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APPLICATIC�'`'�1 FOR CONSTRUCT'`�N PEI�MIT � <br />' TO BE CONiPLETED IN BLACK INK—PLEASE PRINT <br /> I �p <br /> HEATING SYSTEM: J GAS J ELFCTRIC �_C{�p��,�,y.II_ vH�}5 I <br /> BUILDING DEPARTMENT <br /> 259-8810 <br /> i DEMOLITION �COMBINATION BUILDING I I MECHANICAL pLUMBING ! I SIGN <br /> OW�N-/� MAILAODRESS GiV ZIP PMONE <br /> rENnruT ����` 'pSSs�1.� �SZS /UU�"S�I'. SE �II�Q��G��d� 33�- l6�3 <br />' ARCMITECTORDESIGNER MML�DDflESS CI7V ZIP PNONE <br /> �4,�nT�.rH !-�lowne5 ,��� )13�� !-Iti,y99 �V�'�'�1'r-5�2�_'�.��`�'SSbo C.eN'Iv��o��s_eJ <br /> G[NERALWNTRAGOR IAAILADDPE55 CITV ZIP PHONE STATELICF.NSEtt <br /> �Q N'�� �\ <br />� IdEGHANICFLCO.':iRACTOR MNLAO�FE55 CITY ZIP PHOIJE 3TATEUCENSE< <br /> �c�w�lL. � � <br /> PLUAI�INGCONifi�CTOR IANL��ORESS . CITY 21P PHONE STA�ELICENSCx <br /> � a v�.Q — `� <br /> �o�96Ao���P��3 f�;�/ ���� " <br />� DESGiiIpE WOn,�;„ND�OUARE FOOTAGE INVOLVE� CONT�CT PERSON�NO PHONE HU. <br /> jNS�LL up � S MFzTLA�FE 7'fS SS'�D <br /> Stt� 8���+� GrtR,,A�I��AT�e.i-tFf) <br />� r o o�o's oF au o�� µ��� )��� �7f( � APPL CAT ON AND KNOW THE SAME TO BE�TR E AND CO RECT.ALL <br /> I' Cj�=�Q PROVISIONS OF l AWS AND ORDINANCES GOVERNING THIS TYPE OF <br /> �ecn�oesceianonorraoaearv;sHowNee�owoar�I.rnc�r:+o �o iEs� WORK WILL BE �. .��1PLETED WITH WHETHER SPECIFIED HEREIN OR <br /> 'f �� NOT. THE GRA:.�'_JG OF A PERMIT DOES NOT PRESUME TO GIVE <br /> �or—m,__— y�oc�c oF AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANV <br /> OTHER STATE OR LOCAL LAW REGULATING CONSTFUCTION OR THE <br /> — PERFORAIANCE OF CONSTRUCTION.THAT I AM AUTHOR!ZED BY THE <br /> � OWNER F THIS PRCf'ERTY TO PERF RM THE WORK FOR WHICH <br /> APPLIC TIOIJ IS MADE AND I MPLY WITH THE STATE <br /> rnace�Tnx i o r�ur.+oea y/� CONTR C 0 S LAW 18.2?RCW A D 6.200 WAC. <br /> CONSiRUCTIOotOANLEN�ER.4DDFE5S.TELEPHOrOlEONUMBER <br /> c� , �s U,- u ' g . <br /> PROJECT ADDRE S sir.r+ une onre <br /> 0 ) " E � QE • . g o ����„���=55�,�E��S�_•�o <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE Ofl ITEM FEE N0. TVPE OF E�UIPMENT FEE <br /> WATER CLOSET(TOILET) �'C—A.'HNDLG UNITS—H.P. <br /> BATHTUB PORCED AIR SYSTEAdS—B.LU. M E.A. <br /> LAVATORY(WASH BASIN) � UNIT F'EATERS—B.T.U. M I <br /> SHOWER ' CLOTH�S DRYERS � <br /> KITCHEN SINK&DISP VENTIlAl10N FAN <br /> DISHWASHER � RANGE HOOD <br /> LAUNDRY TRAY ; WATER HEATER <br /> CLOTHES WASHER WOOD STOVE � <br /> URINAL METAL FIREPLACE(WOOD BURNING) <br /> DRINKING FOUNTAIN FIREPLACE INSERT � <br /> FLOOR DRAIN HEAT PUMP <br /> BACKFLOW PREVENTERS �� GAS PIPING <br /> ROOF DHAINS—RAINLEADERS � EXHAUST FAN � <br /> SINK(SERVICE—BAR,ETC.) <br /> q �� �+.r' �_ <br /> � <br /> �_ C�FV1I�.Q �YQ, <br /> ..rv.\7- 'thG..n. J'��!' ��L' <br /> SUB TOTAL $ SUB TOTAL 5 <br /> PERMIT $ r PERMIT $ _ <br /> TOTAL FEE 3 T0T4L FEE 3 ' <br /> FOR OFFICE USE ONLY: <br /> FRONTSET�nCK r REARSETB�CK� SIDESETBA�K PLANGHECNlUMBER FEC FECEIPTNO <br /> —� Z� � S'/d�� C0 . 3S o,55$/ <br /> usezoNe� ioTnAEn vncaNrsrte FEES VALUATION _ FEE <br /> —I �7� 9?�j !'�. YES �,.� NO T <br /> BUILDING _1Q 33 � �` ) . <br /> iYPE(1FCOIlS1. �JO.OFSTORIES o¢uvFr,�y nOCfOnElu4Lurl',15 <br /> �- L ' � 003 � PLUh1BING �� <br /> ��y — <br /> i i,S�BLO�j f T FlRE SPRINKL[RS REO'D BASE IEES �O MECHANICAL _�_ <br /> 2 �' . G n�- 0 '�" . <br /> OCGUPnNCVLOno FIPEnLnntARE00 MEIGHiLIIAITnTION ADOITIONALPLANCHECK �/ i <br /> (�� �/ i <br /> OTH[R <br /> REASON - <br /> STATE BUILDING SURCHARGE , 57J _�- <br /> INTnKEBV PLANSnPPRWE�Bv CITYDFEVERETT PUBLICWORKS '- <br /> I � LOCALSALES <br /> onTe 8 � TAX CODE IS 3105 TOTAL ���/ ;�j <br /> � <br />