOF ORAINS—RAINLEADERS EXHAUST FAN � <br /> SINK(SERVICE—BAR,ETC.) ; <br />� � � <br /> � <br /> SUB TOTAL 5 7 ; SUB TOTAL 5 ; <br />� PERMIT 5 PERMIT S <br /> TOTALFEE 5 ; TOTALF[E b ' <br /> FOR OFFICE USE ONLY: <br /> FRONTSETBFCK/ FIEFRSET�4CK � SIDESETOAGK / PL�NCryE,1{1�U1.�8� FEE�� � ✓ RECEIPTN . � <br /> %i (l� ry c�T <br />� usezoOr+E �oTnan�n /�� vncnNrsrte �.� FEES VALUATION FEE <br /> /�-� _Z �VOV '. : YES K IVO BUILDING � . 5 Z/ G� � <br />�I lYPEOfGONSi NOOFSTORIES DCLuepNCr N�nrpH�;iin,cu�n15 �' <br /> �our pLUMBING 2/ � <br /> SIZE OF OLOG FlRE SPRINHLERS REO'D ��SEMENT � / MECHANICAL <br />, SG 0 i��' YES i✓NO – , <br />� occuvnNcv�on0 FIRE FL4R1.1 REO'0 Hei�Hr uMrtnnoJ AD�ITIONAL FLAN CHECK i <br /> i <br />� I� N V Z� _ OTHER i <br /> I NE�WN <br /> VS7ATE�UILDING SURCHARGE �� <br />' MiAKEBV PLFNSAPGROiEQOV CIIYOFEVERETT PU�LIC\NOHKS ���-' <br /> � �r LOCALSALES <br /> oArc 3 Z y�y TAX CODE IS 3705 TOTAL �`��j j4 j� <br /> a <br />