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APPLICATIC'� FOR COt�iST�I�CT'"'1N PEF?.MIY' G��� <br /> TO BE COMPLETED IN BLACK INK—PLEASE PRINT `e�/ <br /> BUILDING DEPARTMENT �EATING SYS"i EM: � GAS G ELECTRIC ❑ _ I <br /> 259-8810 � <br /> I.l DEMOLITION I�COMBINATION +�BUILDING I l MECHANICAL i PLUh7BING f 1 SIGN <br /> C,N�'� 3',�c� �.,���oo j GR�D r�u� � C-v�ie�-Z�'�r.01 �c-d'- '�j� / <br /> TENANT MFILADCRESS Cltt ZIP PNONE <br /> ARCH17EC10ROESIGNER AtAILAD�R;55 GITY ZIF PH01+[ <br /> �R,�vs -1-�-uyus szo7 ��s Evc-,e.�n- A8-� � as9�s��Z z — <br /> GENEHALCONTRACTOR lAAILAD�FE55 y� CITV �/`� 21P PNON[ STATEUCENSEp <br /> � J ' � � LLV'Jd 1 J �� � '_ 11.2 y.P � � -�� ` t�Y�. -- <br /> IdECHFNICALCONTRAGTOR A'AILADDRESS CITY ZIP PHONE STATELIGENSEa <br /> PLUldBINGGONTRAC�OR MAILAODRESS GITV 21P PMONE STATEUGENSE< <br /> COHTFACT PRICE OF WORK <br /> S'� , �� 13�5�� — <br /> DESCRIBEWORKANDSOU�REFOOTAGEINVOWE� GONTAGTPERSONANDPMONENO. GGE <br /> --/�y��r oW 't� �'i Ee i A�E` ' : UT7L _�Q �-�E� <br /> _ ��,�`izn�, — z88 SQ.�T' s8 - 3so9 <br /> I HEREBY CERTIFY THAT I H�VE READ AND EXAMINED TNIS <br /> rao�os=_o u;F:oF em�ow� �p APPLICATION AND KNOW THE SAtdE TO BE TRUE AND CORRECT.ALL <br /> I"1 Est DFU `(,E PROVISIONS OF LAWS AND ORDWANCES GCIVERNiNG THIS TYPE OF <br /> I LEGALCG9C91PTIONOFPROPERTV�SHOW.'�BELOWORA HTWOCOPIES) WORK WILL BE COMPLETED WITH WHETHER SPEGFIED HEREIN OR <br /> �C � �J� 1 �L� , q � /� t/ NOT. THE GRANTING OF A �ERMIT DOES NOT PRESUME TO GIVE <br /> ;,,.1.L._ w e.ocK oF AUTHORITY TO VIOLATE OR CAfJCEL THE PRO'JISIONS OF ANY <br /> OTIIER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br /> --- PERFORMANCE OF CONSTRUCTION.THAT I AM AUTHORIZED dY THE <br /> OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br /> APPLICATION IS tvtADE AND I COMPLY WITH THE STATE <br /> ana r:�rnx i.o.Nuraoea CONTFACTO LAW 1 7 R �'D 296200 WAC. <br /> CCN TRIICTION LOAN L°NDER.ADDRESS.TELEPHONE NUTABEF �—'—— � r <br /> �� 1 ,CC� � �"J" <br /> � PROJECTADDRESS /30 �j ���, S,t,� ��QC)"�— sc. une � .re �— <br /> c�rv nusine,s ucrr+�.No <br /> PLUMBING MECHANIC <br /> NO. TYPE OF FIXTURE OR ITEM FEE N0. TYPE OF E�UIPMENT FEE <br /> WATER CIOSET(TOILET) � A/C—AIHNDLG UMITS—H.P. <br /> BATHTUB ; fORCED AIR SYSTE�dS--B.T.U. M E.A. <br /> � _� I..AVATORY(WASH BASIN) � _ UNIT HEATERS--6.T.1I. 61 _ <br /> SHOWER ' CLOTHES DFYERS � <br /> K,TCHEN SINK& D!SP VENTILATION FCP! I <br /> DISHWASHER � —� RANGE HOOD � <br /> LAUNDRYTRAY ; WATERHEP,TEF <br /> CLOTHES W4SHER WOODSTUVE <br /> URINAL ; METAL FIREPLACE(WOOD BURNING) � <br /> DRINKING hOUNTAIN FIREPLACE INSERT I <br /> FLOOR DRA�N HEAT PUMP <br /> BACKFLOW PREVENTERS GAS PIPING <br /> ROOF DR�INS—RAINLEA�ERS EXHAUST FAN <br /> �SINK(SERVICE—BAR,ETC.) � , <br /> , <br /> � <br /> � <br /> � <br /> — , � <br /> SU8 TOTAL S � �' _ _ SUB TOTh� S <br /> PERMIT � PERIdIT 9 <br /> TOTAL FEE 5 TOTAL FEE 5 <br /> FOR OFFICF. USE ONLY: <br /> FpONTSEf�A�K FEARSET9ACK SIDESETB�CK PLANCMECKNUM�ER FEE fiECEiPTNO. �D <br /> z� � za ' S' ' � <� I9�� � <br /> usezoNe LOTAFEA vacnNr' re FEES VALUATION FEE <br /> '�?j �. �. `� S '� N� BUILDING 3�� I � 'Ch� <br /> TYPEOfLOtlSi. NOAFSTORIES Occc>:tc� I i•oo:�:c[wn,u�du ' r J <br /> I ao = PLUMBING _�_�__ <br /> -�=� 2 "�---�- <br /> SIZEOFBLDG. FIRESPRINKLERSREO'D BASEMfJYT MECHANICAL `. L� <br /> � SF bp �I� ..�YES Li NO — --i'— <br /> . OCCUPANCY LOAD FIRE FLARt.I FEQ'D HEIGNi LIMITATION� ADDITIOYAL PLAN CHECK � �7O I <br /> � <br /> J ! OTHER � <br /> ' REASON ---� <br /> STATE BUILDING SURCHARGE �,_J�� <br /> INTAKEBV PLAtlSAP �E06V CITYOFEVERETT PUBLICWORKS � <br /> LO�AL SALES —T'— <br />� — �ATER ,LZ q3 TAXCOUEIS3105 Tora� 2`�7 ;2(� <br />