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�lPPLiCATIC a F06� CONSTRUC7 'N fPEF�IV1iT ���� <br />� TO BE COMPLETED IN BLACK INK—PLEASE PRINT <br /> BUILDING DEPARTMENT HEATING SYSTEM: l�,GAS ❑ELECTRIC ❑ I <br /> 259-8810 <br /> I I DEMOUTION I I COMBINATION �� BUILDING I I MECHANICAL I � pLUMBING I SIGN <br /> OWNEH lAAIL�DDPE55 GIiY ZIP PHONE <br /> i�il`�!-L`�" �1r?M�lr=`_ "3� ti " - L�).A7��a�=c .l„� i. � ... t�; � � ���, �; P �� ._� _ -� (% ; �� -i �, <br /> TENANT MAILAD�HESS CITY 21P � PHONE <br /> ARCHIIECiOfiDESIGNER MNLADDRES3 CITY ZIP PI/ONE <br /> GENERALCONTRACTOfi MAILAD�qESS CI7Y ZIP PHONE SfAIELICENSE� <br /> `-, r� r�� r= r'� �� r c.�iv c��_ i�A�� y�-�i i a oc 7 <br /> MECHANiCALCONTRACTOR MAILADDOESS GIiY 21P PNONE S7ATELICENSE� <br /> PLUMBING CONTfl�CTOR MAIL ADORE55 CITY 21P PHONE STATE IICENSE a <br /> �LASS O�WORK <br /> l'I NCW f 1 ADDITION f I ALTERATION I I flEPAIR I I DEMOUTION I I WOODSTOVE/FRPL INSERT I I BUILDING RELOCATION <br /> CONT4CT PERSON AN�PHONE NO. <br /> CONTRACTPRICEOFWORK \ (1 I�1 ✓� �� r`-�V{, ' �i J P ,� > ? > <br /> DESCRIBE WORN AND SOUARE FOOTAGE INVOLVEO _ �- � l, /_ <br /> /SC/�'C. � ��� _�:� (-, t =��r'7" _ <br /> PROPOSEDUSEOFBUILOING i HEREBY CERTIFY THAT I HAVE READ AND EXAA4INED THIS <br /> �, '�V���p ���OnM� I �' ��� �.i!,I t'-�n c "r� APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECL ALL <br /> LEGALDESC IPTIONOFPqOPERTV�SHOWNBELOWORATTAGHfOURCOPIES) PROVISIONS OF LAWS ANU OROINANCES GOVERNING THIS TYPE OF <br /> WORK WILL BE COMPLETED WITH WHETHER SPECI�IED HEREIN OR <br /> �or � � a�oce oF �� IVL I�ai,Jk- U--r NOT. THE GRANTING OF A PERMIT DOES NOT PRESiIME TO GIVE <br /> ( AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br /> ���_�- � -I' ("�Cl p (� OTFIER STATE OR LOCAL LAW REGULATING CONSTRUC1lON OR THE <br /> PERFORMANCE OF CONSTRUCTION.THAT I AM AUTHOAIZED BY THE <br /> OWNER OF THIS PRCPEATY TO PERFORM THE WORK FOR WHICH <br /> APPLICl1TION IS MADE AND I COMPIY WITH THE STATE <br /> CONTRACTORS LAW 18.27 RCW AND 296200 WAC. <br /> Ii '-��� <br /> � i� ' �' - - <br />� X ' i:J�-'. . '-�'f'<7;�`•��='� <br />� rr�aeer aooeess s�c�u.une'-' n��e <br /> r t!� 1 � <br /> i <br /> �n �� �" L� '= ��� /=�! CC cirvausieessucerrseeo <br /> PLUMBING �dECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM FEE NO. TYPE OF E�UIPMENT FEE <br /> WATER CLOSET(TOILET) A/C-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 I <br /> SHOWER � �\ CLOTHES DRYERS � <br />' KITCNEN SINK 8 DISP ; � .VENTILATION F�N ; <br /> DISHWASHER � RANGE HO00 <br /> i f.AUNDRY TRAY ; WATER HEATER <br /> CLOTHES WASHER � WOOD STOVE � <br />� URINAL \ ; METAL FIREPLACF&CHIMNEY <br />' L�RINKING FOUNTAIN � FIREPLACE INSERT � <br /> FLOOR DRAIN �\ HEAT PUMP � <br /> BACKFLOW PREVENTERS �'� ; GAS PIPING � ; <br /> ROOF DRAINS-RAINLEAUERS � EXHAUST FAN <br /> SINK(SERVICE-BAR,ETC.) ; <br /> � <br /> -- ' <br /> � � <br /> — ; <br /> I SUB TOTAL $ ; SUB TOTAL S ; <br />' PERMIT S PC-RMIT 5 � <br /> TOTAL FEE $ ; TOTAL FEE 3 ' <br /> FOR OFFICE USE ONLY: <br /> FflONT SE7BACK AEM SETBACN SIDE SEiBACK PLAN CHECK NUMBF�q� FEE A=CEIPT NO � - <br /> ' �Slv> > ,,��7 <br /> ? r ' �7_c> � � � � �� /C�'r- <br />� usezor �ornnen vncn�Jir�sipTe FEES VALUATION FEE <br /> �-! � [7C��i 7v7 BLIILDING � � CS� /l 'rT L' v[J <br /> TYPEOFC01li5.ALLOWABLE TYPE FGONSCACIUAL aNrultr rvoafUwFWxGUGns i <br /> ���J ',� �PO� ' PLUM�ING "—i <br /> SI2E OF BIUG. NO.OF STORIES BASEMENT � <br />� 3CJ9S Sr�GA 2 �v MECHANICAI —* <br />, OCCUPANCYLO�D FlRESPRNKLERSRE00 HEIGHTLIMIiAJION ADDITIONALPLANCHECK 1r- <br />� �/ - N J ZjB -SPRINKtER' I <br />'� J/kJ/Z �}'- <br /> HEASON OflSPRINHLERS �— <br /> STATE BUIL�ING SUFCHARGE ��� ) <br />� INTAKEBY PLANSAPPROVEDBY CITYOFEVERETT PLI6LICWORKS � � i <br /> �J�E LOCAL SALES , <br /> 1 ��,� TAX COOEIS 3105 TOTAL ; <br /> - _----. _. ._ __ _ _� �� .- ,; ; <br />�{� � - -- __-- -- - _ _ <br /> RF�� , ,. <br /> :. "e»��k�.�."' : _. ..._ .- ::.�.:. ._- :>' ' :_:::. ... �,__._-�-�r:..'.� <br /> _!� �� \\-" ,. ...�. . . � � .._ : -'� .rr:, <br /> ,.. . , �-:. '_-_ ._.._ - <br /> ` . .._,,_ _ . _ _ .... _ „ - . - <br /> _ - - -- '.....; <br /> � ... _ �:�. .� <br /> . _... -�1t . ._ .--. - ,-_� n__,_-...,. .._:. - Y � <br /> _ _ �: �.:,� r <br /> ' <br /> - -"_ - '�`--i}. -, . .. . . . . . r.- . ._ -ai aw;y-rsE �a� �� <br />