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APPLICATI�1 FOR CONSTRUC'T�N PERMIT � <br /> TO BE COMPLETED IN BLACK INK—PLEASE PRINT <br /> BU�LDING DEPARTMENT HEATING SYSTEM� ��GAS U ELECTRIC ❑ <br /> 259-8810 <br /> L] DEMOLITION !_I COMBINATION I;� BUILDING ! 1 MECHANICAL f�PLUMBING ❑ SIGN <br /> OWNER MAIL ADOFE55 CITY zlp <br /> PHONE <br /> /�-.'i�. i2VGK/-� vIU(�S- Y�>t/�!�,� �✓ !v'����v l.vfl 4a'U3U 1nG. 77�/ `'� t� <br /> TEHRNT MAIL AOORESS CITY 21P PNONE <br /> ��.— <br /> ARCMITEGTOROESIGNER MLILADDRE55 CITV ZiP PNONE <br /> V;,,���t- HoSs �o ��/� /� <br /> G[NERAICONiRACTOR MAILADOPE�({/ry�,� //J� iY ZIP PHONE STAlELICENSEt <br /> �.. . �. ,✓ l __ "l JJ(/I �ln��l /A1� ��9J ���J <br /> MECNANICAtGONTPACTOR MRILADDRESS CItV � ZIP PHONE STRTELICENSE• <br /> PIUMBING CONTRA�:OR MAIL ADORESS C�iV 21P PMONE ST�TE LICENSE t <br /> CONTqq T PRICE OFypyORK <br /> UESC/��AN�SWAREFW�AGERrvOtV�D�� <br /> CONTAGT PERSON AND PHONE NO <br /> 6�/� 2u c%c:v- i�Y-SL S'6 � - '- 7/�J7 <br /> _ i <br /> " � '� i HEREBV CERTIFY THAT I HAVE READ AND EXAMINED THIS <br /> PROPOSED US OFBIIILOING` APPLICATION AND KNOW THE SAME TO BE 1 RUE AND CORRECT.ALL <br /> PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TVPE OF <br /> LEGRLDESCFIPTIONOFPROPEPiY�5H011T:BELOWORATTACMTWOWPIES) WORK WILL BE COMPLETED WI7H WHETHER SPECIFIED HEREIN OR <br /> �or uocK oF NOT. THE GRANTING OF A PERMIT DOES NOT PHESUME TO GIVE <br /> AUTHORITV TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br /> �[��„�� OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br /> PERFORMANCE OF CONSTRUCI�ION. THAT I AM AUTHORIZED BY THE <br /> OWNER GF THIS PROPEfiTY TO PERFORM TH[ WORK FOR WHICH � <br /> APPLICATION IS MADE AND I COMPLY YJITH THE STATE <br /> PARG,L TA%�Ig NUMBER ( CONTRACTURS LAW 18.27 FCW AND 296200 WAC. <br /> /-�'v�t�. „/.� d <br /> CONSTRUCTIONLOANLEN�ER,ADDRESS.iELEPHONENUMBEq <br /> � `�� <br /> PROJECJ�ADDRESS� /� ��runrA�-y"T—'��` ��t�_/� <br /> � � —J) �yO"\ J /f� J <br /> � � "'� �/�/ �� LY(/ CItVPlI5M65lICCN5CN0 <br /> � � PLUMBiNG MECHANIGAL <br /> NO. TVPE OF FIXTURE OR ITEM FEE NO. TYPE OF EOUIPMENT FEE <br /> ! - WATER CLOSET(TOILET) i A/C—A�HNDLG UNITS—H.P. <br /> BATHTUB FORCED AIR SVSTEMS—B.T.U. M E.A. <br /> LAVATORV(WASH BASIN) UNIT HEATERS—B.T.U. M <br /> OWER OTHES DRYERS <br /> KIT N SINK 8 DISP � VE ILATION FAN <br /> DISHWA ER RAN� OOD � <br /> � <br /> LAUNDRY T ; / WATER H TER <br /> I CLOTHES WASH WOODSTO — <br /> URINAL METAL FIREPLA (WOOD BURNING) � <br /> DRINKING FOUNTAIN i ,;3 FIREPLACE INSERT <br /> � FLOOR DRAIN ' H6AT PUMP <br /> /�V BACKFLCW PREVCNTERS � GAS PIPING <br /> ROOF DRAINS—RAINLEADERS EXHAUST FAN <br /> SINK(SERVICE--9AR,ETC.) � i <br /> i — <br /> i <br /> (ifT*+- <br /> '_ <br /> SUB TOTAL $ SUB TOTAL $ <br /> PERMIT $ PERMIT $ <br /> TOTALFEE $ TOTALFEE $ <br /> FOR OFFICE USE ONLY: �03d�!v3 I <br /> FRONT SETBACI< REAR SETBACN SIOE SETBAGR PLAN CMECN NUMBER 4 ff RECEIPi NO 1 <br /> '� �i0 _ '�v�e�v ,�OJa�� � <br /> USE20NE LO7AflEF yA�pNT51TE FEES VAIUATION FEE <br /> ❑ YES i i NO T— <br /> BUILDING -� �a ;`,-� <br /> TYPEOFCONSi. NO.OFSTORIES Ouuv�xcr x0aovrtwx�u.m5 <br /> — � po�� I pLUM81N6 . .�� <br /> 52E�9LOG FIRE 5 RMNLERS REO'D BASEMENT — <br /> � a sr � ❑ YES ��NO MtCHANICAL - <br /> a <br /> OCGl1PANCY LOAO FlR[A RM PE�'0 HEIGH7 LIM17ATION ADDITIONAL PLAN CHECK g� ; .� <br /> � .�, � <br /> REASON OTHER � . <br /> ���-�� ;�� _ � ) <br /> STATE BUILDING.^�URCHARGE �O <br /> INTAKEBY P�pNSAPPROVEDBV CITYCFEVERETT PUBLICWORHS � <br /> ^� � LOCAL SALES dL ;� <br /> on.e� �� ��3 TA%G�^°IS 3105 TOTRL <br /> _ <br />