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APPLICATIOI _ FOR CONSTRUCTI � N PERMIT � <br />TO BE COMPLETED IN BLACK INK-PLEASE PRINT <br />HEATING SYSTEM: ❑ GAS ❑ ELECTRIC ❑ <br />BUILDING DEPARTMENT <br />259•8810 <br />X DEMOLITION COMBINATION BUILDING MECHANICAL PLUMBING SIGN <br />MAIL A�ORESS <br />MqIL ADDRESS <br />A/AIL AODRE55 <br />MAIL A�DRE55 <br />MAIL ADDRESS <br />� OF WORK <br />NEW . ��. ADDITION ALTEIiATION REPAIR <br />SOIIAPE <br />LEGAL DESCRIPTION OF PqOPERTV �SNOWN BELOW OR ARACH <br />LOT13 /�BLOGK %�� OF �4� <br />/.��_ � /_ /�'` ,d,I,✓.•J� <br />PRO.'ECTADDRESS <br />.�.���_ � ,P�l�,��i <br />PL�I ING <br />NO. TYPE OF FIXTURE OR ITEM <br />WATER CLOSET (TOILET) <br />BATHTUB <br />LAVATORY (WASH BASIN) <br />SHOIYER <br />KITCHEN SINK 8 DISP <br />DISHWASHER <br />LAUNORYTRAY <br />CLOTHES WASHER <br />URINAL <br />DRINKING FOUNTAIN <br />FLOOR DRAIN <br />BACKFLOW PREVENTERS <br />ROOF DRAINS—RAINLEADERS <br />SINK ISERVICE—BAR. ETC.1 <br />SUB TOTAL S <br />PERMIT 5 <br />TOTAL FEE 5 <br />FOR OFFICE USE ONLY: <br />FRONTSETBFCK REARSETOACK SIOESETBACK <br />USEZONE LOTAREA VACANTSITE <br />CITV ZIP <br />CITY ZIP <br />CITV ZIP <br />CITY ZIP <br />cut ur <br />PEE <br />PMONE <br />PNONE <br />PHONL <br />PHON[ <br />PNONE <br />ILITION WOODSTCVErFRPL INSERT <br />LONTACT PEFSON AND PHONE NO. <br />STATE LICENSE a <br />STATE UCENSE • <br />STRTE LICENSE � <br />� BUILOWG RELOCATION <br />I HEREBY CERTIFY 'fHAT I NAVE READ AND EXAMINED THIS <br />APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />FROVISIONS OF LAWS AND ORUINANCES GOVERNING THIS TVPE OF <br />WOFK Wlll BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br />NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br />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 FOR WHICH <br />APPLICATION IS MADE AND I COMPLY WIiH THE STATE <br />CONTRAC'�ORS LAW 18.27 RCW AND 296200 WAC. <br />'G�+ntunl � �ItE <br />CIiV B09NE55 UCCNSE NO <br />MECHANICAL <br />NO. TYPE OF EQUIPMENT FEE <br />A�C—NHNDLG UNITS—H.P. <br />FORCED AIR SYSTEMS—B.T.U. M E.A. � <br />UNIT HEATERS—B.T.U. M ; <br />CLOTHES DRYERS � <br />VENTILATION FAN <br />RANGEHOOD <br />WATER HEATER <br />WOOD STOVE <br />METAL FIREPLACE 8 CHIMNEY <br />FIREPLACE INSERT ; <br />�— <br />HEAT PUMP <br />GAS PIPING ' <br />EXHAUSTFAN � <br />SUB TOTAL S <br />PERMIT S <br />PLAN CNECK NU�d6ER I FEE � RELEIPT NO. <br />BUILDING <br />7YPEOFCONiSAILOWABIE i°PEOFCONSi.AC71)AL attuvextv Haof�wEwNGu4rt5 <br />eaour � pWMBING <br />SI2EOFBLDG NO.OFSTORIES BASEMENT MGCHANICAI <br />OCCUPANCVLOAD FIf1ESPRNNLER5RE0'D MEIGNTLIMITAiION ADDITIONALPLANCHECK <br />SPFINKLER <br />REASON FOR SPR W KLERS <br />STATE BUILDING SU(iCHARGE <br />MTAKFBV PLANSAPPROVEDBY CITYOFEVERETT PUBLICWORKS <br />LOCAL SALES <br />TAX CODE IS 3105 TOTAL <br />� <br />0 <br />