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APPLICATIC�I FOR CONSTRUCT' 1N PERMIT � <br /> TO BE COMPLETED IN BLACK INK—PLEASE PRINT <br /> BUILDING DEPARTMENT HEATING SYSTEM: J GAS [J ELECTRIC ❑ _� <br /> 259-8810 <br /> f�' DEMOUTION IY COMBINATION ! 1 BUILDING I_I MECHANICAL [J PLUMBINi; I SIGN <br /> OWNER M41LApDRE55 GTY ZIP PHONE <br /> C-w�,-� �) USr,�i' z,,ov vi�r�� pc��' E �i=�P'rr 98ur Ls9-ic3s <br /> TENRNT MAIL A�URESS CITY 2iG PHONE <br /> ARCHITECTOROESIGNER M4ILADDRE55 CITY ZIP PMONE <br /> GENEFAL CONTFACTOR MqIL ADORE55 pTV ZIP PNONE STATE UGENSE� <br /> (l//���14f Go�sY 2 I�L N�!-tir.�rn 9�r r�1-`�tT�� /-T `% Kt,' i L,i�--� til� N�V3.9c,y L3ooy <br /> MECNANIC/LCONiNACTOR MAILADDRE55 CITV ZIP PHONE STATEUCENSE• <br /> PLUMBING WNTq�LTOR MAIL RDORESS CITV 21P PMONE STATE LICENSE� <br /> 0/� v�� 1 Fkvl , p[„ � �� on• ;iQ �-S9 t98� p v S.!' I6S 6 <br /> CONiRAGT PRICE OF WOFN <br /> 39s �- <br /> OESCRIBE WORK AND SOUARE FOOT�GE INVOLVED GONiACi PERSON AND PHONE NO <br /> f�9r,� w�e...S Fi>� �9R,eY r/�U3a�.� z�1'7vsc <br /> J'FMr� /k�h !N EkrSl'iy_ s'�,i- -�r�S��!" <br /> G,��SFM/s�./; I�E P6ACE TDI �ET �-P� /9SF(' �t?�Q I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br /> PPOPOSE�7 USE OF BWIDING APPUCATION AND KNOW THE SAME TO BE TRUE AND CORREC'i.ALL <br /> /'-F 3!pl�r� PROVISIONS OF IAWS AND ORDINANCES GOVERNING 7HIS TYPE OF <br /> LEG4LDESCRIPTIONOFPROPERTV�SNOWNBELOWORRTfACHTWOCOPIES� WORK WILL BE COMPLETED WITH WHETHER SPEGFIED HEREIN OR <br /> NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br /> �ot eiocK ov AUTHOR'TY 'f0 VIOLATE OR CANCEL THE PROVISIONS OF ANY <br /> OTHER STATE OR LOCAL lAW REGULATING CONSTRUCTION OR THE <br /> PERFORMANCE OF CONSTRUCTION.THAT I�M AUTHORIZED BY THE <br /> O\NNER OF THIS PROPERTV TO PERFORM tHE WORK FOR WHICH <br /> APPLICATION IS MADE AND I COMPLV WITH THE STATE <br /> PARCEL TAX 10 NUM�ER CONTRACTORS LAW 18.27 RCW AND 296.200 WAC. <br /> �3J 00� !,o/ 00�� <br /> CONSTRUCTIONLOANLENDEH.RDDRESS.TELEPHONENUMBEB ' ` ��� <br /> ,� �V <br /> PROJECT ADDRESS�Oa �, _ / /_ /` ��' sicrv�mnc — o�ie 7�b�y <br /> (.JfO � btVPV5MF55LICENSENO <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FU(TURE OR ITEM FEE N0. TVPE OF EOUIPMENT FEE <br /> WATER CLOSET(TOILET) A�C—A/HNDLG UNITS—H.P. <br /> BATHTUB FORCED AIR SYSTEMS—B.T.U. M E.A. <br /> LAVATORY(WASH BASIN) UNIT HEATERS—B.T.U. M <br /> SHOWER CLOTHESDRYERS � <br /> KITCHEN SINK 8 DISP VENTILATION FAN <br /> DISHWASHER RANGE HOOD <br /> LAUNDRYTFlAY WATER HEATER <br /> CLOTHES WASHER WOOD STOVE <br /> URINAL ' METAL FIREPLACE(WOOD BURNING) <br /> DflINKING FOUNTAIN � FIREPLACE INSERT <br /> FLOOR OfiAIN HEAT PUMP <br /> BACKFLOW PREVENTERS i GAS PIPING ; <br /> (700F DRAINS—RAINLEADERS EXHAUST FAN - <br /> SINK(SERVICE—BAR.ETC.) <br /> --r— <br /> i <br /> i <br /> SUBTOTAL $ SUBTOTAL $ <br /> pEq�,�;r g T— PERMIT $ <br /> TOTAL�EE $ TOTAL FEE 5 <br /> FOR OFFICE USE ONLY: <br /> FRONTSETAACN RERRSETOnCR SIDESET9AGN PLANCHECKNIy�pqEq FEE RECEIPiNO <br /> r /i/�/ � <br /> "> Y d a'-� <br /> usezor+e LOTAREA vncnNrsire FEES VALUATION FEE <br /> J YES � N� OUILDING <br /> iVFEO(LONST NO.OFSTORIES tttuP�va NO.O�C+nuhcu5u — <br /> caour PLUMB�NG <br /> SREOFBLOG. FIRESPpINNLER55W'D BASEMENT MECHANICAL � <br /> C YES ❑ NO <br /> OCCUPANCV L04D FIqE 4L4PM RE00 H[IGHT IIMITATION ��OITIONAL PLAN CHECK i <br /> OTHER <br /> nEA50N —� <br /> STATE UUILDING SURCHARGE i <br /> INTANFBV PLANSAPP�O�DOV CITYOFEVERETT PUBLICWORKS <br /> LOCAL SALES <br /> oATE �, /�/�if TAX CODE IS 3105 TOTAL <br /> 1/ <br />