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APPLi�ATIC'1 FOR CONSTRUCT`1N PERMIT � <br /> TO BE COMPLETED IN BLACK INK—PLEASE PRINT <br /> BUILDING DEPARTMENT HEATING SYSTEM: ;J GAS ❑ELECTRIC !J <br /> 259-8810 <br /> (_1 DEMOLITION f i COMBINATION !� 6UILDING �MECHANICAL I"yPLUMBING I SIGN <br /> ��v R MRILADDRESS �IiY �ZI9 PHONE <br /> a-� �i,.�, � �c%7 ��c,�er�vP �vcr���(/a y�'�e/ ��4� .�s 2 - 3��8�� <br /> TEJANi �— �AAILADDRESS CITV ZIP PHONE <br /> ;�CMITECT OF pE51GN q MAII ADDRE55 CITV �/ �21p PNONE <br /> J��Iq �, ��H�e, !1/) ��.k'n 51 fv�'o�/ /�/r� l��"3 �z��) 3S3—GS3/ <br /> GE RALC TRAGTOR MRILAD�RESS CITY IP PHON STATEIICENSE� <br /> -�LCU 9�oy /y ��'�vP .� �/e�'�� �a 5'�'d�S� ��GJ �.j8'-l�6�/ . <br /> MECHqNICRL C.ON7R TO AIL ADURES CItY ZIP PMONE STRTE UCENSE t <br /> ,�;s�.��.��.,p F .�C'. <br /> PlU�" 'f C�y TRALTOR J�p �RE55 CITV ZIP PHONE STATE LILENSE� <br /> _ �rgce/inP ���.,.dlwS <br /> crr�l —�PpICE OF WORN <br /> � `Yd "� � cF!-Z <br /> OESCR�Wc�9K D SQ�J�AR�On1iGE INVGLVED ` CONi EI N ANO P ONE l . <br /> i�r Y x� �s;� e„cP f� .?�X�/S 6y <br /> �� /��rv �, /��f' �z.�✓ d�•:/�... <br /> ���J• .J �9//'Z�'MS /��J/�r/JJ,{q �[�JLjh �M. I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br /> aao o use oF uaoiNc ^ / � APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECL ALL <br /> �C.S� �stL-� ' si�( f 1-�i/H//�J PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TVPE OF <br /> LEGAIDESCRIPiIONOFPROPERTY�SNOWNB OWORATT�CHTWOCOPIE �— WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br /> �or BIOGN oF NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br /> AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br /> OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br /> PERFORAIANC�OF CONSTRUCTION.THAT I AM AUTHORIZED BY THE <br /> A��/9� � � OWNER OF THIS PROPERTV TO PEPFORM THE WORK FOR WHICH <br /> APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> vnRce�rnx i.o.Nurneea CONTRACTORS LAW 1B27 RC1V AND 296200 WAC. <br /> � 3 vc�3 csoc� <br /> CONSTRU TION LOAN LEN�ER.ADO ESS.T LEPHONE NUMBER ! / /],. <br /> 4 n � .:, � � tYC'/ L"' X_ � � !1 �._i�-�/� � 'o�/ �/% <br /> PROJEC D SS / D / sicNnunc <br /> / � /�'lGo+llS {J!'AhC/7 o.rz <br /> �� �� urvouswcssuceNs�r�c <br /> PLUM IN6 MECMANICAL <br /> NO. TVPE OF FUCTURE OR ITEM FEE NO. TYPE 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 CLOTHES DRYERS � <br /> KITCHEN SINK 8 DISP VENTILATION FAN ' <br /> � <br /> DISHWASHER RAN(iE HOOD �— <br /> LAUNDRVTRAY WATER HEATER � <br /> CLOTHES WASHER WOOD STOVE ; <br /> URINAL METAL FIREPLACE�WOOD 13URNING) <br /> DRINKING FOUNTAIN FIREPLACE INSERT <br /> FLOOR DRAIN HEAT PUMP � <br /> BACKFLOW PREVENTERS GAS PIFING <br /> ROOF DRAINS-RAINLEADERS � EXHAUSI FAN <br /> SINK(SERVICE--BAR,ETC.) ' c vG /n � <br /> C ! : � <br /> .+� Z. �• rr �� <br /> T— —�— <br /> SUB TOTAL $ SUB TOTAL S <br /> PERMIT 5 PERMIT S <br /> TOTALFEE $ ' TOTALFEE $ <br /> FOR OFFICE USE ONLY: <br /> FRONT SETBRGN / REAP SETBACH SIDE SETBACK P;,AN ECK N BER FcE FE EIPt NO <br /> � � 3.�'� �3a �'S �9��i <br /> use zo-e�� toT aqen VACANT SITE _/�, FEES VALUATION FEE <br /> '_: VES ,�!NO BUILOING � 2 �Z � � = <br /> TYPfOiCONSi. NOAFSTORIES ocqnr,xr NottoxTwva�N�ti — i <br /> _ 2 cao� � PLUMAING 2� <br /> SIZ[OF BLOG. FIRE SPRINKLERS REO'D BASEI.yIE T MECHANICAL /�i <br /> Z .sf. DGtil t?�c/ES ...'- NO — - � <br /> OCCUP`AN'CYIORD FIFEAL�RMPEOD HEIGMTLIMITAT�J!I <br /> ADDITIONAL PLAN CHECK � <br /> � /�Y A /J � � + ' <br /> OiHER <br /> REASON �� ���� --� � <br /> ��� STATE BUILOING SURCHAFGE ;�n <br /> INTAK[BV PLANSAPPROV[DpY CITYOFEVERETT PUBLICWOqKS ^'— <br /> �.II} IOCAL SALES ' <br /> oare 3 9 9 TA%CODEIS3105 T�Tp� C)9�,�� <br />