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. APPLICAT�N FOR CONSTRUC"10N PERMIT /;� <br /> TO BE COMPLETED IN BLACK INK—PLEASE PRINT �'T <br /> ' �,� : c�n�OP� �irY ��'�� � <br /> HEA(ING SYSTEM: �GAS U ELECTRIC U __.._� <br /> BUILDING DEPARTMENT <br /> 259-BB10 <br /> I DEMOLITION r!� COMBINATION I I BUILDING I I MECHANICAL i I PLUMBING i � SIGN <br /> UWNER AIMl�U0PES5 CITY ZIP PIIONE <br /> �e�c� Nnm�� ���� '�s� Euvt �r EVEP.FTT ����zz i �sY— �sn � _ _ <br /> ����µ� MRRADDRESS GITY ZiP PIqNE <br /> nNCMI7ECT OR DESIGNEN MAII�DDFESS CITY IIP PHONE <br /> GENEfULCONfNACTOH W��DRE55 CITY ZIP P110NE JIA1El1G[NSE1 <br /> :klYl S��/_l�_ _%�Li�'N l I IEyr r: <br /> IAICNN11CQlPNIN�C1U11 1M4�WRL55 CITY 21P 1'INNIk :.I�II.IM:INSI • <br /> PIUM�MIGCONTMCTOB MAn�DDRE55 CITY 21P P110NE SIMLUCkNX� -- <br /> LONTR^�CT PIiICE OF WORN <br /> C, � <br /> UESGfl10E VIONN AND SOUAi1E FOOUGE MVQVED ACi PERSON AND P110NE NO <br /> Z-S'—i <br /> S FE'_ _ <br /> 1 HEREBY CERTIFY THAT I HAVE READ AND E%AMINED THIS <br /> PROPOSED USE OF Bu1lDiNG APPLICATION AND KNOW THE SAME TO dE TRUE AND CORRECT.ALL <br /> ! F(�' PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br /> �ecn�oescaiPT NOiPRUPEflTY�SNOWNBEIOWIXiATTACHTWOCOPlES) WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br /> NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br /> i.or etceK � AUTHORITV TO VIOLATE OR CANCEL THE PROVIS!ONS OF AI:Y <br /> NRnR R�r�nK�� I SI � OTHER STATE OR LOCAL LAW REGULATING CONyTHUGfI(lN OH 1Hf: <br /> PERFORMANCE OF CONSTRUCTION.THAT I AM AUTHORIZED BY TI{E <br /> OWNER OF THIS PROPEFTV TO PERFOHM THE WORK FOR WMICH <br /> APPLICATION IS MADE �ND I COMPLY WITH THE STATE <br /> I'�RCEL Tl1%I U.NIlMOER CONT T RS W RCW AN 200 WAC. <br /> CONSTRlIC710N LOM1lENDER.ADONESS.IEIEPMONE NUMBER <br /> ��/— '__ <br /> PR0.IECT ADDHESS 'L �[ °°""'"'F ""'� <br /> ST�7 /Sr��� � c�nws�ssi�crnsc�o - — -- <br /> PLUMBING MECMANICAL <br /> NO. TYPE OF FIXTURE OR ITEM FEE NO. TYPE OF EWIPMENT FEE <br /> WATER CLOSET(TOILET) � NC—AIHNDLG UNITS—H.P. _ <br /> BATHTUB � ' FORCED AIR SVSTEMS—B.T.U. M E.A. <br /> UVATORY(WASIi BASIN) � � UNIT HEATERS—B.T.U. M _ <br /> SHOWER ' CLOTNESORYERS __ _ <br /> � KITCHEN SINK 8 DISP i VENTIUTION FAN ' <br /> DISHWASHER � I RANGE HOOD � <br /> LAUNDRY TRAY � WATER HEATER ' � <br /> _.L__ <br /> CLOTHES WASHER � WOOD STOVE <br /> � UHINhL ' METAL FIREPLACE(WOOD BURNING) <br /> DRINKING FOUNTAIN � FIREPIACE INSERT ; <br /> —,--- <br /> FLOOR ORAIN � HEAT PUMP _ __ _ <br /> BACKPLOW PREVEN7EFS i GAS PIPING <br /> ROOF DRAINS—PAINLEADERS �E%HAUST FAN <br /> SINK�SERVICE—BAR,ETC.) ; <br /> � <br /> --— —. <br /> � <br /> SUB TOTAL S i SUB TOTA� f '/ J; — <br /> PERMIT S � PERMIT 5 <br /> TOTALFEc § TOTALFEE f <br /> FOR OFFICE USE ONLY: <br /> IHONTSETBACK REIJi5E1BACN SIDESETBACN GIW�CHEGNNUMBER FEE �EGE�PINO <br /> ' sl�wnl - � �i��o� 30 �aa�� <br /> use zonE l07 AqG v�c :ne FEES VALUATION FEE <br /> -Z� it�vE:s n ►+o g�ILDING 395 l�' ; — <br /> Ir1Y0f fM151� �tORIE � xonPRlliYGwis _ . _ __—_ <br /> PLUMBING 3� <br /> �2yE�?�� fINESPflMN/EN5PE0'0 BASE4ENT MECMANICAL ��� <br /> o � Np ❑ ves t�iao <br /> OLCUPMlLYLOAD FIR[�URMqW'0 MCIGNTIIMIT�710N ADDITIONALPLANCMECK � <br /> U � <br /> OTHER _�6 � <br /> ❑CASON �_ - _ <br /> ST�TE BUILDING SURCMARGE jZ) <br /> INIPNEBY PI�N�I'{�EDOY CITYOFEVERETT PUB�ICWORKS �� � <br /> LOCAL SALES <br /> oere TAX COOE IS 3105 TOTAI Z �� <br />