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_._._ - _ -_� <br /> 1�PPLICATI�.,J� FOR CONS'�RUC"1 _.yN FAEE;MIT //�'�,, <br /> TO BE COMPLETED IN BLACK INK—PLEASE PRINT �a;� <br /> 1��3 <br /> BUILDING DEPARTMENT f HEATING SYSTEM: ' GAS [J ELECTRIC ❑ � <br /> 259-8810 <br /> DEMOLITION COMBINATION ✓ BUILDING MECHANICAL PLUMBING SIr,N <br /> OWNER , MAILADDRE55 <br /> � CITV ZIP PMONE <br /> �;�F„''�-� '�r��.�•; -i��= 3z�o E�c�'1R��A� E �,,-� ;� ��� 9 g l a z 3 � � -��� <br /> TENANi MAILAOOFESS GT� ZiP PHONE <br /> Fi1CHITECTOR0E51GNEF MAILADDRESS GITV 21P PHONE <br /> GGNERALCONTRACTOR MAILADDPESS CITV ZIP PNONE STFTELICENSEN <br /> L`�:'l�l.�,mas 1�� ��r� C�N� �>> � C ��'P a.� SP�`1e �1F�1p7 3�.-FI 377� ���}�ly� s /z�y <br /> MEpFIqNICALCONTRACTOiY MAILAO�RESS C� ZIP PHONE STATELICENSEa <br /> PIUMBINGCO+iRACTOR MAILADDRESS qTY ZIP PNONE STATELICENSEp <br /> CLASS ORK — <br /> � ADDITION ALTERATION REPAIR DEMOLITION WOODSTOVE/FRPL INSERT . BUILDING RELOCATION <br /> GONTACT PERSO �PNONE NO. J <br /> CONTqACi PFICE OF WOPH � �p��p �J,S h �. �D� <br /> ir i-• L <br /> �LSCRIBE WORK ANDSOUARE FOOTAGE INVOLVED <br /> �� '9�� `� � ' �.' �-�, d�� ���^r�� � <br /> VROPOSEDUSEOF ILOING "' _� � <br /> i HEREBY GERTIFY THAT I HAVE READ AND EXAMINED THIS <br /> �� �IY1/IJ' � yiC1) APPLICATION AND KNOW",-FIE SAME TO BE TRUE AND CORRECT.ALL <br /> LEGALOESCRIPTIONOFPR 'RTY�SHOWNP.'cLOWORATTACHFOURCOPIES� PROVISIONSOFLAWSAWDORDINANCESGOVER�INGTHISTYPEOF <br /> WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br /> �or� BLOCH oF C O NOT. THE GRANTING OF A PERMIT DOES NOT P!iESUME TO G�VE <br /> � /I� C,Tt/ o-�' - %e,-b� OTHER S ATE ORVLOCAL L W REGULATING CONSTRIUCOTION OR THG <br /> PERFORMANCE OF CONSTf JCTION. THAT I AM AUTHORIZED BY THE <br /> OWNEA OF THIS PR�PEP�".Y TO PERFORM THE WORK FOR WHICH <br /> APPLICATION IS MAC_' AND I COMPLY WITH TF�E STATE <br /> CONTRACTORS lAW�8..7 RCW AND 296.200 WAC. <br /> PROJECTADDRESS ^^ X,�pr���� � �/n�LJ C.- <br /> �I / � ��A<e fr l/./Il � �.i1vA05i6!�.SSI!CLh5Eli0 �AiF <br /> PLUMBI G MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM FEE NO. TYPE OF EQUIPMENT FEE <br /> WAT"R CLOSET(TOILET) A/C—A�HNDLG UNITS—H.P. <br /> BATHTUB ; FORCED AIR SYSTEMS—B.T.U. M E.A. <br /> LAVATCRY(WASH BASIN) UNIT HEATERS—B.T.U. M <br /> SHOWER � CLOTHES DRYERS , <br /> KITCHEN SINK&DISP VENTILATION FAN � <br /> DISHWASHER � RANGE HOOD <br /> LAUNDRVTRAY WATER HEATER <br /> CLOTHES WASHER � WOOD STOVE � <br /> URINAL METAL FIREPLACE 8 CHIMNEY <br /> DRINKING FOUNTAIN ; FIREPLACE INSERT <br /> FLOOR DRAIN HEAT PUMP , <br /> 6ACKFLOW PREVENTERS ; GAS PIPING � <br /> ROOF DRAINS—RAINLEADERS EXHAUST FAN ' <br /> SINK(SERVICE—BAR, ETCJ � <br /> � � <br /> � i <br /> SUB TOTAL S SUB TOTAL $ <br /> PERMIT S � PERMIT $ <br /> TOTAL FEE $ TOTAL FEE $ <br /> FOR OFFICE USE ONLY: ���G IZ % <br /> PRONTSETBACK RF.ARSETBACK SIOESETBACK PLANCHECKNNA�E� FEE RECEIPTNO. <br /> 'z�' �" s' .,35 735 3Q= <br /> usEzoNe �LOTAyREA VACANTySITE FEES VALUATION FEE <br /> —I ' / C', /E� BUILDING ��)/1 / �,; ��'i� <br /> ivPEOFGONiS.FLLOWABLE TYPEOFCO!ISi.ACtUAL octc�z!�cr uDo�ow[wr;cc:�;s �-V <br /> �- � ^- �� � PLUMBING i <br /> _ <br /> SIZ[OFp�DG NO.OFSTORIES BASEMENT � <br /> ��/I.�� ���J ,� ��O MECHANICAL ; <br /> Y <br /> OCCIIPANCYLOFD FIRESPRNNLERSfiEO'D NEIGHT 1dIT�TION ADDITIONALPLANCHECK �I/') � <br /> �7�IU � L'� , �.�., <br /> SPRINKLER <br /> REASON FOR$PPINKLERS <br /> STATE BUILGMG SURCHARGE � ' %1 <br /> (l <br /> INTAKEAv PInNSAPPROVEDOY CITYOFEVERETT PUBLICWORKS /1 i <br /> LOCAL SALES L�� <br /> � 3/��y'Z. TpX CDDE IS 3105 rorn� —. ;� �i;:� <br />�( }E(F'.'�1.V 7.�^t�\� ,:l�! Y. .. � . . .. . . . �:�~ l�r.vn' ;h�"'_�'Y <br /> �. <br /> �` <br /> . . . :. .i..�. R..��S <br />. . . . . 1...,. � _ . �:2. �/.:_. .._. . ... --ix` . . .�. <br />