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__�. <br /> APPLIC�17'10 � F'OR CONSTi;UCT� 1N PERMIT <br /> � <br /> TO BE COMPLETED IN BLACK INK—PLEASE PRWT �� <br /> � HEATING SYSTEM �GAS ❑ELECTRIC ❑ — � <br /> BUILDING DEPARTMENT <br /> 259-8810 ' <br /> DEMOLITION COMBINATION BUILDING MECHANICAL PLUMBING S� s�' � <br /> 0 NER MAILAODRE55 � CI V ZIP PHON <br /> �AL��/ H�M PS 3��C.� L��� L 9�i��3��' :�7�v — � <br /> TENANT � lAAILADDRESS GITY ZIP PHONE � <br /> ARGNITECTOROESIGNER IdAILADORE55 CITV 21P PHONE � <br /> M <br /> GENERAICONTFFGTOR MNLAD�FE55 CITV ZIP PNONE STATELICENSEN � <br /> �LL MC�S G <br /> M MANCALCOp�ACTOA MAILAOORESS CITV ZIP PMONE STAT LENSEN <br /> �1�5 tc�2r'Wc� �o .6o�C 7�/0/ 13�1( �I��7 7yJ-/('�3 0 ���5-�GE'/.�3GN_ � <br /> PLUMBINGCONTRACTOR MAILAODRESS <br /> CITY ZIP PHONE $TATELICENSEa <br /> GLA55 OF WORK � <br /> �NEW �� ADDITION ALTERATION REPAIR DEMOLITION WOODSTOVE/FFlPL INSERT � BUILDING RELOCATION � <br /> CONTACT PERSON AND PHONE NO. �-7 ! <br /> CONTRPCT PRILE OF WOflK <br /> Z I oc' �j4� . (L� / 7-�b3 O <br /> DESCRIBE WOflK PND SOUARE FOOTAGE INVOLVED <br /> �hl$ ��4LL �0111/� �n` S �J 'LL <br /> PROPOSEOUSEOFBURDING I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br /> APPLICATION AND KNOW THE SAME TO BE TRUE AND CORFlECT.ALL <br /> LEGAL DESCFIPTION Of PROPERTV(SHOWN BELOW OR ATfACH FOUR COPIES� PFiOVI510NS OF LAWS AND OFDINANCES GOVERNING THIS TYPE OF <br /> ���---777 WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br /> �pT� BLOCK oF �� NOT. THE GRFNTING OF A PERMIT DOES NOT PRESUME TO GIVE <br /> AUTHORITY 'O 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 8Y THE <br /> OWNER OF THIS F'AOPERTY TO PERFORM THE WORK FOR WHICH <br /> APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> CONTRACTORS LA 18.27 FCW AND 296.200 WAC. <br />� ��� _ yUT� �� X � _y �� �y <br /> sDnnluae <br /> oar[ <br /> PPOJECT A�J�FESS <br /> u.vnusnrssuceuscr+o <br /> PLUMBING MECHANICAL <br /> FEE N0. TYPE OF EOUIPMENT FEE <br /> NO. TYPE OF FIXTURE OR ITEM � <br /> A/G—AIHNDLG UNITS—H.P. ' <br /> WATER CLOSET(TOILET) ' � <br /> � FORCEDAIRSYSTEMS—B.T.U. M E.A. <br /> BATHTUB ; <br /> LAVATORY(WASH BASIN) UNIT HEATERS—B.T.U. M <br /> SHOWER ' I CLOTHFSDRYERS V�'-'/� <br /> KITCHEN SINK&DI3P ; VENTILATION FAN ' <br /> DISHWASHER � / RANGE HOOD � <br /> LAUNDRY TRAY ; WATER HEATER � <br /> CLOTHES WASHER � WOOD STOb' ' <br /> � METAL FIREPLACE 8 CHIMNEY ' <br /> URINAL � ; <br /> DRINKING FOUNTAIN � FIREPLACE INSERT <br /> FLOOR DRAIN HEAT PUMP � <br /> BACKFLOW PREVENTERS 2 GAS PIPING . ' <br /> ROOF DRAINS—RAINLEADERS � EXHAUST FAN ' <br /> SINK(SERVICE—BAR,ETC.) ; <br /> � <br /> � <br /> � <br /> SUB TOTAL 5 � � <br /> SUB TOTAL S � pERMIT S � ' <br /> PERMIT 5 ' TOTALFEE S ' <br /> TOTAL FEE $ <br /> FOR OFFICE USE ONLY: REceiarNo. <br /> PLANCH� NUAI�ER / FEE <br /> FRONT SETOACK REAR SETBACK SIDE SETBFCK /�T <br /> USEZONE LOTAREA VACANTSITE <br /> FEES VALUATION FEE � <br /> OUILDWG <br /> iYPEOFCONiS.ALLOWABLE 7YPEOiC01151.AC7VAL aGHouvr NOofVxEcmGuxirs PLVMBING � <br /> �— <br /> SIZEOF'BJIDG. NO.OFSTORIES BASEMENT MECHANICAL � - <br /> o,�I�a l� AD�ITIONAL PLAN CHECK ' <br /> OCCUPANCVLOAO FIPESPRNKLERSREO'D HEIGHTLIMITFTION <br /> SPRINKLEF <br /> � <br /> REASON FOB SPRINKLEPS STATE BUILDING SURCHARGE � <br /> INTAKEBV PLANSAPPROVEOBV CITYOFEVERETT PUBLICWOPKS � <br /> LOCALSALES <br /> TAX CODEIS 3105 TOTAL � <br /> — — - _-_,�,.b_-�s —- - <br />