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APP�.�CATIC J FOR �ONSTRUCT.. �N PERMIT � <br /> TO BE COMPLETED IN BLACK INK—PLEASE PRINT <br /> BUILDING DEPARTMENT HEATING SYSTEM: U GAS LECTRIC O <br /> 259•8810 � <br /> fJ DEMOLITION � COMBINATION ✓BUILDING '�MIECHANICAL ✓PLUMBING SIGN <br /> OWNEF MAILADDRESS CITV ZIP PMONE <br /> I.bls Lo w r+-Y �2y1�{-3 .1�112/�.w1 A� fJ� �bT11�`�p°.I ZS �.�� 3��• �7�, <br /> TENANT MAILADDRESS CITY ZIP ?HOKf <br /> L.�F� � �-C��ZE A1 i"l"T' VL�co�.1'1' <br /> ARf.HITECTORDE5IGNER MAI�ppOHE55 CITV 21P PN <br /> v�1a�t-s c�ws-rr�— ��G�G waK �'aTnG w4 ��� �t d�-�5� <br />' GENERAL CONTPACTOF MAIL AODRE55 CITV ZIP PMONE STATE UCENSE I <br /> I.UA LTS C�`23t,' (U�K1F`r� 5 <br /> MECHANICAL GONTRACTOR MAIL ADDPESS QTY ZIP PHONE /� /'� STATE LICENSE> <br /> Cr lK <br /> PLUMBINGCONTflACTOR MAILAODRESS CIiY 21P PHONE STATEUCENSLt � <br /> IXA55OF WORK <br /> I I NEW I✓DCITInN �. ' ALTERATION REPAIR DEMOLITION . � WOODSTOVEiFRPL INSERT BUILDING RELOCATION <br />, �,_,q�+-/ ^fj �o/� CONTACT PERSON AND PHONE N0. <br /> CONTRACi PRICE OF WORK(�Jr��y� / � �5 S ��Q <br /> DESCRIBE WOPK AND SOUA FOOTAGE IHVOLVED <br /> i . 1 �MM��.Y �z S S� <br /> PROPOSEDUSEOfE1UIL01NG I HEREBY CERTIFY THAT I HAV'e ,'�AD AND EXAMINED THIS <br /> S�� APPLICATION AND KNOW THE�AME TO BE TRUE AND CORRECT.ALL <br /> LEGALOESCRIPTIONOF PFOPERN(SMOWN BELOW OR ARACM FOUR COPIES� PROVISIONS OF LAWS AND OflDINANCES GOVERNING THIS TYPE OF <br /> WORK WILL BE COMPLETED WITH WHETHER 5PECIFIED HEREIN OR <br /> �or e�ocK oF NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br /> AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br /> � �(n��� qOD OTHER STATE OH LOCAL LAW RFGULATING CONSTRUCTION OR THE <br /> PERFOHMANCE OF CONSTRUCTIOIJ.THAT I AM AUTHORIZED BY THE <br /> �OT � �US �CiPF]T Z' Lat �j� OWNER OF THIS PROPERTY TO PERFORM THE WJRK FOR WHICH <br /> APPLICATION IS MADE AND I COP�PLY WITH THE STATE <br /> � � CONTRACTORS LAW 1827 RCW AND 296.200 WAC. <br /> v p , 3r I X U�cS 9 v- <br /> PRQIECIAODRE55 `/' sicvnt n onrE <br /> � t '� � QT• C�iYB11SW[SSIICEN5FN0 <br /> PLUMBING MECHANICAL <br /> , NO. TYPE OF FIXTURE OR ITEM FEE NO. TYPE OF E�UIPMENT FEE <br /> WATER CLOSET(SOILET) AIC—NHNDLG UNITS—H.P. _ <br /> BATHTUB ; FORCED AIR SYSTEMS—B.T.U. M E.A. _ <br /> C LAVATORY(WASH BASIN) � UNIT HEATERS—B T U M % <br /> SHOW[R ' CLOTHES DRYERS <br /> KITCHEN SINK 8 DISP ; VENTILATION FAN ' <br /> T— <br /> DISHWASHER RANGE HOUD <br /> LAUNDRYTRAY ; WATERHEATER _ <br /> CLOTHES WASHER � WOOD STOVE _�_ <br /> URINAL ; METAL FIREPLACE 8 CHIMNE <br /> DRINKING FOUNTAIN � FIREPLACE INSERT � <br /> FLOOR DRAIN �_ HEAT PUMP � <br /> BACKFLOW PRE NTERS ; GAS PIPING <br /> ROOF DRAIN RAINLEA�ERS � EXHAUST FAN <br /> SINK(SER CE—BAR,ETC.) ; � <br /> � <br /> — --� <br /> — � � <br /> SUB TGTAL S SUB TO1�AL $ <br /> PERMIT 5 PERMIT S <br /> TOTAL FEE 5 TOTAL FEE S ' <br /> FOR OFFICE USE ONLY: <br /> FFON?SETBA� REAR SETOr1CN/ SIDE SETBAC�Ic PLAN CMECK NUMBER FEE RECEIPT N0. <br /> � �Gi '.� �/� 7.3' l0 8/�J` <br /> USE yJ]ONE lOT AREA VACANT SITE FEES VALUATION FEE <br /> /�"` BUILDING �j� �'ZS �2�/ s� � <br /> tYPEOFCONiS.AIIOWABLE i°PEOf ONSi.ACiUAL a:[uv�4cv r;oormrEwmGcxns �� <br /> � �our - / p�UMBINC� �'� <br /> SRE�9LQG.S��� NQ CF STORIES AASEMENT MECHANICAL �� <br /> LS Z _ <br /> OCLUPANCYLOAD FIRESPRNK:ERSflEO'0 HEIGHTLIMITATION ADDITIONALPLANCNECK � <br /> N�A � � ' <br /> N SPRMKLER r —'" <br /> REASON FOP SPRINKLERS —' ' <br /> STATE dUILDI;�G SURCHARGE � i� O <br /> INTRKEBV PLANSAPPROVEDCV CITYOFEVERETT PUBLICWJRNS <br /> LOCAL SALES � <br /> J� �` yL 7AX CODE IS 3105 TOTAL 7 � � — <br />