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� <br /> APPLIGA41�. _J �Oi� COIVSTRUCT ,N PERMIT � <br /> TO BE COMPLETED IN BLACK INK—PLEASE PRINT <br /> BUILDING DEPARTMENT HEATING SYSTEM: ❑GAS ❑ELECTRIC ❑ _ � <br /> 259-8810 <br /> DEA�IOLITION I COMBINATION BUILDING MECHANICAL PLUMBING SIGN <br /> CWNER MAILAODRESS CITY ZIP PMONE <br /> pq«� m S� T.Y . �ya� r:45ru.rE wa E. �acn Sol-rrr� 98ios 3a8-37iYs <br /> TENANT fAAIL ADDRE55 CITV 21P PHONE <br /> ARCHITECTOROESIGNER lAAILAD�RE55 GTV ZIP PMONE <br /> GENERAL CONTRACTOR MAIL ADDRESS CITV 21P PHONE STATE LICENSc Y <br /> MECHANICAL CONTRACTOR MAIL ADUPESS CITY ZIP PHONE STFTE UCENSE 0 <br /> PLUMBINGCONTRACTOR MNLADDRESS CITY ZIP PHONE STATELICENSEN <br /> ra��F� rJ�� ALw+,0..a6,�Tac. P.o. �o�c 4aa.�y o2E. 44oa.s s*sa•as�ds PherF',.�a�(�vc.N <br /> CLAS F WORK <br /> NEW ' �� ADDITION � '� ALTERATION � REPAIR � I DEMOLITION � WOODSTOVE/FRPL INSERT BUILDING RELOCATION <br /> C0Y i'-�'S PERSON AND PHUNE N0. <br /> CONiPACT PRICE OP WORK <br /> OESCRIBE WORK AND SOIIARE FOOTAGE INVOLVED <br /> PROPOSEDUSEOF8l11LDING i HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br /> APPLICATION AND KNOW THE SAME TO BE TRUE AND;ORRECT. ALL <br /> LEGAL�ESCRIPTION OF PROPEflTV(SHOWN BELOW OR ATTACH FOUR COFIES) PROVISIONS OF LAWS AND ORDINANCES GOVERNING 1 ii15 7YPE OF <br /> WORK WILL BE COMPLETGC WITH WHETHER SPECIPIED iiFREIN OR <br /> �or e�ocK oF NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br /> AUTHORITY TO VIOLATE OR CAtJCEL THE PROVISIONS OF ANY <br /> OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTIOPI OR THE <br /> PFRFORMP.NCE OF CONSTRUCTION.THAT I AM AUTHORIZED 8Y THE <br /> OWNER OF ThIS PROPERTY TO PERFOFM THE WORK FOR N,'HICH <br /> APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> CONTRACTORS LAW 1827 RCW AND 296200 WAC. <br /> � � � " � 9��-� - <br /> PROJECTADURESS �.����'i�� �—_� onL <br /> n o,1C77.J` <br /> � Wr; O rnvr,us�.^+css�icrrvseuo <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM FEE N0. TYPE OF EOUIPMENT FEE <br /> _� WATEFl CLOSET(TOILET) � NC—NHNDLG UNITS—H.P. <br /> � BATHTUB FORCED AIR SYSTEMS—�.T.U. M E.A. <br /> 3 L..4VATORY(WASH BASIN) � � UNIT HEATERS—B.T.U. M � <br /> T <br /> SHOWER ' CLOTHES DRYERS <br /> � KITCHEN SINK&D5P I VENTILATION FAN _�_ <br /> DISHWASHER � RANGE HOOD <br /> _L LAUNDRY TRAY ; WATER HEATER _ <br /> CLOTHES WASHER WOOD STOVE � _ <br /> URINAL METAL FIREPLACE 8 CHIMNEY <br /> DRINKING FOUNTAIN � FIREPLACE INSERT <br /> FLUOR DRAIN HEAT PUMP <br /> BACKFLOW PREVENTERS � GAS PIPING � <br /> ROOF DRAINS—RAINLEADERS � EXHAUST FAN <br /> SINK(SERVICE—BAR,ETC.) � - <br /> � <br /> � � <br /> i —�— <br /> SUB TOTAL S g ' SUB TOTAL 3 <br /> PERMIT 5 Zp � PERMIT S � <br /> TOTAL FEE S /0 � TOTAL FEE $ <br /> FOR OFFICE USE ONLY: <br /> FPONT SETDAGK AEAR SETBACK SIDE SETBACK P�AN LNECK NUMBER � FEE AECEIPT N0. <br /> � <br /> usEzoNe LOTAREA VACANi51TE FEES VALUATION FEE <br /> BUIL�ING <br /> 1YPEOFCONiS,pIIOWABLE 7VPEOFGOtlST.ACiUAL acuvaxcr xa.ovOV+FLlixtuxn5 � <br /> caoua � PLUMBING � <br /> i <br /> SREOFBL�G. NO.OFSTORIES BASEMENT MECHANICAL � <br /> OCCUPANCVLOAD <br /> FIRESPRNKLERSflEO'D IiEIGHTLIMITATION ADDITIOMALPLANCHECK i <br /> i <br /> SPflINKLER i <br /> REnSON FOR SPRINKLEflS STATE�UILDING SURCHARGE <br /> '_ <br /> INTqNEBY PLANSAPPROVEDBY CITYOFEVERETT PUBLICWORKS <br /> LOCAL SALES <br /> TAX CODEIS 3105 TOTAL <br /> $'_- _ � - =� <br />