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APPLICATION �OR CONSTFtUCT10N1 PERMIT � <br /> TO BE COMPLETED IN BLACK INK—PLEASE PRINT <br /> BUIIDING DEPARTMENT HEHTING SYSTEM: U GAS �}}ELECTRIC ^J <br /> 259-8810 <br /> � I DEMOLITION ! ` COMBINATION �' BUILDING MECHANICAL i PLUMBING i SIGN <br /> �OIVN[R MFILF DR[SE CITV ZIP PMONE <br /> �o E- E - `�' '�Sl�� �'��:/K�� �' 9�208 .353�3 `�� <br /> i�NANT MAILADORE55 CITV ' 21P PMONE <br /> VA ` Fl <br /> ARCMIiEGT OR OESIGNER MAII ADOFESS LITv ZIP PHONE <br /> �o C �'�� u S�'!� l 0.�,3 l i a; G,�' ' ' �V �I��o.�' ;� 5 3 �a y. ::. <br /> GENeRALCONTRPLTOR IAAILAODRESS CITV' 21P PHONE STAiEI.ICENSE• � <br /> i �j�� <br /> MECMANILFL CONTRACTOR , /'MFiL ADDFE55 V GTY 21P PHONE STATE LIGENSE• <br /> (/ <br /> PLLMpINGCONTRAGTOR /� MAILAOD�SS . CIiY ZIP PNONE STATELIGENS[� <br /> � ./% ! <br /> CONTRACi PFICE OF WOPN <br /> � a�� r .$,yaod <br /> DESCRIBE WORN ANO SOUARE FWTAGE INVOWED � CONTACT PERSON AND PMONE NO. (,� �`/�_� <br /> 77 � .S� F�r ' .�r � � �`. i /-� _ <br /> � i HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br /> PROPOSED USE OF BUILOING p/� APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT.ALL <br /> TG �4..('.-C."�( PROVISIONS OF LAWS AND ORDINANCES GOVEtiNING THIS TYPE OF <br /> LEGALDESGRIPTIONOFPRJPERTV�SMOYMBEIOWORATTACNPNOLOPIES� y WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br /> , /- h�,o� .�•. �'�?f a,�l," NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br /> �oT—� �r etocn or� AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br /> O-O O - OTHER STATE OR LOCAL LAW REGUTATING CONSTRUCTION OR THE <br /> PERFORh1ANCE OF CONSTRUCTION.THAT I AM AUTHORIZED 8Y THE <br /> OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br /> APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> FARCEL TA%I D NUMBEP CONTRACTORS LAW 18.27 RCW AND 296200 WAC. <br /> �c9 O - O /o-uolo <br /> � GONSiRUCTION LOAN LEN�ER.RDOPESS.TELEPHONE NUMBEN -�� / <br /> /V� l�l � �� i �1 <br /> PROJECT ADDRE§�---� C —� 5i6N" � o��F <br /> ' /o3/J / � \ / CI1VBlISNF55L1LFN5CN0 <br /> ' PLUMBING MECHANICAL <br /> � NO. TYPE OF FI%TURE OR�TEM FEE N0. TVPE OF EQUIPMENT FEE <br /> WATER CLOSET(TOILET) � A�C—AiHNDLG 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 DRVERS ' / ��' � D ! <br /> KITCH[N SINK 8 DISP ( VENTILATION FAN �_� <br /> DISHWASHER Q RANGE HOOD � <br /> LAUNDRY TRAY Q WATEH HEATER <br /> CLOTHES WASHER .J � C O' WOOD STOVE O i <br /> URINAL METAL FIREPLACE(WOOD BURNINGI O <br /> DRINKING FOUNTAIN Q FIREPLACE INSEFT O <br /> FLOOR DRAIN O HEAT PUMP O <br /> BACKFLON'PREVENTERS O GAS PIPING � <br /> ROOF ORF.INS—RAINLEADERS EXHAUST FAN <br /> SINK(SERVICE—BAR,ETC.) -- <br /> ' <br /> i <br /> SUBTOTAL S SUBTOTAL S <br /> — PERMIT 5 PERMIT $ � <br /> � TOTALFEE S TOTALFEE S <br /> FOR OFFICE USE ONLY: <br /> (PONiSETBI.CK / REARSETBACN/ SIDESETBA�/ PIANCHE KNII �� FEE RECEIPTNO <br /> USE20N� LOTAREA vncnnisite FEES VALUATION FEE <br /> - YES .- NO OUILOING <br /> Tv�E01CaNSi. NO.oFSioaiES ocm��Fcv xoo�o�rnumcun.�s <br /> tnouv PLUMBING <br /> —i— <br /> SRCOPOLDG. FIRESPRINNLERSREO'� E15EMENi MGCHPNICAL � <br /> � �Es - No r s <br /> pCLIPANCY LOAD FiAE AIFRM PEOD HFIGHT LIMIIATION <br /> ADDITIONAL PI.AN CHCGK <br /> OTHER <br /> REASOV <br /> STATE 6UILDING SURCHARGE <br /> INTPKEBV PlANSAPPROVE�BY CiTYOFEVERETT PUBLICVIORKS <br /> LOCAL SALES <br /> oaTE TAX CODE IS 3105 TOTp� � <br />