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_ APPLICATI�''`� FOR CONSTRUCT"')N PERMIT � <br /> T7 BE COMPLETE�IN BLACK INK—PLEASE PRINT <br /> BUILDING DEPARTMENT HEATING SYSTEM: AS O ELECTRIC O <br /> 259-8810 <br /> ❑ DEMOLITION ❑ COMBINATION ❑ BUILDING ❑MECHANICAL ❑PLUMBING ❑ SIGN <br /> OWNEfl MAILADDRESS CRY Q ZIP PHONE <br /> ��. aa�a9 ���,��� �SE .�t�ir 98oai q853sa1 9��4�_ <br /> TE MAILADORESS CRY 21P PHONE � <br /> AflCHRECTORDE51GNEfl MAILAJDRESS CITY ZIP PHONE <br /> ,Brrl,�fe�s..�'A•�us�' ��4iti iya��,c N� Ulao�d,hv�'l/� gA2,2 y85-�/90D <br /> ENERALCONTHACTOR /�MAILADDflESSt A / QC,I[N� _ ' ZIPQ� /P�Fq.�ANE ASTATEIICENSE/ - <br /> c.a w �h /��� d�� Ja�,iL�. sG ,/7/1/71Gf/,�JQ 9d�f72� � =J 75�7 /J ��� ,�cQ��l J <br /> �!1 <br /> MEC ICALCAnid/�TOR MAILADDflESS C17V 21P PHONE STATELICEYSE• <br /> �L'%��J�zQ� '��/�i� - <br /> PLUMBINaCONTMCTOR ILADDflE85 CIN ZIP PHOAc STATE�ICENSE� <br /> i ` <br /> CpryTMCTPPICEOFWORK � <br /> � <br /> . DESCPIBEWORK DSOUAHEFOOU�EINVOWED CONTACTPERSONANDPMONENO. <br /> � '�L�f � 2� ` HEREBY CERTIFV THAT I HAVE READ AND EXAMINED THIS <br /> , � PflOPOSED USE OF BUILDING APPUCATION AIJD KNOW THE SAME TO BE TRUE AND CORRECT.ALL <br /> . .. SF PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS iYPE OF . <br /> LEOALDESCRIPTIIXJOFPqOPERTV�SHOWNBELOWOR TTACHTWOfAPIES) WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br /> - � �_ � Q,rjJy�y1J �� NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO OIVE <br /> � �or e�ocK oF AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br /> � OTHER STATE Ofi LOCAL LAW REGUUITING CQNSTRUCTION OR THE <br /> ' PEpFORMANCE OF CONSTRUCTION.THAT I AM AUTHORIZED BY THE <br /> OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br /> APPL CATION IS MADE AND I COMPLY WITH '!F{E STATE <br /> PARCEL X I.D.NUMBEH CONT ACTORS LAW 1827 RCW AND 296200 WAC. <br /> _ D' � <br /> � CONSTflUCT10NLOANI-ENDEfl,ADDRESS, EPHONENUMBEH > <br /> �J <br /> PROJE/C,TA�D1DRESS /7 / E WTE <br /> �U�L. 3-2LB� l //lP .�7' . cmeuawe �c w. <br /> PLUMBING MECHANICAL <br /> N0. TYPE OF FlXTURE OR ITEM FlSE N0. TYPE OF EOUIPMENT FEE <br /> WATER CLOSET(TOILE� � N�NHNDLG UNIT�H.P. � <br /> BATHTUB ' FORCED AIR SYSTEMS—B.T.U. M E.A. ' <br /> LAVATORY(WASH BASIN) i UNIT HEATERS—B.T.U. M i <br /> � - SHOWER ' CLOTHES DRYERS ' <br /> � KITCHEN SINK 8 DISP � � VENTILATION FAN 1 <br /> DISHWASHER � RANGEHOOD � <br /> � LAUNDRY TRAY � ; WATER HEATER ' <br /> CLOTHES WASHER i WOOD STOVE i <br /> � � URINAL ' METAL FIREPLACE(WOOD BURNING) � <br /> ORINKING FOUNTAIN � FIREPLACE INSERT � <br /> FLOOR DRAIN � HEAT PUi�iP ' <br /> BACKFLOW PREVENTERS � GAS PIPING � <br /> ROOF DRAIN�RAINLEADERS � EXHAUST FAN ' � <br /> �SINK(SERVICE—BAR,ETC.) � � <br /> � � <br /> i � <br /> � � <br /> � � <br /> � � <br /> SU8 TOTAL $ ; SUB TOTAL S ' <br /> PERMIT $ � PERMIT $ � <br /> --�— <br /> � TOTALFEE $ ' TOTALFEE S ' <br /> FOR OFFICE USE ONLY: <br /> FRONTSETBACK REARSETBACK SIDESETBACK PLANCHECKNUMBEfl FEE REC TNO. <br /> G o 30 — OCZS� <br /> U5EZONE LOTAHEA vac,wT ire FEES VALUATION FEE <br /> � <br /> YES ❑ NO BUILDING � OG � ' — <br /> TVPEOFfANSL NO.OFSTOHIES ottuwNtY x0.0iPVFLLINGUNrtS i <br /> 2 �W3 PLUMBING i <br /> SIZE OF BLoS�. FIRE SPRINKLERS NE�'D BASEMENT �/ MECHANICAL - (/� <br /> 1439 SP f 0 ❑ YES L'7 NO � <br /> OCCU7ANCYLWD FIREALAFlMREO'0 HEIGHTLIMITATION ADDITIONALPLANCHECK Y <br /> � � <br /> O 28 .e�e� �J � — <br /> HEASON <br /> STATE BUILDING SURCHARGE � <br /> INTAKEBY PLANSAPPROVf�,DBV CITYOFEVERETT PUBLICWORKS i <br /> J N LOCALSALES <br /> o„� 3 TAX CODE 15 3105 ror�� �;g� <br />