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- �. <br /> APPLICATIa.1 FOR CONSTRUCT..lN PERMIT � <br /> TO BE COMPLETED IN BLACK INK-PLEASE PRINT <br /> BUILDING DEPARTMENT [ HEATING SYSTEM:�GAS rJ ELECTRIC l7 <br /> 259-8810 <br /> ❑ DEMOLITION C� COMBINATION ❑ BUILDING �MECHANICAL ❑ PLUMBING ❑ SIGN <br /> OWNER MAIIADDRE55 GTY � ZIP PHONE <br /> ��nG�,�wn ,5531 ZS{=-' �'�,�e.UJ. ��v-ece'� 33 l-�1500 �w�k � 5 2-5780 <br /> TEN—� MAIL ADDRE55 CITY ZIP PHONE <br /> ARCHITECTORDESIGN r MAILAODRESS CITY 21P PHONE <br /> �� <br /> GENEFALCO�:�RACTOR MAIIADDRE55 CITV ZIP PHONE STATELICENSEa <br /> ' MECMANICAL CONTflACTOR MRIL A RE55 CITV ZIP PHONE STATE LICENSE 1 <br /> ('�e\;a�o�S�no���til�u�rty�� �zo`�'ll�. ��.F, k',rklcw,r� �tRG33 �a3-6� 1;F5 R��ZF�SN'13+�S�i- <br /> PLUMBINGCONTFACTOR MAILAODRESS CITY ZIP PMONE STATELICENSEs <br /> CONTRACT PRICE OF WORK <br /> �,3-7.00 <br /> DESCRIBE WORN AND SOUARE POOTAGE INVOLVEO CONTACT PERSON AND PHONE NO. <br /> �� J `�Y�Q "C�� 'FQ-l.'v�\1' � �t�I�V� ��N. �. <br /> ��Y <<`�'�S J I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br /> PROPOSEOUSEOFBUILDING APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT.ALL <br /> PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br /> LEGALOESCflIPTIONOFPROPERTY�SHOWNBE�OWORATTACFITWUCOPIES) WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br /> NOT. THE GRANTING OF A PERMIT OOES NOT PRESUME TO GIVE <br /> �oT BLOCN oF AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS 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 THE WORK FOR WHICH <br /> APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> PARCEL TA%I.D.NUMBER CONTRACTORS LAW 1827 RCW AND 296200 WAC. <br /> CONSTPUCTION LOAN LENOER.ADDHESS.TELEPHONE NUMBEfl /� <br /> 1\1 <br /> G�\ ` 11A�4 �� <br /> PROJECj,A D SS ^ SiGNAT FE UATE <br /> LC�ryB SIM1i55LICENSENO. <br /> � PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM FEE N0. TYPE OF E�UIPMElR FEE <br /> WATER CLOSET(TOILET) � A/C—A/HNDLG UNITS—H.P. � <br /> . BATHTUB 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 OISP � VENTILATION FAN � <br /> DISHWASHER � � RANGE HOOD � <br /> LAUNDflY TRAY ; WATER HEATER ' <br /> CLOTHES WASHER � WOODSTOVE � <br /> URINAL ; METAL FIREPLACE(WOOD BURNING) � <br /> DRINKING FOUNTAIN � FIREPLACE INSERT � <br /> FLOOR DRAIN � HEAT PUMP ' <br /> BACKFLOW PREVENTERS ; a, GAS PIPING - 1�;�e^-\c.c eS ' <br /> ROOF DRAINS—RAINLEADERS EXHAUST FAN � <br /> SINK(SERVICE—BAR,ETC.) I � <br /> , � <br /> , � <br /> � � <br /> — � — <br /> SUBTOTAL $ � SUBTOTAL $ ' <br /> PERMIT $ � PERM�' $ /..�5 � <br /> TOTAL FEE 6 ' OTAL FE $ ' � <br /> FON OFFICE USE ONLY: <br /> FRONT SETBACK REAfl SETBACK SIDE dETBACN PLAN CHECN NUMBER FE RECEIPT NO. <br /> USEZONE LOTAREA VACANTSITE FEES VALUATIGN FEE <br /> u YES ❑ NG gUILDING � <br /> TVPEOF^.ONST. NO.OFSTORIES OctUveN[v uo.ovowElunGunnS � <br /> ceauv PLUMBING i <br /> SIZE OF BLDG. FIRE SPRINKLERS ilEO'D BASEMENT MECHANICAL � <br /> G YES i] NO � <br /> OCCUPANCYLOAD FIFEALARMREO'D I HEIGHTUMITATION AD�ITIOIJALPLANCHECK i <br /> i <br /> OTHER ' <br /> REASON i <br /> STATE BUILDING SURCHAPGE <br /> INTAKEBY PLANSAPPROVEDBV CITYOFEVERETT PUBLICWORKS � <br /> LOCAL SALES <br /> DATE TAX CODE IS 3105 T�TA� ' <br />