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� <br /> � (� APPLICATIO`.;".' FOR CONSTRUCT�N PERMIT � <br /> TO BE COMPLETED IN BLACK INK—PLEASE PRINT ���,�. <br /> �7_." <br /> BUILDING DEPARTMENT HEATING SYSTEM: []GAS ❑ELECTRIC ❑ <br /> 25�-8810 <br /> � I DEMOLITION COMBINATION BUILDING MECHANICAL xPLUMBING SIGN <br /> OWNEB MAILAD�FE55 CITY ZIF PHONE <br /> '�'���� l��'Y�'t'l `?�t�'� I'';a+''�'�' l�!t �1' i��N U� 11� �l r/U I I � ���`��IQ��) . <br /> TENANT MFILADDRESS .l CITV ?lo PXONE <br /> ARCHITECTORDESIGNEq MAILAO�RESS CITY ZIP PMONE <br /> GENEBALCONTRACTOR MAILA�ORE55 GTV ZIP PNONE STATEUCENSEN <br /> �'L"Y�CrH l-I�n�l,t t,ty [y�J'� �")otb��t l k� iA;� i' rY�t �+`�f i �t �f°l��1 r �t <br /> MECNANICA�CONTRACTOR MqILAUDPESS J CITY ZIP PHONE STATELICENSEA <br /> PlU^°�N^WN qACTOR MAIL ADORESS qTV ZIP PHONE STATE LICENSE a <br /> _ �]°� �}-ICu'�lu r�l3�w��I bG lao w �Yiai n Jl�lcr��� 1 � ,a �l����� 7�W�,yy�� 33t�iy�L'� lUlo -�i � <br /> CLASS OF WOflK <br /> ;YNEW I I ADDITION � i ALTERATION �. REPAIR �. DEMOLITION �. � WOODSTJVE/FRPL INSERT �. BUILDING RELOCATION <br /> ,;1 �� CONTFCT PER50�,Nry/1p H/p/NE Np <br /> Yi i�—l�t,C� ��� � � <br /> CONTflACTPRICEOFWOflK � <br /> OESCRIBE YlOPk AND SOUA�E FOOT�NVOLVED � / <br /> wu c fi���. � <br /> <;./ — ,�C. <br /> PflOPOSEDUS�E�OF�OpUIL��I G i HEREBY CERTIFY 7HAT I HAVE READ AND EXAMINED THIS <br /> ���-I�L�TI CL4 V' APPLICPSION AND KNOW THE SAME TO BE TRUE AND CORFECT.ALL � <br /> LEGALOESCRIPTIONOFPpO TV�SNOLYNBEL ORARACHFOURCOPIES� PROVISIONSOFLAWSANDORDINANCESGOVERNINGTHISTYPEOF <br /> ��T , BLOCK oF WORK WILL 8E COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br /> NOT. THE GRANTIN� OF A PEFMIT DOES NOT PRESUME TO GIVE <br /> �� ^'� AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br /> ��'�� � 1�I�1 �� I ) S� VLLLI ` C �Jfi OTHER STATE OR LOCAL LAW AEGULATING CONSTRUCTION OR THE <br /> PERFORMANCE OF CONSTRUCTION.THAT I AM AUTHORIZED BY THE <br /> S � ,L � �' (�) OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br /> �" APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> CONTRACTORS LAW 1g27 RCW AND 296.200 WqC. <br /> � X � � '��;�'�� G��- � �_�;�-9� <br /> PR ECT AD�RE55 / <br /> swruruae l / � � onre <br /> CILY BJS W[SS lICRSE NO <br /> PLUMBING MECHANICAL <br /> . N0. TYPE OF FIXTURE OR ITEM FEE N0. TVPE OF EOUIPMENT FEE <br /> � WATER CLOSET(TOILET) ;O $� � — A/C—A/HNDLG UNITS—H.P. ' � <br /> BATHTUB /a0 ;— FORCEDAIRSYSTEMS—B.T.U. M E.A. <br /> � I LAVATORY(WASH BASIN) O S� �� UNIT HEATERS—B.T.U. M � <br /> SHOWER � ' <br /> — CLOTHES DRYERS , <br /> Q KITCHEN SINK&DISP � ;— VENTILATION FAN � <br /> / DISHWAShcR p ' — RANGE HOOD � <br /> LAUNDRY TRAY ' WATER HEATER � <br /> (� CLOTHES WASHER fU �� WOOD STOVE <br /> URINAL ; METAL FIREPLACE&CHIMNEY <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 /> SUB TOTAL 5 y�f� ' SUB TOTAL 5 <br /> PERMIT $ �V PERMIT $ ; <br /> TOTAL FEE $ bJ7� � TOTAL FEE S � <br /> FOR OFFICE USE ONLY; <br /> FqONTSETBACN REARSETBACK SI�ESETBACK PLANCHECNNUMBER FEE pECEI^iNO. <br /> � S�`U <br /> USEZONE LOTAREA VACANTSITE FEES VALUATION FEE <br /> BUILDING � <br /> 1YPEOFCONiS.ALLOWABtE TYPEOFCONSiACiUAL � <br /> OC[�GANCY M00?bV:FIIPiGUNiiS <br /> cnoua � pLUMBING ; <br /> y ,- , - <br /> SIZEOFBLDG. NO.OFSTORIES BASEMENT � <br /> MECHANICAL i <br /> OCCUPANCYLOAD FIRESPRNKLERSREO'D HEIGHTLIMITATIO�i ADDITIONALPLANCHECK <br /> REASON FOR SPRINKLERS <br /> SPRINNLER I <br /> —�i— <br /> STATE BUILDING SURCHARGE � <br /> INTAKEBV PLANSAP�ROVEOdY CITYOFEVERETT PUBLICWORKS i <br /> LOCALSALES � <br /> TAX CODE IS 3105 TOTAL � <br />