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APPLICATIO�. FOR CONSTRUCTI �N PERMIT � <br /> TO BE COMPLETED IN BLACK INK—PLEASE PRINT <br /> HEATING SYSTEM: U GAS ❑ELECTHIC ❑ <br /> BUILDING DEPARTMENT <br /> 259-8810 <br /> DEMOLITION COMBINATION ,l% BUILDING MECHANICAL PLUM9ING SIGN <br /> OWNER M�IlA0�RE55 CITY ZiP PHONE \ � <br /> ' f l t' �� E ��c'CE.T� �'�CS� � )F7� �nef FVFe�C'f <<icr �l�ZO I <br /> ;�J�+!.�7 '� ��� <br /> TEIJANT ' MAILA�DRESS CITV ZIP PHONE <br /> -"�r��� - <br /> ARCHITECTORDESIGNEA MAILAUDRE55 GITV 21P PHONE <br /> r H'�� � :4�Ft`� <br /> GENERALCONTfl/GTOR MAILAD�RESS CITY 2iP P!1 NE STATE•L/ICENSE• <br /> �lnr�-� N Cc�l��r�r TOrE_, /''3�( /3��ld" S•✓9�nm •S.� Gt� 9fi,,•�c �no�)r'��+'�-��`� N�iQ'y 09 <br /> MECIIRNICAI CONTRr1CTOR MAIL ADORESS CITY 2iP PHONE SiFTE LICENSE <br /> PLUMBINGCONTRACTOF MAILPppRE55 CITY ZIP PHONE SiRTELICENS[/ <br /> CLA55 OF WOFK <br /> I NEW . ' ADDITION ALTEflATION X REPAIR DEMOLI710N WOODSTOVEIFRPL INSERT BUILDING RELOCATION <br /> CONiAGT PERSON AN�PMONE N0. <br /> � ( 5� + w,s.sr_ ,� � <br /> CONTRFCT PRICE OF WORN L <br /> �ESCRIBE WORK RND SOUARE FOOTAG[INYOLVED „ <br /> Y -rr� / � � <�rlt� �Eam 2 .: J� - 6`��b <br /> PIiOf'OSEDUSEOiBUIL�ING I NEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br /> �T I� r`�y��. F�t )I ' � APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT ALL <br /> �,eur.;.oEscaiaiioN ov Pao—� P�SHo N BELOW OR ATTACIIfOU coviE51 PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br /> WORK WILL 8E COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br /> �ot e�ocn oF NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br /> AUTHORITY TO VIOL�TE OR CANCEL THE PROVISIONS OF ANY <br /> OTHER STATE OF LOCAL LAW REGULATING CONSTRUCTION OR THE <br /> PERFORMANCE 01 t�,ONSTRUCT10N. THAT I AM AUfHORIZED BV THE <br /> OWNEF OF THIS 7ROPERTY TO PERFORM THE WORK FOR WHICH <br /> APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> CONT�ORS LAW 19. 7 fl�AND 296200 WAC. <br /> / <br /> x � � �� �l <br /> g INiUBII , ���� DR1 <br /> PR0.IECTADOFE55 <br /> � 3� ��� �• crtvnuswrssi�ccus�Ho <br /> PLUMBING MECHANICAL <br /> NO. TYPt OF FI%TURE OR ITEM FEE NO. TYPE OF EOUIPMENT FEE <br /> WATER CLOSET(T^!LE?) � A�C—AlHNDLG UNITS—H.P. <br /> BATHTUB FORCED AIR SYSTEMS—B.T.U. M E.A. <br /> LAVATORV('rVASH BASIN) UNIT HEATERS—B.T.U. M <br /> SHOWER CLOTHESURYERS <br /> KITCHEN SINK 8 DISP � `:ENTILATION FAN ___�_ <br /> DISHWASHER RANGE HOOD _ <br /> LAUNDRY TRAY � WATER HEATER <br /> CLOTHES WASHER C:OOD STOVE � <br /> URINAL METAL FIREPLACE 8 CHIMNEV ' <br /> DflINKING FOUNTAIN FIREPLACE INSERT <br /> FLOOR DRAIN HEAT PUh1P <br /> BACKFLOW PREVENTERS GAS PIPING <br /> ROOF DHAINS—RAINLEADEFS EXHAUST FAN <br /> SINK(SERVICE—BAR,ETC.) � <br /> ----r— <br /> i <br /> SU�TOTAL 5 SUB TOTAL S <br /> PFRMIT S PERMIT 5 <br /> TOTALFEE 5 TOTALFEE S <br /> FOR OFFICE USE ONLY: <br /> FRONT SETB/CN PEAR SETOFCK SIDE SEiBACK PLAN CH��%%FJ9 FEE AEGEIPi N0. -- <br /> // <br /> r <br /> usezorve �ornaen VALANTSITE FEES VALUATION FEE <br /> BUILDING � <br /> iVPf OF CONiS AIlOWABIE T°P[Of[ONSt.RLiUAI Occun�bLv xo 0�ontw•.�uwis <br /> cvou= PLUMBING � <br /> Aa0 GfU�NG� ---^— <br /> SIZE OF BIDG. NOAF STORIEs BASEMENi MECHANICAL <br /> OCCUPANCYLOAD FIR PRNKLFRSRFnD IIEIGNTLIMIIATION ADDITIONALPLANCHECK <br /> � SPRINKLEF � <br /> T <br /> REA:.JH fUi�EPRiNtlLERS <br /> STATE BUIL�ING SURCHAFGE <br /> iNTANE9Y PIANSAPPROVEDBY CITYOFEVERETT PUBLICWORKS <br /> LOCAL SALES <br /> �z �- J� TAX CODE IS 3105 TOTAL <br />