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APPLICATIC-1 FOR CONSTRUCT` -IN PERMIT <br />TO BE COMPLETED IN BLACK INK —PLEASE PRINT <br />BUILDING DEPARTMENT ( HEATING SYSTEM: 11 GAS +�I ELECTRIC <br />259-8810 <br />1 1 DEMOLITION I I COMBINATION I I BUILDING I I MECHANICAL I I PLUMBING I I SIGN <br />OWNER MAIL <br />A�DrDDRFSSS CITY <br />?IP PHONE <br />TENA ENARTTL�CII,_„�f.(J.L <br />/y- �.y� MAIL ADDRESS CITY 71P PHONE <br />_9 (r Ly <br />ARCH ECT OBDESIONER T MAIL ADDRESS ]IP <br />^f]��� CITY �9EPHONE <br />IFNERAL CON) ACTOR 4 MAII ADDIIF.SS � T 71I+ -- PIION� — STATE LICENSE IT <br />CONTRACTOR MAIL <br />CITY 71P PHONE STATE LICENSE <br />PLUMBING CONTRACTOR MAIL ADDRESS CITY 71P PHONE STATE LICENSE <br />CONTRACT PRICE OF WORK <br />�/�p� <br />i1r� <br />DESCRIBE WORK AND SQUARE FOOIAGE IITVOLVED <br />CGNTA 1 PERSON AND PHONE NO <br />--- <br />-�-fir <br />HEREBY CERTIFY THAT I HAVE READ AND EXAMINED TIIIS <br />PROPOSED USE OF BUILDING _-7 <br />APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT ALL <br />PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br />WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br />LEGAL DESCRIPTION Of PROPERTY (SHOWN BELOW OR AT TACIT TWO COPIES) <br />LOT BLOCK OF <br />NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br />- <br />AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br />OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR TLIF <br />------- <br />PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY TI IF <br />OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br />APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />PARCEL TAXI D NUMBER <br />CONTRACTORS LAW 18.27 RCW AND 296.200 WAG, <br />�� <br />CONSTRUCTION LOAN LENDER.ADDRESS, tELEPNONE NUMBER <br />SK.x.UBT �— <br />PROJECT ADDRESS <br />.IF <br />PLUMBING <br />I:II. RUSMf$SIICI NSf INI -- <br />MECHANICAL <br />NO. <br />TYPE OF FIXTURE OR ITEM <br />FEE <br />NO. <br />TYPE OF EQUIPMENT <br />FEE <br />WATER CLOSET (TOILET( _ <br />A/C-NHNDLG UNITS-H.P. <br />, <br />BATHTUB <br />FORCED AIR SYSTEMS-B.T.U. M E.A. <br />LAVATORY (WASH BASIN( <br />—T— <br />UNIT HEATERS-B.T.U. M <br />; <br />SHOWER <br />CLOTHES DRYERS <br />-�— <br />KITCHEN SINK 6 DISP <br />' <br />VENTILATION FAN <br />DISHWASHER <br />RANGE HOOD <br />, <br />LAUNDRY TRAY <br />' <br />WATER HEATER <br />1 <br />CLOTHES WASHER <br />WOOD STOVE <br />' <br />URINAL <br />METAL FIREPLACE (WOOD BURNING) <br />DRINKING FOUNTAIN FOUNTAIN <br />_ <br />FIREPLACE INSERT <br />-L- <br />FLOOR DRAIN <br />_ <br />HEAT PUMP <br />, <br />_ <br />BACKFLOW PREVENTERS <br />; <br />_ <br />GAS PIPING <br />ROOF DRAINS-RAINLEADERS <br />EXHAUST FAN <br />, <br />SINK (SERVICE -BAR, ETC.) <br />1 <br />SUB TOTAL $ <br />SUB TOTAL $ <br />PERMIT $ <br />_ <br />PERMIT $ <br />TOTAL FEE $ <br />TOTAL FEE $ <br />FOR OFFICE USE ONLY: <br />FRONTSETRACN <br />REAR SETBACK <br />SIDE SETBACK <br />PLAN CHECK NUMBER <br />FEE <br />RECEIPT NO <br />uSEZONE <br />I.OT AREA <br />VACANT SITE <br />f I YES I l NO <br />FEES <br />VALUATION <br />FEE <br />BUILDING <br />d[.� /'✓v� <br />J<7n ; <br />IYR Of CDN51 <br />I FIC <br />NO OF STORIES <br />_ I FEZ TI. <br />rcDIP.Mv <br />I xn Iw IM1111hr INnt <br />_ �" <br />PLUMBING <br />i_-- <br />SIZE OF BLDG <br />3400 TI. <br />FIRE SPRINKLERS REOD <br />Y`* <br />BASEMENT <br />.ld YES I I NO <br />MECHANICAL <br />--� _ <br />OCCUPANCY LOAD <br />M w T-1 • <br />FIRE ALARM RED <br />-WEIGHT -LI <br />MITATION <br />ADDITIONAL PLAN CHECK <br />n' <br />OTHER <br />REASON /� <br />0X`i1T7tV6- 4,q,%TC'm`� <br />STATE BUILDING SURCHARGE <br />_ <br />' <br />INTAKE BY <br />rLANSArErwEDBY <br />UNI <br />DATE % ' 7 ��� <br />CITYOFEVERETT <br />LOCAL SALES <br />TAX CODE IS 3105 <br />PUBLIC WORKS <br />i <br />TOTAL <br />_G I ; <br />�� <br />