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APPLlCATIC ! F'OR COIdSTRI�CT �PI PERiNIT �� <br /> TO BE COMPLETED IN BLACK INK—PLEASE PRINT Err <br /> BUILDING DEPARTMENT HEATING SYSTEM: .J GAS ] ELECTRIC ❑ <br /> 259-8810 <br /> DEMOLIT�Ot� COMBINATION BUILDING XMECHANICAL PLUMBING SIGN <br /> ONNER ^� ' 1 ` MAILAD�RESS CITV ZIP PHONE <br /> � ' <br /> 1 � <br /> TENANT � MAILA��PE55 CITY ZIP PHONF_ <br /> APCNITECTORDESIGNER MFILAOORESS CITY ZIP PMONE <br /> G NERALCONTRACiOR IdA1LADDPESS CITV ZIP PM9NE STATELICENSEtl <br /> qLLy f�om�S <br /> Id HANICAI CO flACTOR MAIL A DflE55 CITY ZIP PHONE TATE UC E a <br /> obs��ce, 1�� gox 7oi�� g�,c� , �BoorJ 7y1-/G3o G�bS�a2is3 N <br /> PLUMBINGCONTHACTOR MAILADDRESS CITY ZIP PHONE STATELICENSEa <br /> CLASS OF YlORK <br /> � ��NEW . . ADDITION � ALTERATION �� REPAIR DEMOLITION �. � WOODSTOVE/FRPL INSF.RT BUILDING RELOCATION <br /> GONTRACi PRICE OF WOFK Z �O G CONTPCT PER50�i�NE NO. � �� �_ /� � 6 <br /> 1 [ <br /> j���P <br /> OESCRIBE WORK AND SOUARE FOOTAGE INVOLVFO <br /> �nSlAr/ !x?�.•J ca�ST C��Ie,Te. �^Q.4T� �j SS. <br /> PROPOSE�USEOFBUIL�ING i HEREBY CERTIFY THAT I HAVE READ AND EXAMINED ThIIS <br /> APPLICATION AND KNObV THE SAME TO BE TRUE AND CORRECT.ALL <br /> LEGAL OESLRIPTION OF PROPERTV�SHOWN BE�OW OFATTACH FOUP COPIES) PROVISIONS OF IAWS ANU ORDINANCES GOVERNING THIS TYPE OF <br /> WORK WIIL BE COMPLETED WITH WHETHER SPFCIFIED HEREIN OR <br /> �ot Z � otocK oF NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br /> � AUTHORITY TO VIOLATF OR CANCEL THE PROVISIONS OF ANY <br /> OTHER STATE OF LOCAL LAW REGULATING CONSTRUCTION 0� 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 STAI�[ <br /> CONTRACTO S LAW 1827 RCW AND 296.20C WAC. <br /> g z� - yd�-r-�, �� � �U��-��,-��. <br /> PP.OJEQ ADDRE55 �r,rinrun[ onre <br /> Clil'BUSINE55 LICENS[NO. <br /> PLUMBING MECHANICAL <br /> �: TYPE OF FIXTURE OR ITEM FEE N0. TYPE OP EdUIPMENT FEL <br /> WATER CLOSET(TOILET) � A/C—AiHNDLG UNITS—H.P. � <br /> BATHT�UB y FORCED AIR SYSTEMS—B.T.U. M E.A. � � <br /> LAVATORY(WASH BASIN) � UNIT HEATERS—B.T.U. M ; � <br /> SHOWER � CLOTHES DRYERS � � <br /> � KITCHEN SINK 8 DISP ; VENTILATION FAN ; �''' <br /> . DISHWASHER � RANGE HOOD �1 <br /> I' <br /> LAUNDRY TRAY ; � WATER HEATER � � i, <br /> CLOL .vASHER WOOD STOVE ; <br /> � URINAL ; METAL FIREPLACE 8 CHIMNEY � <br /> � DRINKING FOUNTAIN FIREPLACE INSERT ; <br /> FLOOR DRAIN HEAT PUMP � <br /> � BACKFLOW PREVENTERS ; 3 GAS PIPING ; <br /> ROOF DRAINS—RAINLEADERS � EXHAUST FAN � � <br /> � SINK(SERVICE—BAR,ETC.) ��� <br /> , ; t� <br /> � , <br /> � , e� <br /> SUB TOTAL S ; SUB TOTAL $ 1 <br /> PERMIT S � PERMIT § j� <br /> TOTALFEE S ; TOTALFEE S � <br /> i <br /> FOR QFFICE USE ONLY: i <br /> FRONTSETBACN REARSETBACN SIOESETBACK PLANCHECKNUMBER fEE REGEIPTNO. ' <br /> Z �j Z I <br /> , <br /> USEiON[ LOTqRGI VACANTSITE FEES VALUATION FEE � I <br /> J <br /> BUILDING i '�� <br /> 7YPEOFCONiS.ALL�WnBtE iYFEOFCONST.ACiUAL xcuvsr�w r:aavow[un;cunns ��� <br /> 4P0pP PLUMBING <br /> �Y <br /> SIZEOiBL�G. NO-0FSTORIES BASEMENT MECHAMICAL <br /> F, <br /> OCCUPANCYLOBD fIFESPFNNLER5RE0'D HEIGNTLIM",iATION ADDITiOIJALPLANCHECK �' <br /> l. <br /> SPRINKLER <br /> i <br /> flEA50N FOR SPRINKLERS T <br /> STATE BUILDING SURCHAFGC <br /> INTANEBV PLA�ISAPPROVEDBV CITYOFEVERETT PUBLICWOFKS � <br /> LOCAL SALES I <br /> TAX CUDEIS 3105 TOTAL <br />