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APPLICATIQ_ . FOR CCIINSTRUCT;�Mi PERMIT �� <br /> TO BE COMPLETED IN BLACK INK—PLEASE PRINT <br /> RUILDING DEPARTMENT [ HEATING SYSTEM: �GAS �J ELECTRIC IJ _ J <br /> 259-8810 <br /> DEMOLITION COMBINATION BUILDING �uIECHANlCAL P�_UMBING SIGN <br /> O NER IdA1LAD�RE55 CITY ZIP PHON[ <br /> 1 L<y /�m�S <br /> TENANT MAILADDB[SS �ITY ZIP PHONE <br /> nFCHIiEGTORDE5IGNER lA�IL4D�FE55 CITY ZIP PHONE - <br /> �NERALCONTRACTOR MAILADDRE55 CITY ZIP PMONE STqTELICENSEp <br /> .9LCv N�ry,e S <br /> ��,f�OF��CON GiOR MAi��D�P�X ��/O/ �eC�ITV ��ZIP ���-/� 3ypNE r,S.TFTELICENSEu <br /> J E r y'�ct_ , I�C�Sl'�2/ S' <C l—� <br /> PLOMBINGCONTRACTOF MAILADDRESS GITV ZIP PHONE ST�TELICENF@r <br /> 'C�/AS'S OF WORN - <br /> 7�vEW ADDITION ALTERATION REPAIR DEMOLITION WOODSTOVE/FRPL INSERT BUILDING RELOCATION <br /> (.�.•�iRACTPRICEOFWORK a(1,S�LL C�jA.PI ' � �lnr �S/T�PERSONFNOP �JC-0� /�� ��`/�3 _ <br /> � J <br /> U?SCRIBE WOPH AND SOUARE FOOTAGE INVOLVED ---- <br /> r�rvoaoseouseoFem�ov+� i HEREBY CERTIFY THAT I HNVE READ AND EXAMINFD "fHl3 <br /> APPLICATION AND KNOW THE SAMF TO BE TRUE AND CORFIECT.ALL <br /> IFG�LOESCRIPTIONOFPqOPERTY�SHOWNBELOWOfl�TTACHFOl1RCOPIES� PROVISIONSOPLAWSANDORDINANCESGOVEFNINGTHISTYPEOF <br /> > q ��5���- WORK WILL BE COMPLFTED WITH WHETHER SPECIFIED HE,4EIN OR <br /> ior J I BLOGK oF 7�-- NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME 7� GIVE <br /> AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS 0= ANY <br /> OTHER Sl"ATE OR LOCAL LAW REGULATING CONSTRUCTION Oia THE <br /> PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br /> OWtJER OF THIS PaOPERTY TO PERFORM THE WORK FOR WHICH <br /> APPLICATION IS M�DE AND I COMPLY WITH THE ST�.TE <br /> CONTRACTORS LAW 1827 RCW AND 296.200 WAC. <br /> ( Z�- yo�s- /�� X � ,E./��/�.y <br /> PRO�ECiADDRE55 ��L�ront Dnif - <br /> arv 1915iLi95 uCilBc r!0 <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR I7EM FEE N0. TYPE OF EOUIPMENT FEE <br /> _ WATER CLOSET(TOILET) � A�C-0.�HNDLG UNITS—H.F. <br /> BATHTUB ; I FORCED AIR SYSTEMS—B.T.U. M E.A. <br /> _ LAVATORY(WASH BASIN) UNR HEATERS—B.T.U. M ;— <br /> SHOWER � CLOTHES DRYERS <br /> KITCHEN SINK 8 DISP ( VENTILATION FAN � <br /> DISHWASHER � RANGE HOOD <br /> IAUNDRYTRAY ' WATER HEATER � <br /> C�7TfiES WASHER � WOOD STOVE ; <br /> URIN,\L ; METAL FIREPLACE 8 CHIMNEY <br /> ORINKI�iG POUNTAW FIREPLACE INSERT ' <br /> FLOOR Oh.�IN HEAT PUMP , <br /> BACKFLOW Ph:VENTERS ' ;� GAS PIPING � <br /> ROOF DRAINS—Rh:VLEADERS � EXHAUST FAN ' <br /> SINK(SERVICE—BAR.=.TC.) � �.-�`T� , <br /> � <br /> —T— <br /> ' � <br /> � <br /> SUB TOTA� S SUB TOTAL 3 <br /> PERMIT S pERMIT $ <br /> TOTAL FEE $ TOTAL FEE $ <br /> FOR OFFICE USE ONLY: <br /> FPONT SETPACH REAR SETBACK SIDE SETBACN PLAN CNECK NU61�ER FEE REC[IPT NO. <br /> ����''('��. � <br /> usezone �oraaEn VACANTSITE FEES VALUATION FEE <br /> BUILDING <br /> iYPEOfCONIS.ALLOWABLE iVPE0fC01lSi.ACiIIAL o[CuvM[v uOovDwEw6aa.':��s <br /> caouv � PWM9ING � <br /> SILEOi8L0G. NOAFSTORIES BASEMENT ry i <br /> �J (�C�t'� �dECHANICAL , r7 '/,�, � <br /> >' J - <br /> OCCUPANCVLOAD FIpESPRNKLERSREO'D HEIGMTLRdITATION AODITIONALPLANCHECK � <br /> i <br /> SPRINKLER � <br /> R@ASON FOR SPRINNLERS � <br /> S7ATE BUILDING SURCHARGE <br /> INTAHE2Y �LANSAPPROVED�Y CITYOFEVERETT PUBLICWOflK$ � <br /> LOCAL SALES <br /> TAX C,OOE IS 3105 TOTAL � <br />