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APPLICATIC 11 FOR CONS4RUCT'7N PERM17' <br /> TO BE COMPLETED IN BLACK INK—PLEASE PRINT <br /> HEATING SYSTE��1: f GAS ❑ ELECTRIC ❑ _ � <br /> BUILDING DEPARTtiiENT <br /> 259-8810 <br /> ❑ DEMOLITION ❑ COMBINATION [�BUILDING ❑ MECHANICAL ❑PLUMBING `.J SIGN <br /> OWNER IAAILA�ORESS qTY ZIP r JNE <br /> �Qr.eS � ��e�5c� I ,� �/.2 � �o�n��C. SG. �uehe:�� R`o� n � 355 - �� �J9 �P <br /> TENANT MAILAf10RE55 GTY ZIP PNONE <br /> AFCHRECTOROESIGNEP MAILAODRE55 CITY ZIP PMONE <br /> G ERALCONTRACTOfl M.4ILADDRE55 CITY ZIP PHONE STATELICENSER • <br /> ���l\'� `�� " <br /> MECHANICALWNTP�CTGR MAILA�DRESS CITV ZIP PHONE STATELIGENSEn <br /> PLUMBING CONTRAQG9 MAIL AD�RE55 GTY ZIP PHONE STATE LIGENSE Y <br /> CONTRACT PRICE OF��AK <br /> 2�JJ3 <br /> DESCRIBE WORK AN�506�RE FOOTAGE INVOLVE� CONTAC7 PERSON AN�PHONE NO. �1S� ` — <br /> '_ —__'__--.__ _—_____ '� \t`^ — . �� _— <br /> �� � ' 02� � Sf`I �� c. �'� � ', ; 355- �S�l <br /> i HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br /> PROPOSED USE OF BNI�IN , � APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br /> S�� �� �0.,�.,�\� �Q � �, PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br /> LEGALDESCRIP IONOFPROPERTV�SMOWNB owoa TinCHTwOCO,P,IESI WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br /> / -7 � j� _ 1-� �� /� NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br /> �or-J 1— BLOCK OF� •�<J=C- ��-foL— AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br /> OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br /> PERFORMANCE OF CONSTRUCTION.THAT I A�vi AUTHORIZED BY THE <br /> OWNER OF THIS PROPERTY TO PERFORM TFIE WORK FOR WHICH <br /> APPLICAlION IS MADE AND I COMPLY WITH THE STATE <br /> PARCE�TA%,I g.NUMEER / CONTRACTORS LAW 70.27 RCW AND 296.200 WAC. <br /> O% 7G —�YI�—D/7 �G'2� G <br /> CONSTRUCTIDN IOANLENOER,AD�RESS,1ELEPHONE NUMBEF . /� � / /) <br /> / Cf� [ <br /> PROJECT ADDRESS � a'°�E oArE - — <br /> . � .� � ih SE �UL �'�' ��i� cirvousw�ssucErsEr+o _ <br /> � PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM FEE N0. TYPE OF EOUIPMENT FEE <br /> � WATER CLOSET(TOILET) NC-AIHNDLG UNITS-H.P. ' <br /> BATHTUB ; FORCED AIR SYSTEMS-B.T.U. M E.A. ' <br /> LAVATORY(WASH BASIIJ) . � UNIT HEATERS-B.T.U. M r_ <br /> SHOWER ' � CLOTHES DRYERS _ <br /> KITCHEN SINK&DISP � VENTILATION FAN _ <br /> DISHWASHER � RANGE HOOD ' <br /> LAUNDRYTRAY ' WATERHEATER � <br /> CLOTHES WASHER � WOOD STOVE � ..__ <br /> URINAL ' METAL FIREPLACE(WOOD BURNING) <br /> DRINKING FOUNTAIN FIREFLACE INSERT <br /> FLOOrI DRAIN HEAT PUMP ' _ <br /> BACKFLOW PREVENTERS GAS PI?ING � <br /> ROOF DRAINS-RAINLEADERS � EXHAUST FAN ' <br /> SINK(SERVICE-BAR,ETC.) - <br /> — <br /> � <br /> � <br /> --i— <br /> SUB TOTAL S � <br /> SUB TOTAL ` ' <br /> PERMIT S � PERMIT 3 � <br /> TOTAL FEE $ ' TOTAL FEt 5 <br /> FOR OFFICE USE ONLY: <br /> RECE�' ��0 <br /> FRONTSETBACK REAFiSETBFCK , SIDE;ETBACK� PLANCHE KNIIldfiER FEE <br /> �� � .5" o ' ��.h"03 /7 , 7 '!�3� <br /> vncnNrs e FEES VALUATION FEE <br /> USEZONE LOTAREA , � —/�J —J — <br /> I�� G YES �_� NO gUILDING _ 2 f �j G ( �� <br /> /v <br /> NO.OFSTORIBS occuvu:[v xc0�0'NELInmuW15 —�— /J <br /> TVPEOFCaN57. �=.ou� PLUMBING L � <br /> y/J � � <br /> SIZEOF9LDG. FIRESPRINKLERSREO'D BASEMENT - / MEC�fANICAL �J_ <br /> p �! YES i(/NO <br /> 7 �� —� ADDITIONAL PLAN CHECK - <br /> OGCUPANCYlOFO FIREFL�RIdFE6D HEIG.N�TL�IMIT+ATIQN <br /> h(, /�fp Uv � OTHEfl i <br /> FEASON 1 <br /> STATE BUILDING SURCHARGE � <br /> INTFNEBY PL4NSAPFR�OyEDBV ��TYOFEVERETT PUBLICWORKS 1-- <br /> �-t'r LOCAL SALES � <br /> onre �� c; TAX CODE IS 3105 TOTAL � <br />