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APPLICATIQ�I FOR CONSTRUCT��N PERMIT � <br /> TO BE COMPLETED IN BLACK INK—PLEASE PRINT <br /> BUILDING DEPARTMENT HEA7WG SYSTEM: �GAS U ELEC7RiC G <br /> 259-8810 <br /> I I DEMOLITION I:l COMBINATION ❑ BUILDING I_;MECHANICAL C 1 PLUMBING l 1 SIGN <br /> OWNER MFIL RDDNE55 CITY 21P PMONE <br /> %//11 �c'Hl�f,^4�1s 5'/i q UrQd C�'/' [3/ �zv? Ls�3-ZS�? <br /> TENANi MAILADDRESS CITY ZIP PMONE <br /> ARCNRECT OR DESIGNER MAIL ADDRE55 GTY ZIP PNONE <br /> GENER�LGONTRRCTOR M�ILRODFE55 GITY 21P PNONE SUTELIGENSEI <br /> MECHANIC�L LONTRRGiOR MAIL ADOB@55 GTY ZiP PHONE ST�iE LIGENSE• <br /> �c.i�s%u��' S% .�N�zr .�l z�7.+7G /6//C /Jl�+,t/dt�//c�r�/L t?i 252"7//Y E//�.Z'l55'/21fi7 <br /> PLUMBING GONTRALTOR M�IL PDDRE55 CITY ZIP PNONE ST�TE LICENSE� <br /> CONTHALT PPIGE OF WORK <br /> Z 6av. ov <br /> DESCPIBEWORKANDSOUAREFOOIAGEINVOlVEO GONTAGTPERSONPNDPNONENO. % —L ' � <br /> i+F a � [t. � '�l <br /> G <br /> I HEREBV CERTIFY THAT I HAVE READ AND EXAMINED THIS <br /> PR01'OSEOUSEOF BUiLDING APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT.ALL <br /> LEGA�J G PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TVPE OF <br /> �PTIONOFPROPERTY�SNOWNBELOWORATiRCHTWOCOPIES) WORK WILL BE COMPLETED WITH WHETHER SPEGFIED HEREIN OR <br /> NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br /> �oT BLOGN oF AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANV <br /> OTHER STATE OR LOCAL LAW REGULATING CONSTFiUCT10N OR THE <br /> PERFORM17ANCE OF CONSTIIUCTION.THAT I AM AUTHORIZED BV THE <br /> OWNEH OF THIS PROPERTY TO PERFORM THE WORK FOR WHlCH <br /> APPLICATION IS MADE AND 1 COMPLV WITH THE STATE <br /> PANCEL TP%I D.NUMBER CONTRACTORS LAW 78.27 RCW AND 296200 WAC. <br /> CONSTRUCTIONIOANLENDER.�UDRE55.TElEPHONENUMeER 'L+,'�// �J� 7 '�! "9�/__ <br /> �� si <br /> PROJECT ADDRESS s�"„°pE °"t� <br /> UiV pOS�N[SS lK[Nti[NO <br /> PLUMBING / MECHANICAL <br /> NO. TYFE OF FIXTURE OR ITEM FEE NO. TYPE OF EOUIPMENT FEE <br /> WATER C�OSET(TOILET) A/C—lvHNDLG UNITS—H.P. <br /> BATHTUki FORCED AIR SYSTEMS—B.T.U. M E.A. <br /> LAVATOFY(WASH BASIN) UNIT HEATERS—B.T.U. M <br /> SHOWER f,LOTHES DRYERS i <br /> KITCHEN SINK 8 DISP � VENTILATION FAN � <br /> DISHWASHER � RANGE HOOD ' <br /> LAUNDRYTRAY / WATER HEATER <br /> CLOTHES WASHER WOOD STOVE <br /> URINAL i METAL FIREPLACE(WOOD BURNING) <br /> DRINKING FOUNTAIN � FIREPLACE INSERT � <br /> FLOOR DRAIN HEAT PUMP ' <br /> BACKFLOW PREVENTERS ; Z GAS PIPING <br /> � ROOF DRAINS—RAINLEADERS � EXHAUST FAN - <br /> SINK(SERVICE—BAR.ETC.) � � <br /> � <br /> � I <br /> SUB TOTAL $ SUB TOTAL $ <br /> PERMIT $ ' � PERMIT $ <br /> TOTALFEE $ TOTALFEE $ <br /> FOR OFFICE USE ONLY: <br /> RECEIPT NO <br /> FRONi5E18AGN NEnRS[ID�CN SIDESE:BALK PIANCM�N U�BER FEE <br /> IISE 20NE LOT PRER <br /> VACANTSIIE FEES VALUATION F��_ <br /> ❑ YES ❑ NO BUILDING <br /> TYPEOFCON57. NO.OFSTORiES occuv�xa xoawnwepuxns <br /> 4PD1P PWMBING <br /> SIZEOFBLW. FlRESPRINKL'RSREO'D BASEMENT MELHANICAL <br /> ❑ YES ❑ NO ; <br /> OCCUPANCVLOAO FIREALARMREOD HEIGHiLI611TATION <br /> ADDITIONAL PLAN CHECK <br /> OTHE(1 �_ <br /> FEASON <br /> STATF I'�� ..i SURCHARGE <br /> INTANEBY PUNSAPPROVEOBY CITYOFEVERETT .��cwoRKs <br /> LOCAL SALES <br /> DFTF <br /> TAX CODE IS 3105 70TAL <br />