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� �' APPLICATIC'� FOR CON�TRUCT'lN PERNIIT <br /> TO BE COMPLETED IN BLACK INK—PLEASE PRINT �n <br /> BUILDING D��TMENT HEATING SYSTEM: ❑GAS ❑ELECTRIC � .�.�J-�� _ <br /> 259-8810 <br /> ❑ DEMOLITION ❑ COMBINATION I}a BUILDING ❑MECHANICAL ❑PLUMBING ❑ SIGN <br /> �y�+ER MAILADDRE55 S Cltt ZIP PHONE <br /> C�S� a�y //�/ ��,o� is" ,a�� � c�/:�z P�r 9�:�� 7Y.�-lia� <br /> TENANT MAILADDRESS Cltt ZIP PMONE <br /> ARCMITEGTORDESIGNER MRILPD�RESS Cltt JP PHONE <br /> �,;�, / ys�s�� z�,� �..�. w- S.� / �� � 1-�s�bPo� <br /> GE ALCONTRR/CTOR / MAILPDDRE5�5{./�[ A � lC,ITY C2�1P�J p ��JP!H/ON�Ep STATEIICENSE� (� <br /> ✓•v.S/ CD��[�J/�U✓SC'.T TTr� � �i�.� (N� SP�/ /CJI/Y GfJT O/(JJ Sl/N�/� Y O�7�/YP <br /> NECH AL CONTRRCTOfl MRIL ROORE55 CITY ZIP PHONE ATE UCENSE I <br /> PLUMBINGCONTA�CTOR MAILADDRESS GITV ZIP PHONE STqTELIGENSE• <br /> CONTRACT PPICE OF WOpK <br /> uo <br /> DESCPIBEWORNANDSOURREF007AGEINVOLVEO/ ��✓l� GONTR TPEPSON PHONENO n <br /> C�Cee..i « i „r <br /> y� �zf�� � ��/y/L,.� - �,r ,/�� d�Yy JyW <br /> �� o G/D� U/Yi�/U•Y (/N�lYJl� .4�/C • I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br /> PHOPOSEUUSEOFBUILDING APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT.ALL <br /> PROVISIONS OF LAWS ANO ORDINANCES GOVERNING THIS NPE OF � <br /> LEGRLDESCflIPTIONOFPROPERTY�SMOWNBELOW�nt���o�Pi�� �u�NC2 NOT. THELGRA T�ING OF A ERMIT'DO SENOT PRIESUMEETO GIOVE <br /> LOT �/S` BLOLN OF �� <br /> y �/ nn AUTHORITV TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br /> W/L '..Si�y NG/f�;'.S'SI��i NJ!/`1 �(, t �t!SQ pERFORMANCE OF�CONS RUCTION.�THAT i AM AUTHORI ED BY THE � <br /> �QG��o ?'J.1�. j � �� � ��.G `��J OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WFIICH <br /> APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> PARCELT�%I.D.NUMBEq <br /> Z O�/�D //O OV,r CONTRACTORS LAW 1827 RCW AND 29i200 WAC. <br /> CONSTRIh:T L LE R.�D RESS.TELEPHONENUMBER / <br /> ' � ,✓/-e..�— 9s9 � <br /> � PROJECT AD ESS „ .�- wr��rune o+�[ <br /> �. �//O/ t'(/CCC/�• zJ� crt.eusiNessuccHsera <br /> PLUMBINO MECHANICAL <br /> NO. TYPE OF flXTURE OR ITEM FEE NO. TYPE OF E�UIPMENT FEE <br /> WATER CLOSET(TOILET) � N�A/HNDLG UNITS—H.P. � <br /> BATHTUB ; FORCED AIR SVSTEMS—B.T.U. M E.A. � <br /> LAVATORY(WASH BASIN) � UNIT HEATERS—B.T.U. M ; <br /> SHOWER � CIOTHES DRYERS <br /> KITCHEN SINK 8 DISP I VENTILATION FAN ; � <br /> DISHWASHER � RANGE HOOD �� <br /> LAUNORYTRAY ; WATER HEATER <br /> CLOTHES WASHER � WOOD STOVE � <br /> URINAL METAL FIREPLACE(WOOD BURNING) � <br /> DRINKING FOUNTAIN fIREPLACE INSERT <br /> FLOOR DRAIN HEAT PUMP � <br /> BACKFLOW PREVENTERS � GAS PIPING ; <br /> ROOF DRAINS—RAINLEADERS � EXHAUST FAN <br /> SINK(SERVICE—BAR,ETC.) ; <br /> � � <br /> � <br /> � <br /> T <br /> SUB TOTAL $ ; SUB TOTAL $ <br /> PERMIT $ � PERMIT $ � <br /> TOTALFEE $ TOTALFEE $ <br /> FOR OFFICE USE ONLY: <br /> FRONT SETBACN RERR SETBnCK ♦ SIDE SETBACK � PUN CHECN NOMBEN FEE RECEIPi NO. <br /> �-� � , � � � 2� , -� <br /> USEZONE LOTRRE� �ACANi51TE FEES VALUATION FEE <br /> �_l YES ❑ NO BUILDING i — <br /> iYPEOFCONii NO.OFSTORIES U.:uvexc� HoOruNalrvGUHrtS � <br /> �"ao pLUMBING <br /> .Q-N <br /> S2EOFBLOG. FlRESPRINNLERSFEOD BASEMENi MECHANICAI <br /> 0 ❑ vEs �0 , <br /> OGWPRNCY LOAD FIRE RLARM NEO'D HEIGHT UMITATION ADDITIONAL PLAN CHECK i <br /> i <br /> A O OTHER ' <br /> REASON <br /> STATE BUILDING SURCHARGE �J <br /> MT�NEBY PlANSAPPROVEOBY CITYOFEVERETT PUBLICWORKS � <br /> JI�I- LOCALSALES <br /> onre �� TAX CODE IS 3105 ror�� D3 � <br />