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APPLiCATIC'1 FOR CONSTRUCT�lN PERMIT � <br /> TO BE COMPLETED IN BLACK INK—PLEASE PRINT <br /> HEATING SYSTEM: ❑GAS O ELECTRIC AI�AI� <br /> BUILDING DEPARTMENT <br /> 259-P810 <br /> Ci DEMOLITION u COMBINATION 4J BUILDING I l MECHANICAL ❑PLUMBING ❑ SIGN <br /> OWNER Mn!IADDPESS CITV ZIP PNONE <br /> �:-�i ��av'earor, 11l11 1 <'� �vc S Eu�v gg2�?C 3iiR ^ h2. 2 �1 _ <br /> TENANT M41L RODFESS QTY 21P PNONE <br /> �RCHITECTORUESIGNER MAILADDRESS CITV ZIP PHONE <br /> s fl �t, ow�n.e•r• <br /> GENERALCONTRRCTOR MRILr1�ORE55 CITV ZIP PNONE STATELICENSEt <br /> -5 �� O v�v��v� <br /> MECHANICALCONTRACTOR M�ILADDHESS CITY 21P PMONE ST�TELICENSE� <br /> 5 A � �W�nQI^ <br /> PlUM81NG CONTRRCTOF MRIL ROORE55 Cliv 21P PHONE STATE LICENSE• <br /> P <br /> CONTRACT PRICE OF WOi1K <br /> 3 �'(�2 2' <br /> OESCRIBE WORK ANO SWARE FOOTAGE INVOLVED � � LONiAGT PEPSON RND PHONE NO. <br /> ` 3 <br /> . i HEREBY CERTIFY THAT I HAVE READ AND EXAMWCD THIS <br /> PROPOSED USE OF BUILDING \ APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT.ALL <br /> S� o•r q q S �u\ �tl 1 V�G PRO�ISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br /> LEGALPESCR�PTIONOFFR�PEPTV�SMOWNBELOWORATTA HTWOCOPIES� WORK WILL BE COMPLE7ED WITH WHETHER SPECIFIED HEREIN OR <br /> NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br /> toT BIOCN oF qUTHORITY 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 AUTHORI2ED BY THE <br /> OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br /> APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> PRRCEL TRIf�D.NUMBEN CONTRACTORS lAW 18.27 RCW AND 296.200 WAC. <br /> CONSTRUGiION LWN LENDER.ADDR[SS.7ELk'PHUNE NIIMBEfl r�� � <br /> �1�� � \ s� Av e S �.. E�e�e. Y� ��n od� o�,. � " ZLl � 43 <br /> PROJECT ADDRESS ;�c�.r�Ae DAIE <br /> o — 3 — 62 ��,.a�s�NE�s������E� <br /> PLUMBIN(i MECMANICAL <br /> Np. TYPE OF fll(TURE OR ITEM FEE NO. TYPE OF EOUIPMENT FEE <br /> WATER CLOSET(TOILET) AIC-A/HNDLG UNITS-H.P. <br /> BATHTUB FORCED AIR SYSTEMS-B.LU. M E.A. <br /> LAVATORY(WASH BASIN) UNIT HEATERS-B.T.U. M <br /> OWER C THES DRYERS ' <br /> KIT N SINK&DISP ' VEN LATION FAN � , � <br /> DISHWA ER � RANG OOD ' <br /> I.AUNDRV T Y ; WAT[R H TER <br /> CLOTHES WAS � WOOD STOV <br /> URINAL METAL FIREPLA (WOOD BURNING) ' <br /> ' FIREPLACE INSER � " <br /> DRINKING FOUNTAIN � --T- <br /> FLOOR DRAIN HEAT PUMP ' <br /> BACKFLOW PREVENTERS GAS PIPING � <br /> EXHAUST FAN � -�— <br /> ROOF DRAINS-RAINLEADERS � <br /> SIiJK(SERVICE-BAH,ETC.) � , <br /> � <br /> T <br /> _ � <br /> � SUB TOTAL $ ' SUB TOTAL $ <br /> i PERMIT $ PERMIT 5 � <br /> TOTALFEE $ ' TOTALFEE S ' <br /> FOR OFFICE USE ONLY: <br /> FRONTSETBACK RERRSETBACK SIDESETBAf.K PLANCHECKNUTABER FEE � , /��i RECE NO.,� <br /> ��� 20' � ' y/ G' �' � <br /> IISEZONE �ornaEn �ACRNTSITL _�` FEES VALUATION FEE <br /> b �' I1 ❑ VES �yN� BUILDING Zf,C� �_ <br /> F <br /> TYPEOfCONST. NO.OFSTORIES occUrwu[r x0amvfllwcu4n5 � <br /> I eeav I PLUMBING � <br /> � <br /> SREOFBLDG. FIRESPRINNlEPSREbO BASEMENT MECHANICFL � <br /> SO �0 ❑ YES ��NO ' <br /> � ADDITIONAL PIAN CHECK � <br /> OCGUPr1NCV LOAD FIRE AL�RM REO'D HEIGHT LIAIITATlOi <br /> V Z OTHER � <br /> REASON � � <br /> STATE BUILDING SURCHARGE <br /> INTAKEBY PLANSA �EOBY CITYOFEVERETT �UBLICWORNS T <br /> LtICAL SALES � <br /> on.e ej TAX CODE IS 3105 TOTAL ' <br />