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APPLIC�TIQI ' FdFt CONSTI�UC'�'��N PEI;MIT � <br /> TO BE COMPLETED IN BLACK INK—PLEASE PRINT <br /> HEATING SYSTEM: �GAS G ELECTRIC J <br /> BUILDING DEPARTMENT <br /> 259-B810 <br /> DEMOLITfON COMBINATION BUILDING )C�(1ECHANICAL PLUMBING SIGN <br /> p ER IdAILApDFESS CITY ZIP FHONF. <br /> TEt��LC� �M���ILA��RESS CITV 21P PHONE <br /> AFCHITEGTOROESIGNER MAILA��RE55 QTV ZIP PHONE <br /> �A�� �mc:.T <br /> G JERA GONT LTOR MNLA�DRE55 CITY ZIP PMONE S TELICENSEM <br /> �o.�s ����-7�io� l�c.� �&�� �y�-iG3o B�E�-�c-,2is 3c� <br /> A1EGM�NICAL CONTR4CTOR lAAIL AOORESS CITY ZIP PHONE STATE UCENSE p <br /> PWMBINGGONTRAC"iOH MAILADDFESS CITV 21P PHONE STATEIICENSEx <br /> G� L/A5�5� OF V.'OPK . <br /> 7�vEW ADDITION ALTERATION REPAIR DEMOLITION WOODSTOVE/FRPL INSEFT � � BUILDING RELOCATION <br /> CONTACTPEPS�C�HONENO.� ^� /��� <br /> Z � o � � <br /> CONTRACT PRICE OF WORK � <br /> DESCR�BE WORH AND SOUARE POOTAGE INVOLVED <br /> � W�L C�w4 �-ih <br /> PROPOSEDUSEOFBUIL�ING i HEREBY CFiITIFY THAT I HAVE READ AND EXAMINED THIS <br /> APPIICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br /> LEGALDES RIPTIONOFPROPEflNISHOWNOELOWORATTACNFOUFCOPIES� PROVISIONSOFLAWSANDORDINANCESGOVERNINCTHISTYPEOF <br /> WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br /> �or� e�oc�c oF NOT. THE GRANTING OP A PERMIT DOES NOT PRESUME TO GIVE <br /> � / AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br /> I OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br /> PERFORMANCE OF CONSTRUCTION.THAT I AM AUTHORIZED BY THE <br /> OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH '�. <br /> APPLICATION IS MADE AND I COMPLY WITH THE STATE ' <br /> / _ �o� n/ ` CONTRACTQRS LAW 78.27 RCW AND 296.200 WAC. <br /> r� <br /> X � �/��/�v <br /> 3�evni� onrc � <br /> PROJGCTn�ORE55 , <br /> LIIY nU5'�:L55 LC�IlSC'!O I <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM FEE NO. TYPE OF EOUIPMENT FEE I <br /> WATE(i CLOSET(TOILET) A/C—AMNDLG UNITS—H.P. ' �I <br /> BATHTUB ; FORCED AIR SYSTEMS--B.T.U. M E.A. ' <br /> LAVATORY(WASH BASIN) � UNIT HEATERS—B.T.U. M � <br /> SHOWER l CLOTHES DRYERS ' <br /> KITCHEN SINK 8 DISP � VENTILATION FAN � <br /> DISHWASHER � / RANGE HOOD i <br /> LAUNDRY TRAY ; WATER HEATER ' I <br /> CLOTHES WASHER � WOOD STOVE � <br /> URINAL METAL I�IREPLACE&CHIMNEY ' <br /> URINKING FOUNTAIN � FIREPLACE INSERT � <br /> FLOOR DRAIN � HEAT PUMP � <br /> I BACKFLOW PF. NTERS GAS PIPING . i <br /> ROOF DRAINS— NLEADERS � EXHAUST FAN ' <br /> SINK(SERVICE—BAR,ETC.) � <br /> � � <br /> � � <br /> � <br /> SUB TOTAL S ' SUB TOTAL S ; <br /> � <br /> PERMIT $ � PERMIT S J� _ <br /> TOTALFEE S TOTALfEE 9 ._S�' <br /> FOR OFFICE USE ONLY: <br /> FECEIPT N0. <br /> PROIlTSETDACN RE4RSETBACH SIDESETBACK PLANCNECKNOIA�ER FEE <br /> L Z <br /> USEZONE LOTAREA VACANTSITE <br /> FEES VALUATION FEE <br /> BUILDING � <br /> 7YPEOFCOflTSALLOWABLE iVPEOFtON4.6Gi0AL oCCUP>4tr r.aotoWEIUNGuairs i <br /> cnouc pLUMBWG ' <br /> i <br /> SIZEOFB�OG. NOAFSTORIES �ASEMENT MECHANICAL <br /> A�DITIONAL PLAN CHECK ' <br /> OCGUPANCYLOAD FlRESPRNKLEPSREO'D HEIGHTLIMITATION i <br /> . <br /> SPRINKLER � <br /> REASON FOfl SPRINNlERS i <br /> STATE BUILDING SURCHAFiGE <br /> INTAKEDY PLANSAPPPOVEDBY CITYOFEVERETT PUBLICWORI:S � <br /> LOCAL SALES <br /> TAX CODEIS 3105 roTn� <br />