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� . <br /> APPL�CAT�G 7 FOR CONSTRUCT7N PERMIT � <br /> TO BE COMPLE7EU IN BLACK INK—PLEASE PRINT <br />, HEATING SYSTEM: �T,�GAS O F.LECTRIC ❑ —� <br /> BUILDING DEPARTti9ENT <br /> 259-8810 <br /> II ❑ QEMOLITIO ' f 1 COMBINATION IJ BUILDING ixMECHANICAL ❑ PLUMBING ❑ SIGN <br /> WN fl <br /> 61AILADDRE55 CIiV ZIP PHONE <br />� ,v,�� avna s���.,;� A„� t��.��ff ��, ► � s8-�vs�; <br /> I ���% F -�` ��� CITV ZP FHONE <br /> ITENANT MAIL ADDRESS <br /> -��T� Z�p PHONE <br /> PRGHITE:'ONDESIGNER MAILADDRESS <br /> GENERALC NTRACTOF MAILADDRESS <br /> CITY ZI° PHONE STATE LICENSE M <br /> !�/�YN�> Gns 1�� r�3ofi SZ�34� �v�cnc.7�/ 9g'Jd� as5-SvS.:L a/l�irr�o�Pl'2_ <br /> MECHAHICALCONTRACTOR MnILADDRESS <br /> CITY ZIP PMONE STATELICENSEi <br /> PLUMBINGCONTRACTOR MAILADDRE55 <br /> CITV Zlh PHONE STATELCENSE� <br /> - CON7RACTPflICEOFWOHK� � <br /> �S7�C7 <br /> CONTACTPERSONANOPHONE"O. <br /> DESCflIBE WORK ARO SOtlRRE FtiOTAGE INVOLVED _ <br /> / ^ <br /> C O�'iFT� �7'KNl4�'�- �`'�oAS iP� . <br /> i HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br /> PROPOSED USE OF BUILDING APPIICATION AND KNOW��HE SAME 1 O BE TRUE AND CORRECT.ALL . <br /> PP,OV;SIONS OF LAWS At:D ORDINANCE�GOVERNiNG THIS TYPE OF <br /> LEGALDC .flIPTIONOFPqOPEPTV�SHOYMBELOWOBARACHTWOCOPIES� WORK WILL BE COMPLETED WITH WHETHEA SPECIFIED HEREIN OR <br /> NOT. THE GRANTING OF A PEFMIT DOES NOT PRESUME TO GIVE <br /> �oT B�ocK or AUTHORITY TO VIULATE OR CANCEL THE Ph,OVISION- OF ANV <br /> � OTHER STATE OR LOCAL LAW REGULA7ING COVS'fRUCTIG:�OR THE <br /> PERFORMANCE OF CONSTRUCTION.THAT I AM AUTHORIZED BY THE <br /> OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br /> i __ _ qpPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> � PRRCEL TAX I.D.NUMBER CCNTRACT RS LAW 18.27 RCW AND 296.200 WAC. <br /> CONSTRUCTION LOAN LENDEP.AUDR�.SS TELEPHONE NUMBER ,�- ��S�v <br /> {Jow = 341b - 3`IT� SY xc � <br /> SIG TURE �ATE <br /> � WECTADDRESS �/ q - <br />, �y�� � ��� y c V9USMESSIILEN5EN0 <br /> I . PLUMBING MECHANICAL <br /> TYPE OF ECUIPMENT FEE <br />! Np, TYPE OF FIXTURE OR ITEM FEE N�' a�aHNDLG UNITS—H.P. ' <br /> � � WATER CLOSET(TOILET) , �ORCED AIR SYSTEMS—B.T.U. M E.A. ' � <br /> ' BATHTUB —; I <br /> LAVATORY(WASH BASIN) __ � UNI';HEATERS—B.T.U. M — <br /> � � — � CLOTHES DRYERS � <br /> ! SHOWER � VENTILATION FAN -� � <br /> . KITCHEN SINK 8 DISP � RANGE HOOD <br /> DISHWASHER � �' <br /> i � LAUNDRY TRAY ; WATER HEATER _ , <br /> CLOTHES WASHER � WOOD STOVE ' <br /> � ��. � METAL FIREPLACE(WCfOD BURNING) ' . <br /> j � UPINAL � FIREPLACE INSERT � ' <br /> j DRINKING FOUNTAIN HEAT PUMP � <br /> . FLOOR DRAIN � GAS PIPING ' <br /> � BACKFLOW PREVENTERS ' � <br /> ROOF DRAINS—RAINLEADERS � EXHAUST FAN —�— <br /> SINK(SERVICE—BAR,ETC.) _ � <br /> � <br /> � T <br /> i � <br /> � <br /> SUB TOTAL S ' SUB TOTAL $ � <br /> � PERMIT $ ' <br /> — PEPMIT $ ' TOTAL FEE S i_ <br /> — TOTALFEE $ � � <br /> FOR OFFICE USE ONLY: aeceiH;r+o. <br /> FRONTSETBACK REpp5ET8ACK SIDESETBAf,N PLANCHE KNUOM�ER FEE <br /> pC% <br /> VA(:ANT SITE FEES <br /> VALUATION FEE <br /> USEZONE LOTAFEP i <br /> L YES ❑ NO BUILDING <br /> �— ' <br /> NO.OFSTORIES OLGJPM'C! NOA�OY�ELl14�ON115 � <br /> T1PE OF CGNSi ;noar PLUMBING � �— <br /> _ ; <br /> FIRE SPRINKLE55 REO'D BASEMFIIT MECHANICAL . <br /> S2E OF BLD!'�. � <br /> G YES ❑ NO � <br /> ADDITIONAL PLAN CHECK <br /> pCCUPANCY LOAD FIRE ALARM REOD HEI�HT LIMITATION i <br /> OTHEN <br /> � <br /> aEA50N STATE BUILDING SURCHARGE � <br /> i <br /> INTAKEBY PLANSAPPROVEDBV CITYOFEVERETT PUBLICWOfiKS � <br /> LOCAL SALES � <br /> I TAX CODEIS 31U5 TOTAL <br /> I onre - <br />