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APPLICATIC�1 FOR CONSTRUCT''1N PERMIT � <br /> TO BE COMPLETED IN BLACK INK—PLEASE PRINT <br /> HEATING SYSTEM: � GAS ,.I ELECTRIC ❑ <br /> BUILDING C1Ef'ARTMENT <br /> 259-8610 <br /> DEMOLITION x COMBINATION I ' BUILDING I 'MECHANICAL LI PLUMBING 1 SIGN <br /> �\K� gvfl K6 AIA�V I55�/"�^`iV , Iv� Ci✓U`y�Wl� 4 IL1P PMONE ��S�ilJ�(f� <br /> TENRNT hl�l�qDDRL55 CIiV�/ ZIP PMGNE �t �r <br /> Q �� ll �f ` �( _ <br /> A MITECTORDESIGNER M�IL0.pDBESS �' CiTV ZIP PMONE <br /> �A�1(�o�n�f �����j �srs ��� ��W,� ��ov� �3�� Y�q23 <br /> GENER4L ONTR�CTOR MA4AODRE55 CItV 21P PMON[ SiAtEIICENSE• <br /> ��,�a�ST��ASs�. ((Ih� /✓EI60�P� 7N�lGC<,1:1. - 6l� L!�-tilG�lA �(3; 1�+4 <br /> MECIIANICFLGONiRAGTOR MNLFODRESS CiTY ZIP PMONE STATELIGENSE• <br /> PWM9iNGCONTRACTOR MAI�RODRE55 CitV i PNONE STAiEUCENSE• <br /> COATR4CT PPIL F�YD�K / v <br /> ��o oa� /2/1034 h <br /> O[SCRIBE WOAK AND SOUA�iAGE Ifi1OW6C 1(. LONT�GT PERSON AND PHCN[N0. — <br /> V <br /> S K- f(.�/GF � l�.��'�i (/I�i�. ��J�" (P( <br /> Z3� / rS� �'T. � HEREPY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br /> rnovoseo use oF emioir+c APPLICATION AND KNOW THE SAME TO BE-lRUE AND CORRECT.ALL <br /> j,���/r �' � �5 , PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS NPE OF <br /> —v�r� <br /> LEGPLD:SCRIP'ONOFPROP[Rtt�SNOWNB[LOWOR�rncr��coFiEs� WORK WILL BE COMPLETED WITH WHETHER SPEGFIED HER <br /> NOT. THE GRANTIN6 OF A PERMIT DOES N0T PRESUME TO GIVE <br /> ioT—� Z eiocK � oF AG�S AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br /> ��� OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br /> PERFORAIANCE OF CONSTRUCTION.THAT I AM AUTHORIZED BV THE <br /> OWNER OF THIS PFOPERTY TO PERFORM THE WORK FOR WHICH <br /> APPLICATION M E AND I COMPLV WITH THE STATE <br /> ❑nacu inz}i�,rvuMeea CO ACTORS L 1 FCVJ AND 296200 WAC. <br /> :(t 2(�Q0000�0 <br /> :0�15TRlICTION 10�N LECNDER,%DDRESS.TELEPHONE NUM�[R '�� /� ,. � " <br /> A�CI 1� 7 �I 3/ <br /> PROJECT ADDRESS 'N sm �+ � w'�_ <br /> CI USiNl55liLfN5lN0 <br /> PLUMBING MECHANICAL <br /> NC. TYPE OF FIXTURE OR ITEM FEE NO. TYPE OF EOUIPMENT FEE <br /> WATER CLOSET(TOILET) � � A�C—A�HNDLG UNITS—H.P. <br /> y BATHTUB � FORCED AIR SYSTEMS—B.T.U. M E.A. <br /> � LF.VATCRV(WASH BASIN) I UNIT HEATERS—B.T.U. M � <br /> SNOWER 1 CLOTHESDRYERS ' <br /> KITCHEN SINK&DISP VENTILATION FAN � <br /> � DISHWASHER I RANGE HOOD ' <br /> ( LAUNDRY TRAY � i WATER HEATER � <br /> ( CLOTHES WASHER � WOOD STOVE �� '��? <br /> URINAL METAL FIREPLACE(WOOD BURNING) <br /> DRINKING FOUNTAIN FIREPLACE INSERT <br /> FLOOR DRAIN � HEAT PUMP <br /> BACKFLOW PREVeNTERS ; _ GAS PiPIN6 _ <br /> ROOF DRAINS—RAINLEADERS EXHAUST FAN / / <br /> SINK(SERVICE—BAR,ETG) � . � �� <br /> � <br /> =� � � 1` !s J I �z, . <br /> SUB TOTAL 5 ' SUB TOTAL S �_ <br /> — PERMIT 5 PEFMIT 5 <br /> — TOTALFEE 5 TOTALFEE S <br /> FOR OFFICE USE ONLY: �` ' —'— <br /> FRONi 5Ei8ACK REM SETOALK SIDE SEiBAGN� PI�N CHE(�1�}10�� 4EE, ���� pE�0538s <br /> 2S � zs ' ?.S �I �%� 7 <br /> FEES VALUATION FEE <br /> USE ZONE LOT pARE4 VFC4NT SI7E r <br />.. �S I /�ID �-' YES � N� BUILDING I7'-}(�j�j((j � <br /> I 7YFE0'CONSi NOAFSTORIES �.wr�rv[r na0�o::[�u:.u'.�5 1 i � ., <br /> � n -°p� I PLUMBING _ � - <br /> V <br />� SREOFALOG RRESPRINK�EFSREO'D �ASEMENi � MECHANICAL �� �� � �l �) <br /> Z 377 Sf• � �1� .���. YES 1/NO ' �� <br /> OCCUPANC�LOAp FlRF.ALARlAREOD NEIGHTlRd114T��/ <br /> ADOIiIONAL PLAN CHECK . � �'� <br /> � �Vi� Z OTHER � � ` <br /> REASON �I � t.. .. <br /> STATE BUILDING SURCHARGE - <br /> INT�KE�Y PLANSAPPROV[ODY CITYOFEVERETT PUOLICWORKS �' � ' �).� 1 <br /> LOCAL SALES <br /> onte <br /> TAX CODE IS 3105 TOTAL <br />