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� APPLICATIL'"1 FOR C�DNSTRU�T'''1N PERMIT � <br /> � TO BE COMPLETED IN BLACK INK—PLEASE PRINT <br /> �� <br /> BUILDING DEPARTMENT HEATING SYSTEM: AS 0 ELEC7RIC ❑ <br /> 259-8810 <br /> ❑ DEMOUTION ❑ COM81NA1'ION ❑ BUILDING ❑�1ECHANICAL ❑ PLUMBING ❑ SIGN <br /> kOWNER MRILA�DRESS � [� �jCI�T�Y[ � Q�2IP^ PQHO`NE e^ Q'/A <br /> �� ,co a�a9 ADDS����� ]� ✓ X1//��� 7��� �0�1E�Ad1 /`�U�4�.f�_ <br /> TE NT . <br /> ARCHITECTORDESIGNER IAAILADDRESS CITY ZIP Q PHONE <br /> _A��,'fs.fg �� ,�51` /Rii i9a^-d�c, NE �laod�h��i'l/� ,qga7a y85 -�/90� _ <br /> ENEFALCONTflACTOR MAILADDPE55 GTY ZIP PHONE STAiELICENSEt <br /> (, a-�/� � �,�9 53�Aua .SE �/,UJa 98�2/ �lg,�,�7 /� �r ,� _o��� <br /> MEC ICAL TOfl MAIL ADDflESS CITV 21P i`HONE STA'E LICENSE A'� <br /> f�Bry`�CYI�al1 'ne /�1d�/f� <br /> � PLUMBINGCON7RACTOR AILADDRE55 � CITY ZIP PHONE STATELICENSEN <br /> 1�._.L�/un�6ii�. <br /> CONTRACT PRICE OF WORK <br /> ' ��. � t�o l4� <br /> DESCRIBE WORK A D SOUARE FOOTAGE INVOWE� CONTACT PEB50 AND PHO�� qy0-/9z8� <br /> S FR �� � <br /> - � � « �-/.bl� I�� i HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br /> � ��-�,' � PROPOSED USE OF BUIl01NG CF Z I l PROV SAONS OF LAWS AND ORDANANCES GOVERN NG TH SRTYPE OF <br /> V <br /> ' '. LEGALDESCRI�IONOPPROPERTV�SHOWNB LOWO ATTACHTNlOCOPIES) WORK WILL BE COMPLETED WITH WHETHEii SPECIFIED HEREIN OR <br /> I �'��� NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br /> �� � ior� e�xK � qUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br /> � ' OTHEfi STATE OR LOCAL LAW REGULATING CONSTSUCTION OR THE <br /> � �� -�-- PERFORMANCE OF CONSTRUCTICN.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 /> � PRRCEL TAX .NUMBER C T ACTORS LAW 1827 RCW AND 296200 WAC. <br /> ; :: - � - G <br /> � �°� CONSTflUCTIONLO�NLENDER,ADDRESS,TELEPHONENUMBER <br /> : 3 <br />� - PRQIECT ADDRESS / 1'- n /� NA ne D�iE <br /> I, /O//9 �2tY"' L.L��� V f / _ CIiVPUSMESS SENJ. <br /> � � � PLUMBING MECHANICAL <br />��� ��`�-�� � N0. TYPE OF flXTUBE OR REM FEE NO. TYPE OF E�UIPMENT FEE <br /> WATER('LOSET(TOILE� � N�A/HNf1LGUNITS—H.P. � <br /> BATHTUB ; FORCED AIR SYSTEMS--B.T.U. M E.A. ' <br />�f�" �"�'�� � UNIT HEATERS—B.T.U. M � <br />, �.;��,,,,:�� , LAVATORY(WASH BASIN) <br /> �� � ' SHOWER � CLOTHESORYERS � <br /> � KITCHEN SINK&DISP � � VENTILATION FAN � <br /> � � DISHWASHER � RANGE HOOD � <br />. LAUNDRYTRAY ; / WATERHEATER ' <br /> � CLOTH�S WASHER � WOOD STOVE � <br /> URINAL ' METAL FIREPLACE(WOOD BURN�NG) ' <br /> - DRINKING FOUNTAIN � FIREPIACE INSERT I <br /> FLOOR DRAIN � HEAT PUMP ' <br /> � BACKFLOW PREVENTERS ; GAS PIPING l <br /> � ROOF DFAINS—RAINLEADERS � EXHAUST FAN � <br />, � ; , �SINK(SERVICE—BAR,ETC.) � � � <br /> , � <br /> , � <br /> , i <br /> i � <br /> � � � <br />��;�` � �. SUBTOTAL $ SUBTOTAL $ ' <br /> � PERMIT $ � PERMIT $ � <br /> � � TOTAL FEE $ ' TOTAL FEE $ ' <br /> FOR OFFICE USE ONLY: <br />�� FflONTSETBACK REARSETBACK SICESETBACK PLANCH GKNUMB[R FEE r' RECEIPTNO. <br /> w � � � 08l0� 3 �� p <br /> r� �� USEZGNE TAPEA VACANTSITE FEES ' YALUATION FEE <br />�,q � � � � � ❑ YES ❑ NO BUILDING D O�o �— <br />' �� � � TVPEOFCONSL NO.OFSTORIES acurexCv No.O�mvEluiuGuxnS i <br /> .f �p� ' PLUMBING � i <br /> �IfSy SF + FIRESPRINKLERSREO'D BASEMENT �/ MECHANICAL � <br /> .r G.aa o ❑ YES l!�NO � <br /> OCCUPANCVLOAD fIREALARMREO'0 HEIGHTLIMITATION ADDITIONALPLANCHECK 2 i <br /> I ' <br /> N (� OTHER i <br /> flEA50N <br /> STATE BUILDING SURCHARGE � J <br /> INTAKEBY PLANSAPfRQVEDOV CITYOFEVERETT PUBLICWORKS (1/i <br /> V%v LOCALSALES <br /> o"TE (e Z/ 93 TAX COUE IS 3105 TOTAL ; ' 3 <br />