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APPLICATIC 1 FOF� CONSTRUCT_ �N PERMIT � <br /> TO BE COMPLETED IN BL.4CK INK—PLEASE PRINT <br /> HEATING SYSTEM: ❑GAS ❑ELECTRIC ❑ <br /> BUILDING DEPARTMENT <br /> 259-8810 <br /> f� DEMOUTION ! 1 COMBINATION I 1 BUILDING I_1 MECHANICAL [ 1 PLUMBING �i SIGN <br /> pµRlER MAILADORE55 / LITY ZIP PHONE <br /> /l <br /> �(l�cj��� Gr'� ��� 7 ✓�SO�K ����rax 9 �zo3 <br /> TENI.NT� MAIL qpDRESS � CIiY 21P PHON[ <br /> G�[! C!% N % <br /> AP.CHITECTORpESIGNER MAILADDFESS GTV 21P PHONE <br /> GENERAL CO'iTqqCTOR MqIL pD�RE55 CIiV ZIP PMONE TE IICENSE� <br /> ��.�� �> -:���,p f��, �-o��- e�>��� �� �� ��r��z� �i �n�AC�z�3 -�.� <br /> MECMRNICAL CONT AGTOR MFII�D�RE55 Cltt ZIP PMONE ST�TE LICENSE� <br /> PWM6INGCONTRACiOR MRILAODRESS QTV ZIP PMONE STATELICEIAE� <br /> /r /o 'Io�T <br /> �O.e �'rR r-e P�oy�c�-1 i� 3v - (ob cu k: n..xJ 1.�o2�Ao �C' ' <br /> Cd�JRALT PPICE OF W09K <br /> yi�� <br /> DESGRI9E WORK�ND SOUARE FOOTAGE INVOLVED CONTACT PERSON FND PMONE N0. <br /> i HEREBY GERTIFY THAT I N.4VE 7EAD AND EXAMINED THIS <br /> PROPOSED USE OF�UILOING APPLICATION AND KNOW THE SAME 7"O BE TRUE AND CORRECT.ALL � <br /> PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br /> LEGALDESCRIPTIONOFPqOPERTYISHOWNBELOWORATiACNTWOGOPIES) WORK WILL BE COMPLETED WITH WHETHER SPECiFIED HEREIN OR <br /> NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br /> ioT B�cxK oF --- qUTHORITV TO VIOLATE OR CANCEL THE PFiOVISIONS OF ANV <br /> OTHFR STATE OR LOCAL LA'JJ REGULATING CONSTRUCTION OR THE <br /> PERFORMANGE O�CONSTFUCTION.THAT 1 AM AUTHORRED BY THE <br /> OWNER OF THIS PROPERTY IU PEPFnRM THE WORK FOR WHICH <br /> APPIICATION IS MADE AND I COMPLY WITIi THE STATE <br /> PRRCEL TA%I U.NOMBER CONTRACTORS LAW 1827 RCW AND 296200 WAC. <br /> CONSTRUCiION IORN lENOER.RPDRESS,iEIEPHONE NUMBER <br /> � <br /> PAOJECT ADDRESS s�cH�roae / ��*��_�' <br /> GiY BUSMESS LILFNSE NO <br /> PLUM8ING MECHANICAL <br /> N0. TYPE OF flXTURE OR ITEM FEE NO. TYPE OF EOUIPMENT fEE <br /> / WATFR CLOSET(TOILET) A/C—AiHNDLG UNITS—H.P. � <br /> BATHTUB FORCED AIR SYSTEMS-6 T.U. M E.�. <br /> LAVATORY(WASH BASIN) UNIT HEATERS—B.T.U. M <br /> SHOWER CLOTHES DflYERS ' <br /> KITCHEN SINK&�RP VENTILATION FAN <br /> DISHWASHER RANGE HOOD <br /> LAUNDRY TRAY ' WATER HEATER <br /> CLOTHES WASH[R WOODSTOVE <br /> URINAL i METAL FIREPLACE(W�10D BURNING) ' <br /> DRINKING FOUNTAIN FIREPLACE INSERT <br /> FLOOR DRAIN HEAT PUMP ' <br /> BACK�LOW PREVENTERS ; GAS PIPING _ � <br /> ROOF DRAINS—RAINLEADERS —� _ EXHAUST FAtJ <br /> SINK(SERVICE—BAR,ETC.) .. _ � <br /> � <br /> — � � <br /> � <br /> SUBTOTAL 5 ��' SUBTOTAL $ <br /> PERMIT S 2� PERMIT $ <br /> TOTAL FEE $ S� � TOTALFEE $ <br /> FOR OFFICE USE ONLY: <br /> FRONi SETBACK PF.AR SETOACK SI�E SETBACK PUN CM K N�BE� FEF PECEIPT NO. <br /> 3 � <br /> usexor+e �otnnen vacnNrsire FEES VALUATION FEE <br /> i I YES ❑ NO BUILDING <br /> iVPFOiCONSi. NOAFSTORIES Otcu^arvw �+OW�vrtu�xGuxnc -- <br /> cAour PLUMBING <br /> SRE OF BLDG. fIR[SPFINNLERS REO'0 BASEMENT MECHANICAL <br /> r'�. YES '�� NO <br /> OCCUPANGV LOAD FIRE ALARM REO'0 MEIGN7 LIMITATION AD�ITIONAL PLAN CHECK � <br /> i <br /> O7HER i <br /> --T <br /> REASON <br /> STATE BUILDING SURCHARGE <br /> — i <br /> iNiANEBY PUNSRPPPOVEDBY CITYOFEVERETT PUBLICWORK$ <br /> LOCAL SALES � <br /> oA,E TAX CODE IS 3105 TOTAL <br />