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��' <br /> APPLICATIC"-1 FOR CONSTRUCT� )N PERMIT � <br /> TO BE COMPLETED IN BLACK INK—PLEASE PRINT <br /> HEATING SYSTEM: '�AS ❑ELC-CTRIC J <br /> BUILDING DEPARTMENT <br /> 259-8610 <br /> ❑ DEMOLITION �_I COMBINATION !-�UILDING ❑ MECkANICAL C�UMBING ❑ SIGN <br /> OWNER MNLAO�FESS GTY ZIP PHOHE <br /> �cR PRT /�L2XANi/l //5,Z /9TyAv 5� �►fzielT 9R �R 3F� /,c�53 <br /> TENFNT ldAILaDDRESS CITY ZIP PMONE <br /> TN✓ Wettr! //R29 35m'/!✓SE ��t'��fi 9Ra�� 337-33/S <br /> ARCHITECTORDESIGNER AtAILADORESS CITY ZIP PHONE <br /> GENERFLWNTRACTOii MNILADDRE55 GITY ZIP PMONE STATELICENSEA <br /> .TcN�v G.�� �-N <br /> MECH�NICALWNTRACTOR MARqODRE55 CITV ZIP PFONE STATEUCENSEtt <br /> . ToNn w�r il � <br /> PLUMBING CONTRACTOR MpIL AD�RESS CITY 21P PHONE STATE LICENSE Y <br /> f H�v c.�L� <br /> CONTRACT PPICE OF yt RK <br /> � dc� <br /> DESCRIBE WORK AND SOUARE FOOTAGE INVOLVED GONTACT PERSON ANO PIIONE NO. <br /> ��.� ToHN [ur't�N 338-/7// <br /> ' P�r uPy PaR7;cr,���✓ L✓A(LS tnsr9[L Go�r.R <br /> C�N ��� � ��` i HEREBY CERTIFY THAT I HAVE READ AND ERAMINED THIS <br /> PROPOSG�USE OF BUILDING APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT.ALL <br /> c��'� PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br /> LEGALDESCFIPTIONCFPFOPERTV�SHOWNBELOWOFATTACMNlOCOPIES� WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR �� <br /> �or s�ock oF NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TG GIVE '' <br /> �UTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br />� OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE � <br /> PERFORMANCE OF CONSTRUCTION.THAT I AM AUTHORIZED BY THE � <br /> OWNEH OF THIS PROPERTY TO PERFOFM THE WORK FOR WHICH ''� <br /> APPIICATION IS MADE AND I COMPLY WITH THE STATE <br /> PARCEITA%ID.NUM�EP CONTRACTORS LAW 1827 RCW AND 296.200 WAC. I� <br /> CONSTRUCTION LOAN LENGER,ADDRE55.TELEPHOtIE NUhIBEA �. <br />�I PROJECT ADDRETSS X N ���'� I/�y/9`/ '� <br /> I 7 /� � (/ / j� LIfY0U5RIC55L¢ENSEFO <br /> PLUMBING MECHANICAL <br /> N0. TYP�OF FIXTURE OR ITEM FEE NO. TYPE OF EQUIPMENT FEE <br /> WATER CLGSET(TOILET) � A/C—fJHNDLG UNITS—H.P. <br /> BATHTUB ; FORCED AIR SYSTEMS—B.T.U. M E.A. <br /> LAVATORY('NASii BASIN) � UNIT HEATERS—D.T.U. M ; <br /> _ SHOWER � CLOTHES DRYERS � <br /> KITCHEN SINK 8 DISP VENTILATION FAN ; <br /> DISHWASHER RANGE HOOD <br /> LAUNDRYTRAY ; 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 DRAINS—RAINLEADERS EXHAUST FAN ; <br /> SINK(SERVICE—BAR, ETC.) ; � <br /> � <br /> � <br /> SUB TOTAL $ I SUB TOTAL S ' <br /> � <br /> PERMIT $ PERMIT S � <br /> TOTAL FEE S TOTAL FEE $ � <br /> FOR OFFICE USE ONLY: <br /> FRONTSETBACK qE�FSETBACK SIOESET�ACN PLANCHEfKNUldBEq FEE RFCEIPTNO. <br /> usezoNe LOTAREA vncnNrerte FEES VALUA710N FEE <br /> i"PEOFGONST. NO.OFS70RIE5 '�' YES � NO BUILDING �� �(�(� <br /> OCLUP�hGv � r,�prp�yfllihGlVlliS � <br /> caaw PLUMBING — � <br /> SREOF�L�3. fIRESPFINKlEfl5RE0'� 6ASEIdENT T— <br /> M[CHANICAL <br /> ��� YES :�� NO — <br /> OCCIIPANCVLOAD FlREALAPh1PEOD NEIGHTLIld17�'�ON ADDITIONALPLANCHECK � <br /> i <br /> O7HER <br /> REFSON — <br /> STATE BUILDING SURCHARGE � ��� <br /> INTANEBY PLANSAPPROVEODY CITYOFEVERETT PUBLIC�VOFKS <br /> LQCAL SALES <br /> DnTE TAX CODE IS 3105 TOTAL 7 L/ i� <br /> J <br />