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pIPP�.i�ATIC"`1 FOR CONSTRUCT�N PERMIT �
<br />� TO BE COMPLETES IN BLACK INK—PLEASE PRINT
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<br /> I �HEATING SYSTEM: ,`,1 GAS ❑ELECTRIC iJ _ —�
<br /> DUILDING DEPARTMENT
<br /> 259-8R10
<br /> DEMOLITION i\! COM(�INATION �C BUILDING I!?MECHANICAL ,I�PLUMBING SIGN
<br />�. OWN[R Id�II.AD�RF.SS CITY ZIP PMONE
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<br /> I IAEGNANiGl.LCONiRAQOR �dRL��JRE55 CItY ZIF PHONE STATELICENSE>
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<br /> PWIdBINGCONiP��TOR Id�ILADORESS
<br /> CITY ZIP PHOYE STAIELICENSEa
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<br /> CONTRACT PRIGF OF WORN •� , , „ �� —_
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<br />�` DESCBI�E W RK ANO SOUAFE FOO"�GL INVOLVEU GOIlTACT PERSON AIID PHOME NO.
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<br /> i HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS
<br /> PHOPOSED USE OP Bu1L01`i/3 ,G� APPLICATION AND KNOW THE SFlME TO B6 TRUE AND CORRECT.ALL
<br /> ��1 ;��ic��9� �7 O�.L�.rc�� _ FROVISIONS OF LAWS AND ORDINANCES GOVERNIN9 THIS TYPE OF
<br /> �Ecnioe cnianoNorrnor� V�SMOWNBELOWORATTAGMTWOCOPIcS) WORK WIIL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR
<br /> r. / `�`,j NOT. THE GRANTING OF A PERMf� DOES NOT PRESU��'c TO GIVE
<br /> ioT� e�ocK aF e�- � � vt'e" qUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS O�� AN'Y
<br /> UTHER STATE OR LOCAL L;.W REGULATING CC'IcTRUC'ION UR THE
<br /> PERFORMANCE OF CONSTRUCTION.THAT I AM AUTHORIZED BY THE
<br /> OWNER O� THIS PROPERTY TO PERFORM THE WORK FOR `NHICH
<br /> APPLICATION IS AtADE AND I COMPLY NJITH THE S7ATF
<br /> annce�rnx i o.Nun+oEa CONTRACTORS LAW 1827 RCW ANU 296.200 WAC.
<br /> GONSiRUCTIONLOAN�ENOER.A00flE5S.TELEPHONENUh1BER � , /
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<br /> SIGNFiII DAiE
<br /> PROJECT ADDRESS _ --
<br /> ,� , � � -2�o�n uP SF. �„Y.,�,s��,Es����E�,=�,r>
<br /> � MEChtANICAL
<br /> � PLUMBING FEE
<br /> NO. TYPE OF FIXTURE OR ITEM FEE N0. TVPE OF EOUiPMENT
<br /> WATER CLOSET(TOILET) r _ � NC—A�HNDLG UNITS—H.P. _
<br /> BATHTUB / ' FORt:ED AIR SYSTEMS--B.T.U. M E.A. ! '
<br /> / LAVATORY(WASH BASIN) ;i UNIT iEATERS—B.T.L. A1 �
<br /> � SHOWER -' / CLOTHESDRYERS - --�
<br /> KITCHEN SINK& DISP � I \'ENT`ATION FAN __ �
<br /> � DISHWASHER / RAN:iE HOOD _
<br /> LAUNDRY TRAY / WA"ER FiEATER
<br /> / CLOTHES WASHER � WOG�STOVE '
<br /> — MEiAL FIREPLACE(WOOD BURNING) � ' ,
<br /> URINAL ' �
<br /> DRINKING FOUNTAIN � FIREPLACE INSERT __�__
<br /> FLOOR DRAIN HEAT PUMP _ -
<br /> BAC�CFLOW PREVENTERS I k GAS PIPING _ —
<br /> ROOF DRAINS—RAWLEADERS � EXHAUST FAN
<br /> ✓
<br /> —
<br /> SINK(SERVICE—BAR,ETC.)
<br /> � �—
<br /> � �
<br /> — ,
<br /> SUB TOTAL S SU9 TOTAL $
<br /> PERMIT 5 PERMIT S
<br /> TOTALFEE $
<br /> TOTAL FEE 5 '
<br /> FOR OFFICE USE ONLY: __ .SI G 2 ___
<br /> PI�NCHECKPNh1�ER FEE
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<br /> fBONT5ET8AGN R[ARSETBACH SIDESETB�GK L
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<br /> VAI.UATIO!J FEE
<br /> usez�n�e �ornnen vncnNrsrt� FEES --/ �T/—��
<br /> ��S�I � 7� r YES .�. NO pUILDING _9� � J '��^�, i '-'
<br /> tYPE0FG0457 NO.OFSi0RIE5 O:nN�.':p '.nn�x;RwiaWa6 � i
<br /> no:�� PLUMBING '
<br /> 2_ K •3 --
<br /> •�1��rRLeSF 'r FiRESPRINKLERSflEO'0 845EIAENT � MECHANICAL - --
<br /> 6R� 3,` �'A� /��J vEs ✓No �
<br /> �.�Re ninnm aEa�D HEiGHi un�irnrioN ADDITIONAL PLAN CHECf: �" ' �
<br /> OCGUPANGYLO�D � //� i
<br /> 1���—� /(lJ 7�3 on,�q r�
<br /> REASON � ' ��
<br /> STATE BUILDING Sl1RCHARGE
<br /> INTAKEBv PLnNSnPROVED�r CITYOFEVERETT PUBLICWOfiKS ��i' �
<br /> �/f LOCALSALES �j
<br /> DATE
<br /> Z �.3��. TAX CODE IS 3105 Tora� � �J / � � �
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