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pPp�,m ��"�"I( l FOR COIdSTRl1C7 �I�1 PERIVe1T ���� <br /> TO BE COMPLETED IN BI.ACK INK—PLEASE PRINT <br /> �HEATING SYS'i EM: GAS U ELECTRIC ❑ I <br /> BUILDING DEPARTMENT <br /> 259-8810 <br /> I I DEMOLITION I I COMBINATIOP' � BUILDING I J MECHANICAL I I PLUMBING i SIGN <br /> �iNLAD�RE55 GI7V Z�P PHONE <br /> OWNER _ <br /> : t> > i (o_ � <br /> 1. i � �I - _ '�'-� �- l_ FL.iT �'�V C /- `,J!J I� _ . . - '`i <br /> �.��� - �(��rV- - . .. - - CITY ZIP PHONE <br /> TENANi � MAILADDfiE55 <br /> ABCHITECTORf1E51GNER MAILADDRESS <br /> CIiY ZIP PHONE <br /> / CITV 1�P PIIONE SiATEUCENSEII <br /> GENER�LLONTRf.G1UP MAILAU�RESS <br /> iZA i� y r,'.i r :?<„_ � <br /> j/�)J�� � 1.�_�.i✓/'JG/� �iNELICENSE� <br /> MEGHANICALCOt1'H/�CTOH MAILADDRESS <br /> GITV ZIP PHONE <br /> PLUMDINGCONTFi:.TOF MAILAUD4iE55 <br /> CITV 21P PHONE STr1TELIGENSE� <br /> \C'J�SSOi WOAK <br /> Ip' NEW I I ADDITION I I ALTERATION I I REPAIR I I DEMOLITION I I WOODSTOVE/FRPL INSERT I ; BUILDING RELOCATI �J <br /> CONTACTPEfl50NANOPNONENO. <br /> � ��1� �'z- '� /+UL ` ? -� Y.- :57 � � <br /> CON7R�CT PNIGE OF WORK i.y � ? p+(o <br /> DESCHIBE YIORK AND SOUnRE FOOTAGE INYOLVEO � <br /> 1� A , c l '�/ �> 3�� s��r. <br /> PROPOSEDUSEOFBIIILDING I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br /> �� APPLICATION AND KNOV/THE SAME TO BE TRUE AND CORRECT.ALL <br /> ���!U".%� �9 >� i i y,� �f.4�/��lSvl i" � <br /> PROVISIONS OF LAWS AND ORDINANCES GOVERNI��G THIS TYPE OF <br /> IEGALDESCRIPTIONOFPflOPERiV�SHOYlNBELOWOiiATTACHFOURCOPIES� T WORK WILL 9E COMPLETED WITH WHETHER SPECiFIED HEREIN OR <br /> L �' =>��''�t� �'��v�� � NOT. THE GRANTING OF A PERMIT DOES NOT F'RES�IME TO GIVE <br /> LOT / BLOCI( OF � <br /> FO,/•'c�T /��R� AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br /> OTHER STATE OR LOCAL LAW REGULATING CONSTRUCI"ION OR TH[ <br /> PERFORMANCE OF CONSTRUCTION.THAT I AM AUTHORIZED BY THE <br /> OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR NJH�CH <br /> APPLICATION IS M�DE AND I COMPLY WITH THE STATE <br /> CONTRACT RS LAW 1827 rICW AND 296.200 WAC. <br /> �� ' Q <br /> �' �� <br /> x i ����-r�/�//—c:. J- /�`-J � <br /> SIGNAiUj�E� O��E � <br /> PROJECTALDRESS � / <br /> C� � ) L� � ����C'(� GItV OUS�NE55 L4'CNSE NO � <br /> PLUMBING MECHANICAL — <br /> FEE <br /> Np, TYPE OF FI%TURE OR ITEM FEE N0. TYPE OF EOUIPMENT ' . <br /> � WATER CLOSET(TOILET) � NC—NHNDLG UNITS—H.P. __ <br /> BATHTUB ' FORCED AIR SYSTEMS—B.T.U. M E.A. _�_ <br /> LAVATORY(WASH BASIN) I UNIT HEATERS—B.T.U. M __;___. <br /> SHOWER ' CLOTHES DRYEFS —_ <br /> KITCHEN SINK&DISP ; VENTILATION FAN _, —__ <br /> DISHWASHER RANGE HOOJ <br /> LAUNDRYTRAY ; WATER HEATER <br /> CLOTHES WASHER � WOOD STOVE _� <br /> URINAL METAL FIFePLACE&CHIMNEY � <br /> DRINKING FOUNTAIN � FIREPIACE INSERT ' — <br /> FI.00R DPAIN �— HEAT PUMP _ � <br /> EACKFLOW PREVEN�TERS ; GAS f'IPING _ — <br /> ROOF DF:AINS—RAINLEADERS � EXHAUST FAN <br /> SINK(SERVICE—BAR,ETC.) � � <br /> � � <br /> i <br /> � <br /> — � T <br /> i <br /> SUB TOTP.L $ ; SUB TOTAL $ � <br /> PERMIT $ � P[RMIT $ _ � � <br /> TOTAL FEE $ ' TOTAL F[E S <br /> FOR OFFICE USE ONLY: �FcemrNo. <br /> PqONTSETOACN REARSETOACK/ SIOESETOAGY, PLANGHECNNWd�� FEE �� d ` /� <br /> k� v 5 J <br /> vncnNrsite FEES VALUATION FEE <br /> USE ZONE LOT AREA p� � <br /> '� � 9 /L � BUILDING �Cl J I� z � - <br /> — � <br /> TYPEOFLOHIS.RllOYlAOLE IYPEOfCONSi.AC1UAL otCp����r uoMmVuux4uNu5 � <br /> PLUMBIIJG ' <br /> --/� - ---f— <br /> i <br /> Z����pGf T NO.OFSTOflIES BASEMENT 1dECHANICAL � <br /> 5� Sf GN/l 2 � � <br /> AODITIONAL PLAN CHECK ' <br /> OCCUPANCY LOAO FIRE SPRNKlEflS REO'D HEIGHT LIIAIiqT40N /� �! <br /> N�a �tl� ��� ��N,c�— � �l�OAI — I <br /> T <br /> REASONFORSPNNKLERS �, �l <br /> STAiE OUILDING SURCHARGE <br /> INTAKEBY PI�NSPPPRUVEDBV CITY6FEVERETT PUBLICVJORKS �L�� , <br /> �J F-(- LOCAL SALES ; <br /> ��,J�����. fAX CDDE IS 3105 rom� /[��.�� �5�� <br /> [ <br /> -� --�.. ---- ..�. _ __ <br /> � <br /> --- - _ <br /> . ,. _. _ _.. <br /> -u ��+,�� <br /> �,� <br /> � <br /> ti <br /> . . . , .- "m`.r:3:oaT �.�_7'{r�.. . . _. <br />