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�_ , . . . .�. <br /> APP�ICAT1�" ' FOR CONSTRUCT��N P�RMiT <br /> TO BE COMPLETED IN BLACK INK-PLEASE PRINT �"�-`T� <br /> � <br /> 6UILDING GEPARTMENT L HE�TING SYSTEM: J GAS !J ELECTRIC ����?{f��� I <br /> 259-8810 <br /> DEMOLITION i : COMBINATION !-1 BUILDING ❑ MECHANICAL ❑ PLUMBING �.l SIGN <br /> OIVNER 6111L ADDRES� � L_ CITV ZIP � PMONE <br /> ] j J <br /> ��AIIdT��E. ��E7h'S�S '�D� � /C!� � S� /—�-,i f %0���-' ' s-.3/�'� – <br /> lEkA1JT M�ILADDRE°S CITV ZIP PHONE <br /> ARCHITECTOFDESIGNER h161LA�DRESS CIiY ZIP PHONE <br /> ��.d.R�� �,enl�Acc�r� ��30�REysgl.Y Ln.( v�err �,�a�'��' -�—�s`d I <br /> GENERALCONTRAC'iOR IAAILAG�RESS CITY ZIP PHONE ST EIIGENSER <br /> ��.�RE�z�� �k�.1F� <br /> I.�ECM4NICALCCNTRACTOR MAILFODRESS GTY 21P PhONE STATELIC6NSE: <br /> PWIABINGCON�aFCTCR MNLADDRESS CITY ZIP PHONE SiATEIICEN5E4 <br /> J�g1_,�'3� :r.crziwl� hg ' Iwl t RL.. _ <br /> CONTRACT PRiCF OF WORN � <br /> OESCRIBE WOFK.1ND SOUARE FOOTAGE INVOLVED GCNTAGT PER$ON FND PHONE NO. <br /> I HEREBY CERTIPY THAT I HAVE READ AND EXAMINED THIS <br /> aaoPoseo usE oF ew�owc ,qppLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALI_ <br /> PROVISIUNS OF LAWS AND ORDINANCE."i GOVERNING THIS TYPE O�� <br /> LEGALDESCRIPTIONOFPROPEFttISHOWNBEIOWORATfACHTWOCOPIES) �A'ORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br /> NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GI��� <br /> LOT— BLOCH oF AUTHORIT`! TO VIOLATE OR CANCEL THE PROVISIONS OF Ai:Y <br /> OTHER STATE OR LOCAL LAW REGULATING CONSiAUCTION OR Thll- <br /> — PERFORMANCE OF CONSTRUCTION.THAT I AM AUTHORIZED BY �i I1E <br /> O�NNER OF THIS PROPEflTY TO PERFORM THE WORK FOR WHICH <br /> APPLICAT IS MADE AND I COMPLY WITH THE STATE <br /> PARCCL TAX I.D.NUM9ER CONTR S LAW 18.27 RCW AND 29G.200 WAC. <br /> CONSiFUCTIONLOANIEN�ER.ADDFESS.iELEPHONE NUM�ER <br /> - � -� a.2.2 9� <br /> PROJECT ADDRESS • "0C "rE <br /> .� Li �' ��. CIiTbUiPlLSSLIrEN5EN0 <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM FEE NO. TYPE OF EOUIPMENT FEE <br /> WATER CLOSET(TOILET) A/C—NHNDLG UNITS—H.P. _ <br /> DATHTUB - FORCED AIR SYSTEMS—B.T.U. M E.A. <br /> LAVATORY(WASH BASIN) � UNIT HEATERS—B.T.U. M __ <br /> SHOWER � CLOTHES DRVEFS <br /> KITCHEN SINK 8 DISP � VENTILATION FAN <br /> DISHWASHER RANGE HOOD _ <br /> LAUNDRYTRAY ' WATERHEATER __ <br /> CLOTHES WASNE9 WOOD STOVE ,.__, <br /> URINAL ' METAL FIREPLACE(WOOD BURNING) <br /> DRINKING FOUNTAIN FIREPLACE INSERT � <br /> � <br /> FLOOR DRAIN HEAT PUMP _.. <br /> BACKFLOW PREVENTERS ; GAS PIPING _ <br /> ROOF DRAINS—RAINLEADERS � EXHAUST FAN _ _ <br /> SINK(SERVICE—BAR,ETC.) � -.. <br /> � <br /> � � <br /> SUBTOTAL S �,j,� i =' SUBTOTAL $ ___ <br /> PERMIT S . D ' PERMIT S � <br /> TOTAL FEE $ (2 ' � TOTAL FEE S _ <br /> FOR OFFICE USE ONLY: <br /> FRONTSETBFCK RE4RSETB4CK SIDESETBACH PLFNCHECKNUMBER FEE FECEIPTNO. ' <br /> �. Q;�S <br /> uSEZONe �oinaen VACANTSITE FEES VALUATION FEE <br /> ❑ YES . ; NO BUILDING <br /> iYPEOFCONSi. NO-OFSTORIES otcurpucv ��oorp�![LutGt,'Jis — � <br /> cnouo PWMBING <br /> SREOFBLDG. FIRESPRINKLERSREO'D BASEMENT AIECHANICAL � <br /> f-. YES �.�] NO � —.. . <br /> OGCIIPANCV LOAD FIRE ALARM REOU MEIGHT LIIdITATION �DDITIONAL PLAN CHECK <br /> OTHER <br /> R[ASON <br /> STATE BUIL�ING SURCHARGE <br /> INTAKEBY PLANSFPPFOVEDBY CITYOFEVERETT PUBLIClVOi74:$ � <br /> LOCAL SALES -- <br /> D�TE TAX CODE IS 3105 TOTAL <br /> ."� ca., . � ,v-- "_R�.l.'""�+,�..-k...,..�.*.�s . ...- , i� � .e.. <br /> i � . . . , rst�slii�l i� ���;� <br /> ��'� .� ^a-,� � ✓It� �;a �a�Y" .. _ -, ..�xs �.� +. R'i� <br /> l�✓ ^r�lM r SM�y���rJ� ,. y � . . <br /> � � , . -......-.'"^..."`�r t FnW'_'�I}� �';y�Yt 5."v s.7.���.9�..,.a — <br />