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I�PPLICATIC'f FOR CONSTRUCTr7N PERMIT : <br /> TO BE COMPLETED IN BLACK INK—PLEASE PRINT <br /> HEATIN�SYSTEM: ❑GAS ❑ELECTRIC U <br /> BUILDING D'ePARTMENT — <br /> 259-8810 <br /> ❑ DEMOLITION ❑ COMBINATION ❑ BUILDING ❑MECHANICAL ❑ PLU G �SIGN <br /> OWNER MAILAUDRESS CITY ZIP PHONE <br /> �l�; GP4(pP I• /�d�UPI"IC 903�Ur r a Ll.�u .f.-?l� 9�2c� � -�7�� Z- <br /> TENANT �� MA PD RE55 �CITY ZIP ON[ <br /> ./ • YN a# � D o83— <br /> �� �i�y� �. <br /> F_u-+-- <br /> ARCHITECTCR�ESIGNER �" IL�ADUR SS CITV /_' ZIP PHONE <br /> _�L�Cl?� �S Q�"� �'F' <br /> GE Ef:y,C'JN��,�CTOR MAIL/DD ESS CITV ZIP PHON STATELICENSE• <br /> ��IIeX�'r�,�fl�o/%�c .�$T 3¢'�"ar.� .dI/. �,�'�4�•� 9,v/ za� � G v <br /> MECHANICAL CONTRACT R MAIL aDORE55 CITV ZIP P !E STATE LICENSE k <br /> PLUMBINGLONTRACTOR MAILADDRESS CITV ZIP HONE STATEUCENSEN <br /> CONTRACTPRIf,ECF'NOHKy� � <br /> � O <br /> ' DES�E:HE WOHK AND SOUA FOOTAGE INVOLVED CONTACT PERSON ANO ONE NO. <br /> fi'��°G e '�'f/ � /�l � �/"i r� ��Z ZOe a� 3317D�� <br /> � V' -/' �� � � Gf `�Y i HEREB CERTIFY THAT I HAVE READ AND EXAMINED THIS <br /> ROPOSE USE OF BUILDING APPLIC ON AND KNOW THE SAtiiE TO BE TRUE AND CORRECT.ALL <br /> PRUVI NS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br /> LEGALDESCRIPTIONGrPflOPERTV�SHOWNBELOWORARhCHTWOCOPIES� WOR ILL DE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br /> � /�„ � / �,�,yr��..�4�/P NQT. HE GRANTING OF A PERMIT DUES NOT PRESUME TO GIVE <br /> LOT� BLOCK�L— OF —G �L AU ORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br /> R�'�., �ul �'nD �fS'( /b �1'l�l.y A�.b �U 1JV D�,LUtI L� �T R STATE OR LOCAL LAW REGULATING CONSTRUCTION OR lHE <br /> ,� �D-��� ,T�� LL.ro-���7'��� P FURMANCE OF CONSTRUCTION.THAT I AM AUTHORIZED BY THE <br /> NER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br /> .r •t'��'jTQ�7f/� 9n LD7I L � pp�iCATiON IS MADF AND I COMPLY WITH THE STATE <br /> � PARCEL TA%I.D.NU=BERO� �} O/ w O CONTRACTORS LAW 18.27 RCW AND 296200 WAC. <br /> C STFUC ONLOANLENOER.AO�flESS.TELEPHONE X� {,.� � � <br /> � / � <br /> PROJE ADDRE S �, 9 O <br /> GIiV BUSINESS IICENSE NO. <br /> � PLUM ING MECHANICAL <br /> NO. TYPE OF flXTURE OR REM FE NO. TYPE OF EQUIPMENT FEE <br /> �� W4TER CLOSET(TOILET) � A/C--NHNDLG 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 DHYERS ' <br /> KITCHEN SINK&DISP I VENTILATION FA.`7 � , <br /> � DISHWASHER � RANGE HOOD ' <br /> LAUNDRYTRAY ' WATER HEATER � <br /> � CLOTHES WASHER � WOOD STOVE � <br /> URINAL ; ME7AL FIREPLACE(WOOD BURNING) ' <br /> - DRINKING FOUNTAIN � FIREPLACE INSERT � <br /> � FLOOR DRAIN � HEAT PUMP ' <br /> BACKFLOW PREVENTERS ; GAS PIPING � <br /> ROOP DRAINS—RAINLEADENS � EXHAUST FAN ' <br /> � -SINK(SEP.VICE—BAR,ETC.) � , <br /> i ' <br /> � ' <br /> , � <br /> � <br /> � ' <br /> � UB TOTAL $ � SUB TOTAL $ ' <br /> PERMIT 8 � PERMIT $ � <br /> TOTAIFEE $ ' TOTALFEE $ ' '- , <br /> FOR OFFICE USE ONLY: <br /> FRONTSETBACK REA TBACK SIDESETBAC1� PLANCH�NUMOER FEE ��7)Y PECEIPTNO. �I <br /> , � �l' �/ ].1 a� <br /> USEZONE ? AREA VACANTSITE � FEES VALUATION FEE <br /> r,� �' r: NO ' ' <br /> . � _ �� �� . „��( ❑ YES BUILDING ' � <br /> . 7YPEOFCON51. NO.OFSTOFtIES atuv.wcv �m.aow[wxcunrts � <br /> . . caour PLUMBING i <br /> --r— <br /> i <br /> � SIZF OF BLDG. FIRE SPRINNLERS flE0'D BASEMENT MECHANICAL ' � <br /> ❑ YES L NO � <br /> � � ADDITIONAL PL1N CHECK � <br /> FIREALARMREOD MEI(iHTLIMITATION � — � <br /> . � OCCUPANCYLOAD � i <br /> � OfHER � <br /> j' . ' qEA5Cr1 STATE BUILDING SURCHAHGE i�� <br />� ' INTANEBY PLANSAPPROVEDBV CITYOFE4ERETT PUBGICWORKS i <br /> ��� LOCAL SALES , <br /> onre Gj ' p y TAX CODE IS 3105 TOTA� � 9 ;.�Z1 <br />— <br />