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� APPLICATIO. FOR CONSTRUCT!"�N PERMIT � <br /> TO BE COMPLETED IN BLACK INK—PLEASE PRINT <br /> BUILDING DEPARTMENT HEATING SYSTEM: ]GAS ❑�ELECTRIC ❑_ <br /> 259-8810 � � <br /> ❑ DEMOLITION L:`'COMBINATION ❑ BUILDING C;MECHANICAL ❑PLUMBING ' ! SIGN <br /> OWNER MAIIADDRE55 QTY 21P PHONE <br /> /�/; /�S �e�.s� /�v� 1 02$ CL 4 '�h �� �'✓e.�.lf� 9 B Z�,3_ <br /> TEN NT 61AILADDRE55 CITY ZIP PNONE � <br /> i) <br /> �F � � �J�n�ntT J � � 333s ��� c s }- � <br /> ARCNITECTORDESIGNER MAILADORE55 CITY IIP PHONE <br /> GENERRLCONTRFGTOR MAILAOy�E55 CITY 21P STpTELICENSE+ <br /> �vcvs: 1 � 9t%� Ca 29�L S-1+�� .�✓Qv�.ffW� }�rVERR �sozro <br /> MECHANICALCONTRALTOR MAILA ESS CITY ZIP PNONE STAiELICENSEa <br /> PLUMBINGCONTRACiOR MNLADDRESS CITY ZIP PHONE STFTEUCENSEa <br /> COf��T R/R�CT PRILE OF WORY r <br /> 1 42 1Z� �� <br /> DESCRI�WORKCRND SOUARE F��E INVUIVED LONTFCT PERSON AND PMON 0. <br /> Aty� �r [ ��,Oria-' !C� Ofl s �c l Z –4 64 l— <br /> �5"'�r I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br /> P OSED lISE OF BUILOING 1-�.,, APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT.ALL <br /> �/�'�— s �/" t ����s PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br /> LEGALOESCPIPTIONOFPROPERN�SHOWNBELOWORATTACHi1VOCOPIES� WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br /> NOT. THE GRANTiNG OF A �ERMIT DOES NOT PRESUME TO GIVE <br /> �or e�ocK 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 AUTHORIZED BY THE <br /> OINNER OF THIS PROPERTY TO PERFOR'd THE WORK FOR VJHICH <br /> APPLICATION IS MADE AND I COA!PLY WITH THE �STATE <br /> PARLEL TA%ID.NIIMBEP CONTRACTORS L . 7 RCW AND 2962L7 WAC. <br /> CONSiRUCTIp�J LOA/�[NpC � iiE55. �J NE NUMBER �j//�� <br /> / � �i Y <br /> , 7n� <br /> PROJECTADDRESS scr+�rua onc — <br /> � 3 3 S ��l CI1V SINf55lICENS[NO <br /> PLUMBING M CNANICAL <br /> N0. TYPE OF FIXTURE OR ITEM FEE NO. TYPE OF EQUIPMENT FEE <br /> WATER CLOSET(TOILET) NC—AiHNDLG UNITS—H.P. <br /> BATHTUB FORCED AIR SVSTEMS—B.T.U. M E.A. <br /> LAVATORY(WASH BASIN) UNIT HEATERS—B.T.U. M � � <br /> SHOWER ' CLOTHESORYERS <br /> ---�— <br /> KITCHEN SINK&DISP VENTILATION FAN _r_ <br /> DISHWASHER RANGE HOOD <br /> IAUNDRY TRAY WATER HEATER <br /> CLOTHES WASHER WOODSTOVE <br /> UAINAL 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 EXHAUST FAN _ <br /> SINK(SERVICE—BAR,ETC.) <br /> i <br /> i <br /> —�— <br /> SUB TOTAL 5 SUB TOTAL $ <br /> PEFMIT 5 PERMIT 3 <br /> TOTALFF.E 5 TOTALFEE S �— <br /> FOR OFFICE USE ONLY: <br /> FRONT SETBACN REAR SEIBACN SIOE SETBALK PLAN GHEC NUMlBER FEE REL[IPT NO. <br /> / ��/c�J <br /> use zuuE LOi r1REA vnenrvt siTe ' FEES VALUATION FEE <br /> . � YES �I NO BUILDING .�C�O(� ��d ' ���� <br /> ttPEOFLON51 NOAFSTORIES cauvnscr NOO�ov:FwNcc4rtS <br /> `'""j° PLUMBING <br /> 52EOFBl�G. FIRESPRINNIERSREO'D BASEMENT MECNANICAL <br /> ; � YES ,, NO -- � <br /> OCCUPANCY LOAD FIRE AIARM RE00 HEIGMi LIMITFTIDN ADDITIONAL PLAN CHECK <br /> OTNER <br /> aEn50N i �- <br /> STATE BUILDING SURCHARGE � <br /> INTRKEBV PLANS�PPROVEDBY CITYOFEVERETT PUBLICWORKS <br /> LOCAL SALES <br /> onrE TAX CODE IS 3105 TaTA� // ) ,;: � <br />