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APPLICATIC�1 FOFi CONSTRUCT�N PERMIT � <br /> TO BE COMPLETED IN BLACK INK—PLEASE PRINT <br /> BUILDING DEPARTMENT HEATING SYSTEM: lJ GAS J ELECTRIC ❑ <br /> 259-8810 <br /> � DEMOUTION ! 1 COMBINATION I l BUILDING ! i MECHANICAL �'iPCUMBING ! ' SIGN <br /> �d�CJ�V/f{`� /Til����`'f�7/=� n ��G'/y �OG�T,n�-�£LL t°6^H/�Ci/_ ��� <br /> TENPNT �/ ldAILA00RE55 GI7Y 21P PHONE <br /> APCNITECTOf�0�51GNER lAAILADORE55 CITY ZIP PHONE <br /> � <br /> GENERAL CO/NTRACTOR MFIL ADDFE55 CITV ZIP PNON[ STATE UGENSE e <br /> ( / <br /> MECHANICAL CONTRAQOq MAIL�DDRESS dTY ZIP ANONE SiATE LICENSE e <br /> PLUMBING CONiPACTOR MAIL ADDRESS CITY 21P PMONE STATE LICENSE• <br /> CONTRACT PRICE OF WORK <br /> OESCRiPE\VORK AND SOUARE FOOTRGE INVOLVED CONTACT PERSON AND PNONE N0. <br /> I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br /> FROPOSEDUSEOFBUILDING APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT.ALL <br /> PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br /> LEGA�DESCRIPTIONOFPROPERTV�SHOWNBELOWOIiATTAGHTWOCOPIES� WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br /> NOT. THE GRANTING OF A PERMIT DOES NOT PRESUM� TO GIVE <br /> toT e�ocrc oF AUTHORITY TO VIOLATE OR CANCEL THE PAOVISIONS 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 FOR WHICH <br /> APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> PARCEL TRX 10.NUbIBER CONTFACTORS LAW 1827 RCW AND 296.200 WAC. <br /> CONSTRUCTION LOAN LENDER.ADDRE55,TELEPHONE NUM9ER p� � / / <br /> x c�,,,�—`��1� �l/S�l S-�_ ` <br /> PROJECT ADDRESS^// sicN�rune wtt <br /> �y CIiY OUSMESS 14AN5C NO <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM FEE NO. TYPE OF EOUIPMENT FEE <br /> WATER CLOSET(TOILET) � p:—A/HNDLG 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 8 DISP � VENTILATION FAN <br /> DISHWASHER RANGE HOOD _ <br /> LAUNDRY TRAY WATER HEATER ' <br /> CLOTHES WASHER � WOOD STOVE <br /> URINAL ; M�TAL FIREPLACE(WOOD BURNING) <br /> DRINKING FOUNTAIN � FIREPLACE INSERT � <br /> � <br /> FLOOR DRAIN HEAT PUMP <br /> BACKFLOW PREVENTERS ; GAS PIPING ; <br /> ROOF DRAINS—RAINLEADERS EXHAUST FAN � <br /> SINK(SERVICE—BAR,ETC.� � <br /> — � <br /> � <br /> � <br /> � � <br /> SUB TOTAL $ ' SUB TOTAL $ ; <br /> PERMIT $ � PERMIT $ <br /> TOTAL FEE $ TOTAL FEE $ <br /> FOR OFFICE USE ONLY: <br /> iRONT5ET8ACK �EpRSETBACK SICESETB�CK PLANCI�.ECKNUMBER FEE RECEIPTNO. <br /> ���7� <br /> USF ZONE LOT AREA VACANTSITE FEES VALUATION FEE <br /> ;"�1 YES u NO BUi�DirvG <br /> iVPEOFCON51 NO.OF5T091ES C:CUP�r:tv Noo�on'[uixGVNns i <br /> canuv PLUM�ING � <br /> SIZEOFBLDG. FIRESPPINRLERSREO'D BASEMENT MECHANICAL <br /> -; YES ���-: NO <br /> OCWPA4CYLOAD FlREAIARMREO'D MEIGMiLIM1iAT10N ADDITIONALPLANCHECN <br /> OTHER <br /> RE�SON <br /> STATE BWLDING SURCHARGE <br /> MTAKEBY PLANS�PPROVED�V CITYOFEVERETT ruaucwoaKs <br /> LOCAL SALES <br /> oniE TAX���E�$3��5 TOTAL � <br />