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APPLICATIC'�1 FOR CONSTRUCT�"9N PERMIT � <br />� TO BE COMPLETED IN BLl'.CK INK—PLEASE PRINT <br />� � HI EATING SYSTEM:���GAS �J ELECTRIC U � <br /> BUILDING DEPARTMENT <br /> 2ss-aaio <br /> ��EMOLITION !�! COMBINATION ikr BUILDING 1�MECHANICAL �PLUMBING ;_I SIGN <br />� OtYNEF MAII�D�RE55 <br /> CITY ZIP PHON[ <br /> �izr�� � o ,E s 7,u� i39i:1 6Yr��s� �n���io��� ,�� l��U �.�G6s� 337-/a�� <br />� IEN�NT � MMLADORESS CRY <br /> ZIP PMONE <br />( -- PHONE <br /> �RCNiTECTORDE5IGNER GAILADORE55 ��TY ZiP <br /> ALc�� rC-,�— 'Srf/.� �,��.�A�if/� ��ru/�N %l.a "I L ���C� y�cS- 5�9D ti _ <br /> CITV ZIP �HONE STATEUCENSEa <br /> GE/N�ERALCONTRACTOR MAIL�DDRESS �/� / / / ' <br /> f ��1��Ll����rs.7�lC /?"l/,7���r�,(N.�- �.C�/k�it,.�/7 [�ilt %�z%0 ����7/�1�7% �A�'('dIG'7/GIC� <br /> MEnGMFHIC�LCON�T�RACTOR � 1.1pIL�DORESS <br /> CITY � ZIP PNONE STATCLICENSEa <br /> ( � ) �JOAI 1 � Z�p PHONE STATELICENSEN <br /> PLUMBING CONTRACTOR MAII ADOFESS CITY <br /> �v��ui�/�:n i o ' _. G`1��,.� ��n�u�n,��� �,1.�7 %F"9/� ��o(�-� �/'r� CS 73 <br /> GONTRACT PRIGF OF ORK <br /> 77.5�"n _ r <br /> D°SCRI6E WORK�ND$OU�FE FOOTAGE INVOIVE� —� / �,S GONTFCT PERSON A �PtNF.N0, � C/� �_ �/ //1����5 <br /> ...,lq ' ,nv l t`fi /"I — <br /> _ � _ � ! <br /> I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED TH1S <br /> PROPOSE�I1SE OF BUILOING APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br /> T J � y. �y PROVISIONS OF LAWS AND OFDINANCES GOVERNING THIS TYPE OF <br /> `Jr u` WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br /> LEGALDESC IPTIONOFPROPERTY�SHOWNOELOWORATTACHTWOCOPIES� � <br /> �� �'��� �e �E� NOT. THE GRANTWG OP A PERMIT OOES NOT PRESUME TO GIVE <br /> �oi-1�— biOCK oF AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br /> OTHEfl STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br /> PERFORMANCE GF CONS7 qUCTION.THAT I AM AUTHORIZED 8Y THE <br /> OWNER OF THIS PROPEf+I'Y TO PERFORM THE WORK FOR WHICH <br /> APPI_ICATION IS MADE AND I COM"LY WITH THE STATE <br /> PARCELTAX�D.NUMBER CONI"RACTORS LAW 78.27 9CW AND 29o.20G WAC. <br /> / .L���/"'-'4�E.t�� _ <br /> CONSTRUCTION LOAN LENDER.AO�RESS.TEIEPHONE 4U61BER /, /GI�Lf� <br /> sicru uae� °n'[ <br /> PROJECTADDRESS �� /U - �-- <br /> cnv ouSi��E,S uC[rvs[rcn <br /> PLUMBING MECHANICAI <br /> NO. TYPE OF FIXTURE 0!i ITEM FEE N0. <br /> TYPE OF E�UIPMENT FEE <br /> � WATFR CL6SET(TOILET) � AIC—:.�HNDLG UMITS—H.P. _ <br /> '� BATHTUB ' / FORCED.4IR�YSTEMS—B.T.U. M E.A. _ <br /> JS LAVATORY(WASH BASIN) � UNIT HEATE� �—B.T.U. M _ _ <br /> SHOWER CLOTHESORYERS ' — <br /> KITCHEN SINK 8 DISP VENTILATION FAN ' <br /> DISHWASHER RANGE HOOD <br /> LAUNDRY TRAY I W:�TER HEATER � <br /> CLOTHFS WASHER � WOOD STOVE <br /> URINAL ' METAL FIREPLACE(WOOD BURNING) Q, � _ <br /> ; FIREPLACE INSERT ' <br /> DRINKING FOUNTAIN �— <br /> FLOOR DRAIN � HEAT PUMP �— <br /> BACKFLOW PREVENTERS � � GAS PIPING <br /> ROOF DRAINS—RAINLEADERS � EXHAUST FAN <br /> SINK(SERVICE—BAR, ETC.) � � <br /> � <br /> — , �_ <br /> FiUB TOTAL 5 I SUB TOTF,I. S <br /> PERMIT $ _ PERMIT S <br /> TOTAL FEE 5 ' TOTAL FEE 5 , <br /> FOR OFFICE USE ONLY: J S G �yZ <br /> FECEIP�/ <br /> SIDESETBA�K PLA'ICHECKNU6I�ER FEE /L <br /> FPONTSE'�BACK/� � RE�f15ETB4GK � . i rj�/ 3 <br /> (/" — — `J <br /> — � VFCANTSITE FEES VALUATION FEE <br /> USEZONE �oJTQ'`��EA . r , , <br /> ��5� I `�/ ��� ��F' �-! NO BUILDING �/Z_ � <br /> NO.OFSTOFIES nLCr'anGr im0�ovlEwsGuui�S ���� <br /> 7VPEOFCONSL ;p o � , � � <br /> Z �� �i PLUMBIH� - <br /> �- �l 3 — <br /> SRE OF BS f1t FIRE SPRW14ER5 FEOD A�SEME�'�T MECHANICAL __ � <br /> Il� � -1 YES �✓0 �i i � 3 <br /> i Sf GnR ppr,iTIONALPLAt:I'HECK <br /> GCCUP�NCYLO�O FIRE�LARIdR[7U HEIGIITIIldITAiION ' - _ <br /> ( � I <br /> �_ n N' -- ? OTHFfl f,��DaN _ — �D <br /> REASON � <br /> S1ATE'1UILDING SIIfiCIi�RGE <br /> — �� i <br /> INiAKEB� PIANSAFFFOVED9V CITYOFEVERETT PUBLICWORKS --___ %�"��� <br /> J P LOCAL SALES <br /> onTe Z� TAX CQDE IS 3105 TOTAL — _ <br /> �� <br />