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APPLICATIC _J FOR CONSTRUC7 _ JN PERMIT � <br /> TO BE COMPLETED IN BLACK INK—PLEASE PRINT <br /> V��/ HEATING SYSTEM: U GAS ❑ELECTRIC C� 01�" � £x�s r.i�a� <br /> BUILDING DEPARTMENT <br /> 259•8810 � <br /> 1 DEMOLITION I✓COMBINATION BUILDING MECHANICAL I . PLUMBING SIGN <br />� OWNER MAILADDFE55 dTV ZIP PHO4E <br /> 3�4� Lnr,G� s 7..'e-oy 5+� St C„eKTf' �41.0� z.s9'36�5 <br /> TENANT <br /> MAIL ADDRESS CIiV ZIP PMONE <br /> ARCHITECT OR DESIGNER MAIL ADDRESS CITV ZIP PHONE <br /> �,,,��,q„�.Gn•.cew,tu /8Y93 BA//� A SeArrie 9Piss 3 � 5 -�-0�3 <br /> GENERAL CONTRACTOR MAIL A��PESS � � ZIP PHONE STATE LICENSE N <br /> C.vtNGo� r�.v.tt'ZNc. '7�3 5 � E.�•w'Cr'lKoitu+4•�� cr'i,a��' 9ff2.vY 353-G�3 ,GANbuNlob/K7_ <br /> MECHANICAL CONTRACTOR MA14 ADDflESS CITV ZIP PHONE STATE LICENSE N <br /> � <br /> PLUMBING CONTRACTOVi MAIL ADORc55 ! CITV ZIP PHONE STATE LICENSL a <br /> ti �'I�A0.VSJILLC PL.uM�lA7(a (3� ISSICS�dNE, AQ.I/N6TO�V �lZZ3 ��Jr'sJ�.55 /I�,eyS�iaiJ"� <br /> CLA55OF WORN � /� <br /> I J NEW I �� ADDITION I✓ALTEP.ATION ��. REPAIR . ��. DEMOLITION � WOODSTOVE/FRPL INSERT � BUILDING RELOCATION <br /> CONTACT PERSON AND PMONE NO. <br /> CONTPACTPFICEOFWOPN 7.�0/O // �,-� �-ANGys 353'�'_°3 _ <br /> OESCRIBE WORK AND SOUARE FOO7FGE INVOLVED ����/ � / <br /> GA� TJ/J '� (�l.u'M�IhIV (O-T�o �r• <br /> PROPOSEDUSEOFBUILUING i HEREBY CEFTIFY THAT I HAVE READ AND EXAMINED THIS <br /> S� 2 APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT.ALL <br /> LEGALDESCRIPTIONOFPROPEFTV�SMOWNBELOWORATTACHFOUflCOP�ES) PROVISIONSOFLAWSANDORDINANCESGOVESNINGTHISTYPEOF <br /> WORK WILL BE COMPLETED WITH WHETHER SPECIfIED HEREIN OR <br /> �ot 7-b BLOCK oF 6�JN P�!t NOT. THE GRANTING OF A PERMIT DOES NOT PRES�IME TO GIVE <br /> - AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br /> , N � 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 WIiICH <br /> APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> CONTRACTORS LAW 18.27 RCW AND 296.200 WAC. <br /> . <br /> � G�� � <br /> z�� 9 sTs s-t- x _��.�s-- s I�.� �9 a . <br /> SIGNATOPE n �A�� <br /> PRQIECTADDRESS V ^ OaL�3'�S� <br /> CrtV OUSiNE55Li ENSE NO <br /> PLUMBING MECHANICAL <br /> N0. TYPE OF FIXTURE OR ITEM FEE NO. TYPE OF E�UIPMENT FEE <br /> 1 WATER CLOSET(TOILET) � NC—A/HNDLG UNITS—H.P. <br /> BATHTUB ' FORCED AIR SYSTEMS—B.T.U. M E.A. <br /> 2.. LAVATORY(WASH BASIN) � UNIT I��ATERS—B.T.U. M <br /> � SHOWER _ ' CLOTHESDRYERS <br /> KITCHEN SINK&DISP I VENTILATION FAN . _ <br /> DISHWASHER � RANGE HOOD <br /> LAUNDRY TRAY ; WATER HEATER <br /> � CLOTHES WASHER � WOOD STOVE ' <br /> URINAL ' METAL FIREPLACE&CHIMNEY ' <br /> DRINKING FOUNTAIN � FIfiEPLACE INSERT � <br /> FLOOR DRAIN HEAT PUMP � <br /> BACKFLOW PREVENTERS � GAS PIPING <br /> ROOF DRAINS—FAINLEADERS � EXHAUST FAN <br /> SINK(SERVICE—BAR,ETC.) � <br /> � <br /> � ' <br /> � SUB TOTAL S �' <br /> SUBTOTAL $ � ; <br /> PFRMIT S � PERMIT 3 � <br /> TUTALFEE $ TOTALFEE 5 <br /> FOR OFFICE USE ONLY: <br /> FRONT SETBACK REAR SETBACK SIDE SETBACN PLAN CHEGK NUM9ER FE�� �� AE���N�://a <br /> ZO• .La� 5 ' � Z�:� <br /> usezoNe LOTAREA VACANTS-IT`E FEES VALUATION FEE � <br /> �� y Q�jb � N BUILOING ('y �l�o L d 7 ��/� <br /> TVPEOfCONTS.ALLOW0.BLE TYPEOFC NSTPCiUAL octuv>,:v MoovmvFwx,wots � <br /> nou�„ � I PLUMBING � � <br /> -� ��� ' i <br /> SREOFOLDG. NO.OFSTOR�ES BASEMEYT MECHANICAL � � <br /> (7�� SF DOnI ' � ADDITIONALPLANCHECK '-� <br /> OCQIPANCYLOFD FIRESPRNHLERSREOD HEIGHTLIUITATlO� <br /> n �O SPRINKLER i <br /> REASONFORSPflINKLEPS / � � <br /> STATE BUILOING SUFiCHAFGE <br /> INTANEBY PLANSAP R VEOBV CITYOFEVERETT PUBLICWORKS � <br /> ,��� LOCAL SALES "�/� � <br /> �� q3 TAX CODE IS 3105 rorn� ��'Y[p ;G j) <br />