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� APPLICATIC � I FOR CONSTRUCT )N PERMIT �✓� <br /> ^ / TO BE COMPLETED IN BLACK INK—PLEASE PRINT <br /> , a�(J' <br /> �DING DEPART61ENT HEATING SYSTEM: iJ GAS �ELECTRIC J � <br /> 259-8810 <br /> f. i DEMOLITION : i COMBINATION �BUILDING i� MECHANICAL ❑ PLUMBING ❑ SIGN <br /> OWN F � IAAILFDDRESS CITY ZIP PHONE <br /> -�a�rn�r `�.r`sa,� ��o3-s-",A�� �J. �ve,e� �gao� �s�����' <br /> TENANT M11qILAD�FESS GTV ZIP PNONE <br /> Ff1CHIiECTORDE5IGNER IdAILADDFE55 �I7Y ZIP PHONE <br /> GENER4LCONTFACTOR MAILADDRESS CITY ZIP pNONE STATELICENSEY <br /> MECHANICAL CONiRACTOR MAIL F�OPES$ GITY ZIP PHONE STqTE LICENSE Y <br /> PLUMBING CONTRACTOR MFIL AODFESS CITv ZIP PHONE STATE LICENSE a <br /> CONTRACT PRICE OF WORK <br /> �i 7Ul)l� <br /> DESC IBE WORK AND SOUARE FOOTAGE INVOLVED CONTACT PERSON qND PMONE NO. <br /> — ��-r �P 30 ic r 5_ 'x���o iv C�,v�p ro <br /> - l "emPL-TE �� '.ED91� � cE <br /> -F_12{�r � SynAz.L . GESN�'7�5. ' $� i HEREBY CEFTIFY THAT I HAVE READ AND EXAMINED THIS <br /> raoroseouseoFewiowc APPLICATION AND K�OW THE SAME TO BE TRUE AND CORRECT.ALL � <br /> m�� .U'�'Ele'rAin)M=^"r PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br /> LEGALDESCRI TIONOFPROPEFTV�SHOWNBELOWO n rnc��rnocoaies� WORK WILL BE COMPLETED WITH WHETHER SPEGFIED HEREIN OR <br /> � NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br /> �or BLOCK oF 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 AM AUTHORIZED BY THE <br /> OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br /> APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> PARCEL TAX I.D.NUMBER ^Oa G CONTRACTORS LAW 1827 RCW AND 296.200 WAC. <br /> � U <br /> CONSTRUCTIONLOANLENDER.�CDRESS,TELEPHONE NUMfiER <br /> /� <br /> PROJECTADD ES,S�yy� scti q��� �onre <br /> � � ._J �' � crtrousmessuc�eser+o -� <br /> PLUMBING MECHANICAL <br /> . N0. TYPE OF FIXTURE OR ITEM FEE N0. TYPE OF EOUIPMENT FEE <br /> WATER CLOSET(TOILET) A/;-AiHNDLG 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 L'LOTHES DRYERS � <br /> KITCHEN SINK&DISP VENTILATION FAN � <br /> DISHWASHER RANGE 1100� , <br /> LAUNDRY TRAY ; WATER HEATER <br /> CLOTHES WASHER WOOD STOVE ; <br /> URINAL ; METAL FIREPLACE(WOOD BURNING) <br /> DqINKING FOUNTAIN � FIREPLACE INSERT ; <br /> FLOOR DRAIN HEAT PUMP —,r— <br /> BACKFLOW PREVENTERS GAS PIPING � <br /> ROOF DRAINS-RAINLEADERS � EXHAUST FAN ; <br /> SINK(SEAVICE-BAR,ETC.) � <br /> I{J 'J-1 C' N -lD S£S`c E i <br /> � <br /> � - <br /> SUB TOTAL S '%� SUB TOTAL S <br /> PEqMiT 5 PERMIT 5 ; , <br /> TOTAL FEE S TOTAL FEE $ <br /> FOR OFFICE USE ONLY: � .3C1 ,— � <br /> FRONTSETBACK REFRSEiBACK SI�ESETBACK PLANCH f,Kl tdBEF FEE qECEIPTN <br /> �o ' ' s ' - - l0��/�3 <br /> usez ° LOTApEA� vncnNrs�re FEES VAIUATION FEE <br /> _-� -'�. YES . NO BUtLoiNG �j�OO �/��GU <br /> TYPEOFWNSL NO.OFSTORIES �_�pm•,y yoorm•�[u�.�rt.'.�s — <br /> GP0'� PLUMBING ��- <br /> ' � � <br /> S2E0 BIDG. FIRESPFINKIEFSP[OD BASEIdENT i <br /> f (� ... YES ..' NO h1EChIANICAL <br /> OCCOf NC LOAD FIRE ALARfd REOD HEIGHT LI1.11T,+SION :�UUITIONAL PLAN CHECH <br /> � N I ( OTHER <br /> NEAS� <br /> STATE BUILDING SUFCHARGE 'a� <br /> IN7AKEBY P�ANSAPPRQyEODY CITYOFEVERETT PUBLICWORKS �� <br /> J I� LOCAL SALES <br /> on.e Z y TAX CODE IS 3105 70TAL Y �y��;�� <br /> I�/ ..JrU <br />