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APPLICATIQ ! FOR CONSTRUCT' lN PERMIT � <br /> TO BE COMPLETED IN BLACK INK—PLEASE PRINT <br /> BUILDING DEPARTMENT HEATING SYSTEM: J GAS ❑ELECTRIC J <br /> 259-8810 � <br /> I 1 DEMOLITION L ! COMBINATION f ' BUILDING iJYMECHANICAL ;!PLUMBING �i SIGN <br /> OWNER IAAILAODRE55 CIiY ZIP PMONE <br /> c��.����ai.4,P S �� S�v�c� �� re vetiT � G-S��SH 9�:�Q -� , <br /> TENANT MAILApDRE55 QTV ZIP GNONE <br /> �' 9�� �'097 <br /> ARCHITECT OR DESIGNER MAIL A�DRESS LITY ZIP PHONE <br /> GENERALGONTRACTOR MRILADDRE55 CITV ZIP PMJNE STATELICENSE/ <br /> MECH CRLCONTPAGTOR MAiI�_�qE55 CITV ZIP PMIN�E STATEUCENSEI <br /> W� <br /> ❑WMBINGCONTRACTOR AIqILq00RES5 qTV IIP PNON[ STRTE4CENSE� <br /> CONTFACT PPICE OF WORN <br /> DESCRIBE WORN AND SOOARE FOOTAGE INVOLVE� CONTALT PERSON AND PHONB N0. <br /> � ) <br /> lt C�/ <br /> i H�AEBV CERTIFY THAT I HAVE READ AND EXAMINED THIS � <br /> PROPOSE�USEO'BUILOING APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT.ALL <br /> S v PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br /> LEGALUESCRIPTIONOFPROPERTV�SHOWNBELOWORATTACHTVOLOPIES� WOPK WILL 8E COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br /> iot aiocH �� _ NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br /> AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANV <br /> OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br />' PERFORMANCE OF CONSTRUCTION. THAT�AM AUTHORIZED BY THE <br />� OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br /> APPLICATION IS MADE AND I COMP�Y WITH THE STATE <br /> I reqee�Tnz i o.rvuMeea CONTRACTORS LAW 78,27 RCW AND 296.200 WAC. <br /> CONSTRUCTIONLORNLENpER.ADDRESS,TELEPHONENt1M0[R <br /> 1DL� /� // <br /> . G�I//f�CC-r� 1 ����y— <br />� PROJECT ADDRES'S] /' p) //��� � s�o r � wrz <br /> � O� L^��'S� '� ✓ Ci1vBo5M[65liCFN5LN0 <br /> PLUMBING MECHANICAL <br /> NO. TYPE OP FUCfURE OR ITEM FEE NO. TVPE OF EOUIPMENT FEE <br /> WATEP CLOSET(TOILET) A,'C—A'HNDLG UNITS—H.P. <br /> BATHTUB FORCEDAIRSVSTEMS—B.T.U. M E.A. <br /> LAVATORY(WASH BASIM) � UN11 HEATERS—B.T.U. M ; <br /> SHOWER CLOTHESDRYERS �— <br /> _ KITCHEN SINK&DISP VENTILATION FAN � <br /> DISHWASHEF RANGE HOOD T <br /> LAUNDRV TRAV WATER HEATER <br /> CLOTHES WASHER WOOD STOVE <br /> URINA� METAL FIREPLAGE(WOOD BURNMG) <br /> DRINKING FOUNTAIN FIqEPLACE INSERT <br /> FLOOR DRAIN HEAT PUMP <br /> BACKFLOW PREVENTERS GAS PIPING <br /> ROOF DRAINS—RAINLEADERS EXHAUST FAN <br /> SINK�SERVICE—BAR,ETC.) <br /> � � <br /> SUB T��TAL � SUB TOTAL $ ' <br /> PERMIT $ � PERMIT $ � <br /> TOTAL FEE 5 TOTAL FEE $ <br /> FOR OFFICE USE ONLY: <br /> FqONT SETBACK RE�R SETBACK SiDE SETBACK PLAN CNECK� 61BEP FEE R[CEIPi NO <br /> L��� <br /> use zor+e �oT aqen vnenNi srte fEES VAWATION FEE <br /> ��. VES � NO BUILDING <br /> 1YPE Of CONSi. NO OF STORIES occunn�cv qn cr p�x�o ir�s ix,�5 <br /> G�r��;� pLUM81NG <br /> SREOFBLDG. fIRESPqINKLER5PE00 PnSEMENi MFCHANICAL i <br /> � �. VES � NO — <br /> � <br /> OCCIIPANCVL0A0 FlRGALqRMR[00 HEIGHTLIMItATiON ADDITICNAL!'LANCHECK � <br />� OTHER <br /> HE450N — <br /> STATL BUILDING SURCHARGF. <br /> INLqKEOV Pl/.NSAPPPOV[�BY CITYOFEVERETT PUBLIGWORK$ <br /> LOCALSALES ' <br /> onte TAX CODE IS 3105 rora� <br />