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APPLICATIC'1 FOR CONSTRUCT`lN PERMIT � <br /> TO BE COMPLETED IN BLACK INK—PLEASE PRINT <br /> HEATING SYSTEM: ❑GAS ❑EIECTRIC 0 <br /> BUILDING DEPARTMENT <br /> 259-8810 <br /> ❑ DEMOLITION I� COMBINATION ❑ BUILDING �MECHANICAL ;1 PLUMBING `.7 SIGN <br /> py�ryEq ,� MRIL aDDBESS .La�= f- GIiY r: 2iP PHONE <br /> T�ty;�� I)cc�C ��/I 1 (.�O_j�]1ntQ /'UQvtf'� IF10 1 � S2 - (�474 <br /> N�NT M�ILAO�RESS CITY 21P PNONE <br /> RRCNITECTORpE51GNER MAILRDORE55 GITY ZIP PHONE <br /> GENENRLLONTR�CTOR MAILaDORE55 CITV 21P oNONE STATELIGLNSEI <br /> MECH�NIGILCONTPAC70R MAILAODFESS GTV Z�P FMONE STRTELICENSFt <br /> V G�,.,v,aY <br /> � PLUMBING CONTR�LTOF NAIL ADORESS QTV ZIP PIIONE STRTE UCENSE t <br /> GONTP�CT PRIGE OF WORN <br /> OESCRIBE WORK�ND SOU�RE FOOT�GE INVOWED CONTAGT PERSON�ND PHON[NO <br /> i �EREBV CERTIFY THAT I HAVE READ AND EXAMINED THIS <br /> PROPOSED USE OF BUILOING AI�PLICATION AND KNOW 7HE SAME TO BE TRUE AND CORRECT.ALl <br /> PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br /> IEGAlOESGRIPTIONOFPROPERTY�SMOWNBELOWORATTACNTWOGOPIES� WORK YVILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br /> NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br /> �oT B�ocN oF AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br /> OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br /> PERFORMANCE OF CONSTRUCTION.THAT I AM AUTHOR12E0 BY THE <br /> OWNER OF THIS PROPERTY TO PERFORM THF WORK FOF WHICH <br /> APPLICATION IS MADE AND I COMPLV WITH THE STATE <br /> P�RCELTA%I.O.NUMBER CONTRACTOFS LAW 1827 FCW AND 296.200 WAC. <br /> GONSTRUCTIONLO�NLENDER.ADDNESS.TEIEPHONENUMBEH <br /> i� �a�c�.QS����—�/ic,/ �3 <br /> PROJECT ADDRESS sa�•*u r "E <br /> ,�, �;nveusm¢ssueeescrvo <br /> PLUMBING MECMANICAL <br /> yp, TVPE OF FlIITURE OF REM FEE N0. TYPE OF EOU�PMENT FEE <br /> WATER CLOSET(TOILET) � NC—NHNDLG 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 /> SHOWER CLOTHES DRVERS ' <br /> KITCHEN SINK&DISP � VENTILATION FAN <br /> DISHWASHER RANGE HOOD <br /> LAUNDFY TflAY ; WATER HEATER <br /> CLOTHES WASHER WOOD STOVE <br /> URINAL METAL FIREPLACE(WOOD BURNING) � <br /> DRINKING FOUNTAIN FIREPLACE INSERT � <br /> T <br /> FLOOR DRAIN HEAT PUMP ' <br /> BACKFLOW PREVENTERS GAS PIPING � <br /> ROOF DRAINS—RAINLEADERS ExH�I'ST FAN ' <br /> SINK(SERVICE—BAR.ETC.) � <br /> SUB TOTAL $ SUB TOTAL S <br /> PERMIT $ PERMIi $ <br /> TOTALFEE $ ' TOTALFEE $ <br /> FOR OFFlCE USE ONLY: <br /> FRONT S[TBRCN REFR SETBACK SIDE 5[TBACK PUN GNECK NUMBER FEE RECEIPT NO <br /> USE 20NE LOT AREA VACANT SITE FEES VALUATION FEE <br /> -; vES ;7 No aui�oiNc <br /> ttPkO�CON57 NO.OFSTORIES �ccuvevc. NoawrEwxcuwu <br /> 4900P PWMBING <br /> S2EOFBLDG. FIRESPRINNLEHSREO'D BASEMENT MECHANICAL � <br /> ."-� YES i,� NO <br /> OCGUPANCYLORO FIREALARIARE�D HEIGHTLIMITRTION AODITIONALPLANCNECK <br /> OTHER � <br /> �T <br /> REPSON <br /> S7ATE BUILDING SURCHARGE <br /> INT�'(EBV PLANSAPPROVE�BY CITYOFEVERETT PUBL�CWORKS <br /> LOCAL SRLES <br /> DRTE TAR CODE IS 3105 ruu� <br />