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APPLICATIt�"'1 FOR CONSTRUCT"�N PERMIT � <br /> TO BE COMPLETED IN BLACK INK—PLEASE PRINT <br /> HEATING SYSTEM:Xj GAS ❑ELECTRIC ❑ <br /> BUILDING DEPARTMENT <br /> 259-8810 <br /> ;� DEMOLITION Ll COMBINATION L] BUILDING ECHANICAL �PLUMBING Cl SIGN <br /> ONTIER RILADDiiE55 GITV ZIF PHpNE <br /> �, 'l�� � ,� �i� LrJe�D,�� �e,-�'—r� � �53- 8'�i/ <br /> TENANT M ILADDRESS CITV 21P �HONE <br /> ARCHITECT OR DESIGNER MAIL ADLFESS CITY ZIP PHONE <br /> GENENALCONTPACTOR MAIL�DDRESS GTY 21P PHONE STATELIGENSE• <br /> MECHANICALCONTRACTOR MFILADORESS LITY ZIP PMONE SiATELIGENSE• <br /> LYD,i'}C�ST �`^�QC5��0.�� ���� Z�P PHONE STRTEUGENSE� <br /> � /aaa � — <br /> ONTRACiP� � <br /> 1 <br /> OE RIBE ORN SOUARE FOO7RGE INVOLVEO CANTACT PERSON AND PHONE NO. <br /> T <br /> � i HEREBY CERTIFY THAT I HAVE flEAD AND EXAMINED THIS <br /> PROPOSED USE Of BUILDING APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECL ALL <br /> PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br /> LEGIILDESCRIPTIONOFPROPEFTY�SMOWNBELOWORATTACHTYOCAFIES� NOT. THELGRA T�ING OF A PERMITJDOES NOT PR'ESUME TO GNE <br /> � �oT PLOCK oF AUTHORITV TO VIOLATE OR CANCF.L THE PROVISIONS OF ANY <br /> OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br /> PERFORMANCE OF CONSTRUCTION.THAT I AM AUTHORIZED BY THE <br /> OWNER OF THIS PROPERTV TO PERFORM THE WORK FOR WHICH <br /> I APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> PAPCEI TA%1 p.NUMB'cH CONTPACTORS LAW 7827 RCW AND 296200 WAC. <br /> �pN$TRU�ONLO�S�. 1\ESS.TEQ LEPHONENUMBER N�7 // 'L , <br /> �� i lJi qE^�A ��� DATE � <br /> �HOJEC�ADWiESS — <br /> CILY BUSME55 UGFMSC Iq <br /> ��8�� MECHANICAL <br /> Np. TYPE OF fll(TURE OR ITEM FEE NO. TYPE OP E�UIPMENT �E <br /> WATER CLOSET(TOILET) � Al�: NNDLG UNITS—H.P. <br /> BATHTUB ; FORCED AIR SYSTEMS-B.T.U. M E.A. <br /> LAVATORV(WASH BASIN) UNIT HEATERS—B.T.U. M � _ <br /> SHOWER � CLOTHES DRYERS ' <br /> KITCHEN SINK 8 DISP VE4TILATION FAN � <br /> DISHWASHER � flANGE HOOD �� <br /> UUNORY TRAV ; WATER HEATER <br /> CLOTHES WASHER WOOD STOVE ' <br /> URINAL METAL FIREPLACE(WOOD BURNING) ' _ � <br /> DRINKING FOUNTAIN FIREPLACE INSERT . <br /> FLOOR DRAIN HEAT PUMP � <br /> BACKFLOW PREVENTERS ; GAS PIPING � <br /> ROOF DRAINS—RAINLEADERS � EXHAUST FAN <br /> SINK(SERVICE—BAR,ETC.) <br /> � <br /> � ' <br /> SUB TOTAL $ ' SUB TOTAL $ ' <br /> PERMIT $ PERMIT S <br /> TOTALFEE $ TOTALFEE $ <br /> FOR OFFICE USE ONLY: neceiar r�o <br /> FRONT SETBACN REAR SETBACN SIDE 5[TBACK PLAN CHECK HU�C FEE <br /> y=� .� <br /> U3EZONE lOTAREA <br /> VFCANTSITE FEES VALUATION FEE <br /> l:l YES � N� BUILDINCa � _ <br /> iVPE Of LONS. NO.OF STOFIES pccuowtv xa 0�wrtuweuxns � <br /> �"�ryj° PLUMBING ' <br /> SIZE OF BIOG. FIRE SPRINNlERS REO'D B�SEMENT MECHANIGAL <br /> ❑ YES C NO ; <br /> OCLUPANGY LOAD FIRE AIARM REOD MEIGHT L'MIiAT1011 <br /> ADDITIONP.L PLAN CHECK _ <br /> OTHER <br /> REASON � <br /> S1ATE BUILDING SURCHARGE <br /> INTRKEBY PLPNSAPPROVEDBV g�r(OFEVERETT PUBLICWORKS <br /> LOCAL SIILES <br /> op,E TAX COUE IS 3105 TO7AL <br />