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APPLICATlC-�1 FOR CONSTRUCT' 1N PERMIT � <br /> TO BE COMPLETEQ IN BL11CK INK—PLEASE PRINT <br /> HEATING SYSTEM: U GAS i,ELECTRIC Ll <br /> BUILDING DEPARTMENT <br /> 259•8810 i I MECHANICAL ! PWMBING I i SIGN <br /> � DEMOGTION I 1 COMBINR.TION F( BUILDING <br /> MAILA�OFESS CIIY 21P PHOYE <br /> �"'"�" s208 206 3s3 - 977'7 <br /> S�u, � aI.LA �D Io9oV IT� D� S�`. Eds¢6TT 4 � <br /> TENANT MAILFD�r. SS <br /> GIiV ZIP PIIONE <br /> ARCHITECTORDLSIGNER MAILFDDAESS <br /> GI1V Z�" PHONF <br /> GENERnLLONTRACTOF MRILADORE55 CI1V ZIP PMONE STATELICENSEY . <br /> BLUE RIBBON STEEL BLDGS,ING Rl.�d� QS� 1 B 1 LL <br /> M Z�p PMONE STATE LI;,ENSE v <br /> �IECHANICNLCON�9RC70R MAILpDDRESS MLVERNON��VA.9821J <br /> pUp��r.mnr� �n�ee� `f�_ `P PMONE STATELICENSE• <br /> � v <br /> PLUMBINGGONTRAGTOR MAILADDRESS <br /> CONiRAGT PRICE OF WJRK <br /> �O ���O <br /> OESCRIBE WORN AND SOUnRE FOOTAGE�NVOLVEO <br /> CONTACTPERSONANDPMONENO. <br /> ��/X'Zo �s3T F� a Ma LD4 <br /> (�Jo e p r iC w�m 6 ST�'c�G. <br /> l%Ov ���D �� O � , I HERcBV CERTIFY THAT I HAVE READ AND EXAMINED THIS <br /> PROPOSEDUSEOFBUILOING APPLICATION AND KNOW THE SAME TO BE TRUE AND CORFECT.ALL <br /> G qe q y PF70`:iSIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br /> LEGALDESCHIP110NOFPROPERTYISNOWNBELOWORATTACHTWOCOPIE5) NOT THELGRA TOING OF A ERMITyDOES NOT PRESUI EETO GIOVE <br /> ior eiocK oF AUTHORITY TO VIOLATE OR fANCEL THE PROVISIONS OF ANV <br /> OTHER STATE OR LOCAL LAW REGUTATING CONSTRUCTION OR THE <br /> PEPFORMANCE OF CCNSTPUCTION.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 TAX I D.NUMBER 3 9 �s.. �6 O 0 � O,T I �D6 O I CONTRACTORS LAW 1827 RCW AND 296200 WAC. <br /> GONSTRUCiION LOAN LENDER,ADDRE55.TELEPHONE NUM�ER _ 1 �� ,� .. '��9� <br /> /(.P^� — — <br /> SiGN>iN�L DeIE <br /> PRWECTADDRESS 3E. - -ua- � <br /> /09 a4� 1 s D 2 ��,.o�s,��ss�<E�st�o <br /> PLUMBING MECHANICAL <br /> N0. TYPE OF FlXTURE OR ITEM FEE N0. TYPE OF EQUIPMENT FEE <br /> WATER CLOSET(TOILET) � A�C—AIHNOLG UNITS—H.P. <br /> - � FOFCED AIR SYSTEMS—B.T.U. M E.A. <br /> BATHTUB ' <br /> LAVATOFiY(WASH BASIN) UNIT HEATERS—B.T.U. M ___�_ <br /> SHOWER <br /> CIOTHES DRYERS <br /> KITCHEN SINK&'JISP � VENTILATION FAN <br /> DISHWASHER RANGE H00� <br /> LAUNURY TR/�Y ' <br /> WAT�R HEATER <br /> CIOTFI[S WASHLH � WOOD STOVE <br /> � METAL FIREPLACE IWOOD BURNING) <br /> URINAL ' <br /> DRINKING FOUNTAIN FIREPLAC[INSERT <br /> FLOOF Df1AIN � HEAT PUMP <br /> BACKFLCN�PP''.��ENTEFS GAS PIPING <br /> ROOF DF; .JF -HAINI F�IiERS EXHAUST FAN <br /> SINK(SERJICt �3•:R.F 1�_:1 <br /> — _�_ <br /> SUB TOTAL 5 SU9 TOTAL 5 _ <br /> PERMIT S PEFMIT S <br /> TOTALFEE S <br /> TOTALFEE S <br /> A� FGR OFFICE USE ONLY: <br /> klR1, _ PLANGHECKNUM�EN FEE V REC[IPTNO. � <br /> ' FRUNiSETOFCK � REAPSETBRCN SI�ESET�ACN ' ->; � <br /> � - y�, �- ��� � � ��,;.,; , <br /> r�� —� Lv � 5 vncnNrsrte FFES VALUATION FEE <br />�l LOTAREA <br /> USEZONE J� <br /> l.V �— � U �j 3 � '.1 VE$ f" NO BWLDING 7 $�p i _ <br /> iVPEOFGON57. NO.OFSTOPIES aar�xcr naorowuu5Gctins i <br /> �°W° ' PLUMBING <br /> _1.� - �— <br /> SIZEOFBIOG. F�q[SPRINKLERSREO'0 BASEMENT / MECHANICAL � <br /> �7 YES i�NO - — ' <br /> ZCJ SF� G�Z N� ADDITIONALPLANCHECK � <br /> OCCUPANCVLOAD FIHEALARMREO'D HEIGHTI�IM7IiAT�ON <br /> V L_� OTHER � <br /> REn50N STATEBUILDINGSUflCHARGE L ��O <br /> INTAKEeY PIANSAF$F�VEOBV CITYOFEVERETT PUBLICWORKS '� <br /> �j�1 LOCALSALES �� .� ; �� <br /> onre ��/j7�C/�f TAX CODE IS 3105 iorn� � �- <br />