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APPLICATI�. _J FOR CONSTRUCT_ �N PERMIT � <br /> TO BE COMPLETED IN BLACK INK—PLEASE PFINT <br /> HEATING SYSTEM: �GAS U ELECTRIC �J _. —� <br /> BUILDING DEPARTMENT -- <br /> 259-8810 <br /> i ! DEMOLITION i i CO�rlflINATION BUILDING �?(MECHANICAL � PLUMBING Li SIGN <br /> 014NEii MAIIA�OPE55 / OTY TiP PHONE <br /> lLY.n OUrvL /SZ��t���.�✓t'x! �C/G �PA. t_ Vc RE� S��o70a �.�9 - PD/3� <br /> TENANi MAiLA0DRE55 CITY ZIP VNONE <br /> ARCHITECTOPDESIGNER MARADDRE55 CITY ZIP PIIONE <br /> GENERALCONTRRCTOfl M41LApDRE55 CITV ZIP PHONE SiATELICENS[a' <br /> MECHANICALGONTRACTOF MFILADDPESS CIiV ZIP PNONE SiAIEUCENS[a <br /> .,Z-i��s� E�✓Fw+Gs� /97,�i-G�lrx..4vF� .�r�v.✓w000 9Ao36 77v-S3iS1oc��Esolo6TH <br /> PIUMBING CONTFACiOR Ml IL ADDRESS CITY ZIP PIION[ SiATE UCENSE♦ <br /> CONTR4Ci�RICE OF WORK <br /> ���0 �� <br /> OeSGFiBEWORKANOSOUAREF00TlGEMVOLVE� CONtACTPER50NANp NENO. <br /> __ _ oGE� NE�so.�/ <br /> GAS G'aNv�2.SlO - P i,s <br /> i HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br /> PIiOPOSED lISE OF BUIL�ING APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT.ALL <br /> PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br /> LEGAlDESCRIPT�ONOFPROP[FTV�5110WNBELOWORAiTACNT\YOCOPIE57 WORK WILL BE COMPLETED WITH WHETHER SPECIPIED HEREIN OR <br /> NOT. THE GRANTING OF A PERMIT DOES NOT PRFSUME TO GIVE <br /> ioT B`°°K °F AUTHORITY TO VIOLATE OR CANCEL THE PROOISIONS OF ANY <br /> OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTIUN OR THE <br /> PERFORMANCE OF CONSTRUCTION.THAT I AM AUTHORIZED BY THE <br /> OWNER OF iHIS PROPERTY TO PERFORM THE WORK f-OR WHiCH <br /> APPLICATION IS MAGE AND I COMPLV WITH THE STATE <br /> PARCEL tA%I D.NUMBF.R CONTRA.TORS LAW 18.27 RCW AND 296200 WAC. <br /> iya8os - �-oay-o <br /> CONSiRUCT10N LOA��LENDER.AODRESS.TELEPHONE NUMOEfi <br /> PROJECTADDRES� �'''7 ����y�� -1 �/yi <br /> se iva� Oa7'/.S/ o�i� <br /> sa ct1• u,<✓Ez .Gt. 1S�v ci�.euz�vrssiictnscr�o <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIICTURI:OR ITEE.� FEE N0. TVPE OF EOUIPMENT FEE <br /> WATER CLOSET�TOILET) i A�C—A�HNDLG UNITS—H.P. <br /> E'ATHTUB / FORCED AIR SYSTEMS—B.T.U. M E.A. <br /> LAVATORY(WASH BASIN) UNIT HEATERS—B.T.U. M <br /> T <br /> SNOWER CLOTHES DRYERS <br /> KITCHEN SINK 8 DISP VENTILATION FAN <br /> DISHWASHER RANGE HOOD <br /> LAUNDRY TRAY � / WATER HEATER <br /> CLOTHES WASHER WOOD STOVE <br /> URINAL METAL FIREPLACE(WOOD BURNING) <br /> DRINKING FOUNTAIN i FIREPLACE INS'_RT � <br /> FLOOR DRAIN � HEAT PUMP <br /> BACKFLOW PREVENTERS �.. GAS PIPING <br /> ROOF DRAINS—RAINLEADERS EXHAUST FAN <br /> SINK ISERVICE—BAR,ETG) <br /> T <br /> SUB TOTAL $ SUB TOTAL 5 "7 <br /> PERMIT S PERMIT $ <br /> TOTALFEE 3 TOTALFEE S <br /> FOR OFFICE USE ONLY: <br /> FqONi SET9ACN FEM SET9ALK SIOE 5[iH/CK PLAN CHECK HUMfi FFE R[CEIPT NO <br /> use zor+e LOT�REl. vncnrvr srte FEES VALUATION FEE <br /> � �' YES ❑ NO BUILDING <br /> TVPEOFCON57. NO.OFSTORIES occuv�qtv x00�mvFwNsuNrte — — <br /> G°0u> PLUMOING <br /> — —i— <br /> 9ZEOfBLDG. FIRESPRINNLERSREO'0 BASEMENT MFCHANICAI <br /> [�� YES i: NO <br /> OCCUPANCVI.OAD FlqEALAiiMR[OD HEIGHTLRdI1Fii0N ADDITIONALPLANCHECK <br /> OTHER <br /> REASON T <br /> STATE�UILDING SURCHARiiE <br /> INTpKEOV PIAI:SRPPHOV[DBY CITYOFEVERETT PUBUCWORKS ' <br /> LOCAL SALES <br /> on.e TAX CODE IS 3105 TOTAL <br />