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APPLI�GATI� _. FOR CONSTRUC7 )N i�EREVIiT <br /> TO BE COMPLETED IN BLACK INK—PLEASE PRINT �� <br /> BUILDING DEPARTMENT HEATING SYSTEM: i,j GAS ❑ELECTAIC ❑ � <br /> 259-8810 <br /> DEMOLITION COMBINA"i ION BUILDING MECHANICAL LPLUMBING SIGN <br /> a�vN�� MAILADDRE55 QTY ZIP ��/E PMONE p <br /> DAL�v I�OnEl -vG .3:Ly'tl C"9dr/aE.r .�l�E �Adf f�Tb a200 'O/O 'Z .��i0 J7�O <br /> TENANT MAILAJORESS GN Z�p <br /> PMONE <br /> AqCHITECTOR�ESIGNER MAILA�DRE55 CITV ZIP PHONE <br /> GENE6ALLONTRACTOq MAILAD�RE55 CITV ZIP PNpNE <br /> STATE LICENSE a <br /> MECHANIC<.LWNTRACTOR MAILR�DRESS CRY ZIP PHONE — <br /> STATE LICENSE n <br /> �PLUM6INGCONTRACTORA �ANLA��RE55 CITY ZIP PMONE - <br /> �C�F/L N• �• rI STqTE UCENS[a <br /> LM6/ ..Z'�.c �o Q'ox ZS 7'7 J�,on/t Lv 9�/l S J'3-15PJ" �'ac,r-n. )�`fc <br /> GLASS OF WORN <br /> �.(/NEW ADDITION 4LTERATION REPAIR � DEMOLITION WOODSTOVE�FRPL INSERT BUILDING RELOCATION <br /> GOPIACT PEFSON AND PHONE NO. <br /> CONTRACTPRICF^.I WORK <br /> OESCRIBE VlOdK AN�SOUARE FOpTAGE INVOLVED — <br /> PROPOSE�USE OF BUIl01NG <br /> � HEREBY CERTIFY THAT I HAVE READ AND EXAMItJED THIS <br /> ��"—�-' -r �"2 APPLICATION AND KNOW THE SAME TO BE TPUF AND CORRECT.ALL <br /> IEGALDESCRIPiIONOFPpOPCRTV�SHOWNOELOWORqTfACMfOURCOPIES� PROVISIONSOFLAWSANDORDINANCESGOVERNWGTHISTYPEOF <br /> ��*� `f' etocK oF WORK WILL BE COA7PLETED WITH WHE7HER SPECIFIED HEREIN OR <br /> NOT. THE GRANTING OF P. PERMIT DOES NOT PRESUME TO GIVE <br /> AUTHORITY TO VIOLATE OR CANCEL THE PHOVISIONS OF ANY <br /> 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 1 HE WORK FOR WHICH <br /> APPLICATION IS MADE AND I COP.IPLY WITH THE STATE <br /> CONTRACTORS LAW 78.27 RCW AND 296200 WAC. <br /> X a,G��/=2�1 Z <br /> PROJEGTAODRESS SiGr+,u��[ <br /> �/7 y�sT �l °��E <br /> arr ous�at ss ucehso-r,� -� <br /> PLUMBING MECHANICAL <br /> NO. TYPE OP FIXTURE OR ITEM FEE NO. TYPE OF EOUIPMENT FEE <br /> WATER CLCSET(TG�E7) /� � A�C—A�HNDLG UNITS—H.P. <br /> Z BATHTUB o ; FORCED AIR SYSTEMS—B.T.U. M E.A. �— <br /> LAVATORY(WASHBASIN) ,�G � UNITHEATERS—B.iU. M � <br /> � SHOWER � CLOTHES DRYERS �— <br /> / KITCHEN SINK&DISP ,f'� ; VENTILATION FAN <br /> � DISHWASHER RANGE HOOD <br /> LAUNDRY TRAY ; WATER HEATER <br /> CLOTHES WASHER � WOOD STOVE � <br /> URINAL ; METAL FIREPLACE&CHIMNEY <br /> DRINKING FOUNTAIN FIREPLACE INSERT <br /> FLOOR DRAW � HEAT PUMP T— <br /> B�CKFLOW PREVEWTERS ; GAS PIPING <br /> _ RJOF DRAINS—RAINLEADERS � EXHAUST FAN � <br /> SINK(SERVICE—BAR,ETC.) ; <br /> � <br /> _1_ <br /> ' �— <br /> �— <br /> / , <br /> __ SUB TOTAL S L 5" ' S1,9 TOTAL $ <br /> PERMIT • $ /v � PERMIT g ' <br /> TOTAL FEE $ ����� TOTAL FEE $ <br /> FOR OFFICE USE OIdLY: — <br /> FflONTSET�ACN REARSETBACK SIqE5ET8ACK PLANCHECNNUldBER FEE RECEIPTNO. <br /> JG.�' j % <br /> USEZONE LOTAREA VACFNTSITE FEES VALUATION FEE <br /> BUIIDING � <br /> iVPECiWNTS.ALL014ABLE TYP'OFCOHSiACiIIAI o[cuaar,cv naorowEwmGuynS — - <br /> cnou� <br /> PLUMBING �S � ' <br /> S12EOF�LUG. NO.OFSTORIES �TSEMENT — <br /> MECHANICAL � <br /> i �� <br /> OCCIIPANCYLOFD PIRESPRNKLERSREQD V:EIGNTLIh1RATI0N ADDITIONALPLANCHECK i ,y <br /> i <br /> REASON FOR SPRINKLERS SPRINKLEFi � <br /> —l—'__ <br /> S7ATE BUIL�ING SURCHARGE <br /> INTAKEBY PLqNSAPPROVEDBV CITYOFEVERETT <br /> PUBLIC WORKS <br /> LOCAL SALES <br /> TAX COOE IS 3105 TOTAL � <br /> 71" ' �c. <br />