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APPLICATIC-1 �OR CONSTRUCT`1N PERMIT <br /> TO BE COMPLETED IN BLACK INK—pLEASE PRINT � <br /> BUILDING DEFARTMENT HEATING SYSTEM: GAS 'J ELECTRIC ] � <br /> 259-8810 <br /> DEMOLITION ; COMBINATION BUILDING �iAECHANICAL <br /> owNea :-� PLUMBING ; SIGN <br /> MAiL ADDRESS CITY Z�p � <br /> PNONE <br /> t�mtr enn'�k1u., 2v3� (�o�/t�el��� Cvp�eN' 98�41 <br /> iEN4NT hINL ADDRESS '2�� w N�/,� <br /> CITV ZIP PNONE <br /> ARCNIiECTORDESIGNEF MAILq�ORESS <br /> CITV IIP PHONE <br /> GENERqLCONiqqCTOR MAI�ADDRESS <br /> ' G�V ZIP pMON[ STATE LICENSE� <br /> MECMFNICALCONTRACTOq MqILAD�RES$ <br /> ��i� �1 Z�P PMONE STFTE LICENSE• <br /> fva.<r�o_ S�-4`�¢ 5�.,� P D t�.,,c ISad crP�tTT y'�XU6 2�,t �311Y �'✓E2CS. S'f��.Q7 <br /> PlUl.l NGCONTfinCTOR hIqILA00RE55 <br /> CIiV ZIP PNONE STATELICENSEn <br /> CONTqACT PRICE pE WORK <br /> R �sS v o <br /> OESCPIBE VfORK qND SOUARE FOOTAGE 1NVOlVED <br /> CONTACi PERSON AN�.WIONE N <br /> i <br /> ��• y����� T� 2�.2 • 31 (Y <br /> ' CI,� o -� fl•I �„ 6ts Fti�n.�cc <br /> � — <br /> PROPOSEDUSEOF ILUING � HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br /> �s������Q APPLICATION AND KNOW TfiE SAME TO BE TRUE AND CORRECT.ALL <br /> PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TVPE OF <br /> LEGALDESCRIPTIONOFPROPERTV�S/IOWNBELOWORqTTACNTWOWPIES� WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br /> LOT oiocK oF NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br /> AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF qNY <br /> — OTHER STATE OR LOCAL LAW REGULATING CONS7RUCTION OR THE <br /> PERFORA7ANCE OF CONSTRUCTION.THAT I AM AUTHORIZED BY THE <br /> OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br /> FAFCELTA%IDNOMBER APPIICATION IS MAOE AND I COMPLY WITH THE STATE <br /> CONTRACTORS LAW 78.27 RCW AND 296200 WAC. <br /> CONSTRUCTION LOAN IEN�ER.ADDRE55.TELEPHONE NIIMBER <br /> PROJECT ADDRESS x -+�'� ��^-� ' /o- 1 9•9 Y <br /> � nai[ <br /> �ac t Q Pf cnve��s�n[ssucrmsrrvo <br /> PLUMBING <br /> NO. TYPE OF FIXTURE OR ITEM MECHANICAL <br /> FEE NO. TYPE OF EOUIPMENT FEE <br /> WATER CLOSET�TOILET) � q;C—ArHNDLG UNITS—H.P. <br /> BATHTUB ; � FORCED AIR SVSTEMS—�.T.U. <br /> LAVATORY(�YASH BASIN) � UNIT HEATERS—B.T.U. M d <br /> SHOWER � CLOTHES DRYERS � <br /> KITCHEN SINK 8 DISP VENTILATION FAN <br /> DISHWASHER � ' <br /> LAUNDRYTRAY ' RANGEHOOD �— <br /> WATER HEATER <br /> CLOTHES WASHER WOODSTOVE <br /> URINAL ; METAL FIREPLACE(WOOD BURNING) � <br /> DRINKING FOUNTAIN � FIREPLACE INSERT <br /> FLOOR DRAIN � HEAT PUMP � <br /> BACKFLOW PREVENTERS ; � GAS PIPING <br /> ROOF DRAINS—RAINLEADERS � EXHAUST FAN <br /> SINK(SERVICE-9AR,ETC.) <br /> � <br /> � <br /> � --�_. <br /> SUB TOTAL S SUB TOTAL 5 <br /> PERMIT S PERh117 $ � <br /> TOTAL FEE 3 TOTAL FEE 3 <br /> FOR OFFICE USE ONLY: <br /> fqONTSGTAACN q[ARSETB4CK SIDESETBACK <br /> PLAN CHCCN NUMBER FEE RELBPi NO. <br /> US[ZONE LpTARU VA��NTSITE <br /> _ FEES VALUATION FEE <br /> YES � i N0 <br /> iYPE0FC04Si NO.OFSTOPIES DUILDING <br /> ocro�:uv NOD�ow[un�cuqns <br /> caouo — <br /> PLUMBING <br /> 52EOFBLDG. FIRESPRINNLERSREO'D BASEMENT <br /> . . YES ;-' N� MECHANICAI � <br /> OCCUPANCVLOAD FlREALARMREOD HEIGH7UMITpTION ADDITIONALPLANCHECK <br /> PEASON OTHER <br /> STATE BUILDING SURCHARGE T— <br /> irvrnKEov rinNsnrraoveoev CITYOFEVERETT — <br /> LOCAL SALES P�OLIC WOHHS <br /> o�*E TAX CODE IS 3105 TOTAL <br />