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ppPLICATIO�. FOR CQNSTRUCTC"1N PERMIT �� <br /> TO BE COMPLETL'� �'' ��-AGK INK—PLEASE PRlNT <br /> HEATING SYSTEM: U GAS ❑ELECTRIC �__ <br /> BUILDING DEPARTMENT <br /> 259-8810 , PLUMBING ❑ SIGN <br /> ❑ DEMOLITION ❑ COMBINATION f7 BUILDING iLPMECHANICAL oNe <br /> n /, MR(IL�At��DHE55 � /� �� <br /> �NTIER /L w.4.r �/L I'ql ' I e..2�'f./� d�r CITY� l ' 21P PM(�NE <br /> / � <br /> tE MA1l AD�RC55 <br /> QTY 2iP PMOI�E <br /> pRCHITECTORDESIGNER MPRADORESS <br /> CITY ZI NCNE STATELICENSEII <br /> GENERALCONTRPCTOA h1nRADORE55 ,'� CrL��J(� �3p � S �Uy <br /> ^ � �dn S /S �. o L <br /> CITV ZIP PHONB STATE UGENSE� <br /> ME ANIGALCONTFACTOR MAILAODRESS _ <br /> LIiV 21 NE S1ATE ULENSE� <br /> PLUMBINGGONTRA.TOR MAILRDDFESS ,� /e��vf pd S6g'yZ;7�-�T�IJ �/j;�Q <br /> �}r� /1 L �" .`� <br /> c- <br /> GONTPRCT PRiCE OF N'ORK ^ <br /> �� <br /> DESCRIBE WORK RN�SOU4PE FOOTAGE INVOLVED <br /> CONTAC7 PERSON AND PMONE NO.%O���F S6Y. —S,� <br /> � � i HEREBV CERTIFY THAT I HAVE READ AND E%AMINED THIS <br /> PFJPOSEDUSE OFBl11l01NG APPLICAI�ION AND KNOW THE SAME TO BE TRUE AND CORRECl.ALL <br /> PROVISIONS OF LAWS AND 7RDINANCES GOVERNING lri:5 NPE OF <br /> LEGAL�ESGNIPTIONOFPFOPERTVIS�!OWM1BELUWpqpTTpCHTWOCOPIES) WORK WILL BE COMPLETED WITH WHEYHER SPECIFIED HcREIN OR <br /> NOT. THE GRANTING OF A PFHMIT DOES iJOT PRESUME TO GIVE <br /> ioT PLO�:N o�� — AUTHORITY TO VIOLATE nR CANCEL Tf1E PRO�'ISIONS OF ANV <br /> OTHER STATE OR LOCAL LAW REGULATING CO�ST(iUCTION OR THE <br /> PERFORMANCE OF CONSTRUCTION.THAT I AM A'JTHORIZED BY THE <br /> OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br /> APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> a�RCE�Tnx i.o.rvuMeee CONTRACTORS LAW 1827 RCW AKD 296200 WAC. <br /> - GOASTNULTION LOAN LENDER.AODRESS.TELEPHONE NUMBEN � �C, /�—� �_/�f'� <br /> � <br /> s �' orrc <br /> s�cn.nae <br /> PROJECT DDRESS �nveosmcssucenseuo <br /> MECHANICAL FEE <br /> PLUMBING FEE NO. TYPE OF EOUIPMENT <br /> NO. TYPE OF FlXTURE OR ITEM q��piHNDLG UNITS—H.P. ' — <br /> WATEF CLOSET(TOILET) , FORCED AIR SYSTEMS—B.T.U. M E.A. ' <br /> BATHTUB � UN1T HEATERS—B.T.U. M ' <br /> LAVATORY(WASH 6ASIN) , CLOTHES DRYERS � <br /> SHOWER . VENTILATION fAN <br /> KITCIIEN SINK 8 DISP RANGE HOOD <br /> DISHWASHER ydATER HEATER <br /> LAUNDRVTRAY ' <br /> WOOD STOVE �— <br /> CIOTHES WASHER METAL FIREPLACE(WUOD BURNING) <br /> URINAL FIREPLACE INSERT --r— <br /> DRINKING FOUNTAIN HEAT PUMP <br /> fLOOR DRAIN GAS PIPING <br /> BAGKFLOW PREVENTERS _ �� EXHAUSTFAN <br /> ROOFDRAINS—RAINLEADERS �_ <br /> SINK(SERVICE—BAR.ETC.) ' ' <br /> _ � <br /> � <br /> T <br /> SUB T07A1 R � <br /> SUB TOTAI 5 pERMIT $ ' <br /> PERMIT 5 TOTAL FEE $ <br /> TOTALFEE $ . <br /> FOR OFFICE USE ONLY: FEE aeceiar r+o <br /> SIDE SETOPGN PLAN CNECN NUMBER <br /> FRONTSETBFCH R[ARSETBACK � ��D <br /> LOT AREA VACANT SITE <br /> FEES VALUATION FEE <br /> USEZONE �_, yEs I,�� NO <br /> (1UILDING <br /> NOOFSiOF1ES aCurANc x0amv[luacu4rts <br /> iYrEO�cOxst euwv pLUM01NG <br /> FIRESPRINKLEPSREO'0 BASEMENT MEGHANICAL _ <br /> srze oF eio�. [1 YES [.-� NO <br /> NEIGNTUMITni10N ADDITIONALPLANCHECK � <br /> pCCUPANGV LOAO FIRE ALAFM REO'D � <br /> OTHEF � <br /> qe�sorv STATE BUILDING SURCHARGE � — <br /> INTRKEBY PIANSAPPROVE�BV CITYOFEVERETT PUBLICWORKS <br /> LOCAL SALES <br /> onre <br /> TAX CODEIS 3105 TOiAL <br />