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APPLICATIO� _ FOR CONSTRIIC7�I,�;N PERMlT � <br /> TO BE COMPLETED IN BLACK INK—PLEASE PRINT <br /> BUILDING DEPARTMENT HEATING SYSTEM: p�GAS `�ELECTRIc: ;J _ — <br /> 259-8810 <br /> i_l DEMOLITION � ' COMBINATION I ' BUILDING I I MECHANICAL I PLUMBING ' SIGN <br /> O�WNER,rtr� �� IAAiLADDPESS CI7V /��P I P110NE <br /> A��( c 7tcvt�� (_i1�b<�^�— STZn (.1.7i�l�vt�in„�c.l�l L,/Ucrc.E7 �.tl�., o?}Z �{2yU _ <br /> 1�NT MAI p00R[55 � Z�P PHONE <br /> ARCNIi6CTOROESiGNER I.IAiLqD�RE55 CITV ZiP PMOqE <br /> �(s,��rn� — <br /> GENERPLCO. CTOR lANLAOOqESS CRY ZIP PMONE ST�TELICENSE• <br /> F' G/ U i t'i�l Il� ���J� , <br /> h1ECNANICPLCONiR . tdAIL�GORE55 CITY ZIP PMONE StATEIICENSE� <br /> PLUMBINGCONTRACTOR MNLADDRESS CITV ZIP PHONE STAiELICENSEt <br /> �CUNTRPCTPRIC O�WORk <br /> SGT�1�� <br /> DESCRIE[wORN AND SOUARE FOOT�GE INVOLVED CONTACT PERSON AND PMONE N0. <br /> � I ��� __ <br /> '` /G` 1'�'1 �I/L L I HEREBY CFRTIFY THAT I HAVE READ AND E%AMINED THIS <br /> PROfPOSIED USE OF,BUIIUING APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT.ALL <br /> LEGA�[scni�io ocraoeenrrisNowNaeiowoanrmcNTwocoriesi WORKSWILL EFCOMPLETE�D WIDTIH WHET EFS ECN ED EREN OR <br /> NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br /> �or /(�e�a:n oF AU7HORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br /> Cy�'"'_.___ � �LC d( c,� I� VE OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br /> PERFORAIANCE OF CONSTRU(:TION.THAT I AM AUTHORIZED BY THE <br /> � 1 1\ OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br /> APPLICATION IS MADE AND I COMPIY WITH THE STATE <br /> Peaee�raa i.o Nuueea CONTRACTORS LAW 1827 R W 296200 WP.C. <br /> / <br /> CON i AN L 1DE .AD RES T�L�yy=N�MBER � � <br /> /� / // <br /> Vfj — <br /> $IGN Vf1E 0��� <br /> �P CT ADD SS /� ` <br /> ���. �A(�l� t�^ �Ul. �UY w� " cnrnusm[ssii. usc.rx+ <br /> � PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM FEE NO. TYPE OF EOUIPMENT FEE <br /> WATER CLOSET�TOILET) A�C—NHNDLG UNITS—H.P. <br /> BATHTUB FORCED AIR SYSTEMS—B.T.U. M E.A. <br /> LAVATORY�WASH BASIN) UNIT HE�TEPS—B.T.U. M <br /> SHOWER CLOTHES nRYERS � <br /> KITCHEN SINK 8 DISP VENTILATION FAN _ � <br /> �'_ <br /> DISHWASHER � RANGE HOOD <br /> LAUNDRY TRAV � WATER HEATEA _�__ <br /> CLOTHES WASHER WOOD STOVE <br /> URINAL METAL FIRcPLACE(WOOD BUfiNING) <br /> DRINKING FOUNTAIN FIREPLACE I�SERT � <br /> T <br /> FLOOR DRAIN � HEAT PUMP ' <br /> BACKFLOW PPEVENTERS GAS PIPING <br /> ROOf DRAINS—RAINLEADERS EXHAUST FAN <br /> SINK�SERVICE—BAR,ETC.) ._ <br /> i <br /> _"T___ <br /> SUBTOTAL S SUBTOTAL S _ <br /> PEPMIT 5 � _ PERMIT S <br /> TOTAIF�E[ 5 TOTALFEE S <br /> FOR OFFICE USE ONLY: <br /> FRONTSETBACK RE4NSETBACK SIOESETBACK �LANCHEC Nt11PER FE@ REC[IPTNJ. <br /> r 3�ro �-- <br /> useio!.- iotnaen VACANTSITE FEES VALUATION FEE _ <br /> . YES ��� NO BUILDING ��� �-�� _ <br /> iVPEOfWNSi NO.OFSTORiES o¢wnu 'mo:owuuxcux:s <br /> �`"'b° PLUMBING <br /> SIZEO��IDG FlRESPPiNKLERSREO� F3ASE1dENT MECHANICAL� <br /> , YES �,-1 NO — --- <br /> OCLUPAYCVLO�D FlRE4LAAMREOD NEIGNTLItAITAT10N ADDIiIONALPLANCHECK _ i <br /> � <br /> � OTHCR _ <br /> RFASON <br /> S7ATE dUII.DING SURLHARGE / ��l�� <br /> iYiAKE�Y PL�NSAPPROVEOBY CITYOFEVERETT PUBLICWORKS <br /> LOCAL SALES <br /> oa,e TAX CODE IS 3705 Tora� <br />