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APPLI�ATIC"'1 FOR CONSTRUC7�'"JN �ERMIT � <br /> TO BE COMPLETED IN BLACK INK-PLEASE PRINT <br /> HEATING SYSTEM: ❑GAS ❑ELEI.TRIC ❑ <br /> BUILDING DEPARTMENT <br /> 259-8810 <br /> i ', DEMOLITION COMBINATION BUILDING MECHANICAL PLUMQING �SIGN <br /> CWNER MA'L AO�NLSS C�T�� I. Z�P ` � � PHONE - �� <br /> Y //�����'�j�c/�/�� � �x� <br /> T NANT �SS � � ,•,`�, 21P � N n <br /> ..��. <br /> �1/ r <br /> APCNITECTORDES�GNER AfAILADDRESS CITv 21P PNO - <br /> Si9�L l�(�Nr �:'!�/L��S <br /> f.ENERALCONTPFCTOR MAII.ADDRE55 CI1Y ZIP PNONE STATELICENSEI <br /> ���i,u��'�t-r0 —C�rZt_R,cf� �. 2�0� 14-4z3�� <br /> EGHANICALCONTRRCTOR MAILAO�RE55 ZIP PHONE STRTELICENtiE� <br /> PUIMBINGCONTRACTOP MpRA00RE55 CIN ZIP PHONE STATEUCENSEY <br /> CLA55OF WORK <br /> : I NEW ��. '. ADDITION ��. ALTERATION I . REPAIR � UEMOLITION �. � YlOODSTOVE/FRPL INSERT I 1 BUILDING REI.00ATION <br /> ��� ��� ` CONTr1CTPEH50NANDPMONENO. <br /> ONTRACT PRICE OF WORK <br /> ESGRIBE WORK ANO SOUAPE FOOTAGE INVOIVED <br /> PROPOSEDUSEOFBl11LDING I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br /> APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECL ALL <br /> IEGRL DESCRIPTION OF PROPERTY�SNO/WN B�l.o W OR ATTACH FOUR COPIES� PROVISIONS OF LAWS AND ORDINANCES GOVERNING fHIS TYPE OF <br /> ��n \NORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br /> �oT gLOCN / oF � NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br /> ��,� �l� AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br /> ��i- OTHER STATE OR IOCAL LAW REGULATING CONSTRUCTION OR THE <br /> PERFORMANCE OF CONSTRUCTION.THAT I AM AUTHORIZED BY THE <br /> OWNER OF THIS PROPEHTY TO P OFiM THE WORK FOR WHICH <br /> APPLICATION IS E AND COMPLY WITH THE STATE <br /> CONTRACTORS L�� CW ND 296200 WAC. ��y! <br /> j v <br /> A x,�„„ �.,E� � <br /> �PRpJEGTA0DRE55 � <br /> / � �� LirvBU5iNE55lIC NSE � <br /> n PLUMBINO MECMANIC L <br /> NO. TYPE OF FO(TURE ON ITEM FEE NO. TYPE OF EOUIPMENT �E <br /> T <br /> WATER CLOSET(TOILET) A/C—NHNDLG UNITS—H.P. ' <br /> BATHTUB FORCED�\IR SYSTEMS—B.T.U. M E.A. ' <br /> LAVATORY(WASH BASIN) UNIT HEATERS—B.T.U. M � <br /> SHOWER � CL0T4ES DRYERS � <br /> KITCHEN SINK 8 DISP VENTILATION FAN � — <br /> DISHWASHER RANGE HOOD ' -- <br /> LAUNDRY TRAV ; WATEH HEATER � _.._ <br /> CLOTHES WASHER � NJOOD STOVE ' --- <br /> URINAI ' METAL FIREPLACE 8 CHIMNEV ' __ <br /> DRINKING FOUNTAIN � FIREPLACE INSERT � _— <br /> FLOOR DRAIN HEAT PUMP '.— <br /> BACKFLOW PREVENTERS GAS PIPING __.r-— <br /> RUOF DRAINS—RAINLEADERS � EXHAUST FAN __ ' — <br /> � <br /> �INK(SEFVICE—BAN,ETC.) � <br /> � <br /> ---T— <br /> � <br /> � <br /> — � <br /> —' � <br /> � <br /> � SUB TOTAL 5 SUE TOTAL $ <br /> -- PERMIT $ PENMIT $ � <br /> — TOTALFEE $ TOTALF9E $ <br /> FOR OFFICE USE ONLY: pECEiPTN�� <br /> FRONTSE7BAGK � REp �T�CC SIDESFTBRCN PIANCHECNNUMBER FEE� !3 <br /> ♦ �C C.'�� � / (0 <br /> i) L <br /> USE20NE AREp <br /> VpCANT SITE FEES VALUATION FEE <br /> 2 � / � G� <br /> r BUILDING <br /> i <br /> iYPEOfCON15AllOWABIE TYPEOFCONSi.PL1URl YGqao�Y NOaDwRuxGuxifl i <br /> / PLUMBING ' <br /> SIZEOFBLDG. NO.OFSTORIES BRSEl�.ENT MECHANICAL � <br /> i <br /> AODITIONAL PIAN CHECK ' <br /> OCLUPANCYLOAD FIR[SPRNNLEFSNEOD HEIGMTLIMI7�ION � <br /> S SPRINKLER � <br /> REASON FOR SPRINKLENS y i�� (_J <br /> STATE OUILOING SURCHARGE <br /> MTAKEBY PLANSAPPRO��EDBY CITYOFEVERETT PUBLICWORNS � <br /> LOCAL SALES � <br /> I/ JM TAX CODE IS 3105 TOTAL "�'� ��?�- <br />