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APPLICATIO. FOR CONSTRUCTI � N PERMIT �✓� <br /> TO BE COMPLETED IN BLACK iNK—•PLEASE PRINT <br /> BUILDING DEPARTMENT HEATING SYSTEM: ❑GAS ❑ELECTRIC ❑ _� <br /> 259-8810 <br /> �-i DEMOLITION ❑ COMBINATION 17 BUILDING ❑ P;iECHANICAL f I PLUMBING C SIGN <br /> 01YNER M�ILA�pRE55 CITV ZI�' PHONE ' <br /> pN(7 NC��IEN P� o t3oX hJ-S� i�Fni� 9s'o7 (:�oG) �',�1� �131f <br /> TENANT IdA1LADDRE55 CITY ZIP PHON= <br /> 3C1g i�-I�' c'�z.t8�-P <br /> ARCNITECTOR�ESIGNER IdAILAD�RE55 CITY ZIP PHONE <br /> GENERALCONTPACTOR MAILAODRESS CITV 21P PHONE STATECCENSEp <br /> C�t)JYIE� �' <br /> MEGMANICALGONTRHCTOP MA!LADDRESS CITY ZIP PHONE STATFUCENSEp <br /> PLUM�ING CONTFAGTOfl MAIL AD�RE55 CITY IIP PHONE STATE LIGENSE a <br /> CONTRACT PRICE OF WOPK <br /> �',L r� <br /> DESCRIBE WORH AND SOUARE FOOTAGE INVOWED CONTACT PEFSON AND PMONE NO. <br /> _ � "/�.n I � UV <br /> i HEREBY CERTIFY THAT I HAVE READ AND EXAMIN�D THIS <br /> PROPOSEDUSL OF 9UILDING APPL��ATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br /> PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br /> LEGALDESCPIPTIONOFPROPERTV�SHOWNBELOWORATTACMTWOLOPIES� WOflK WILL BE COMPLET[D WITH WHETHER SPECIFIED HEHEIN OR <br /> � NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br /> �oT e�ocK 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 Bl'THE <br /> OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br /> APPLICATION IS MADE AND ! COMPLY WITH THE STATE <br /> PARCEL TAX Lp.NUMBER CONTRACTORS LAW 18.27 RCW AND 296.200 WAC. <br /> GONSiRUC710NLOANL-NDEP,AODI�}�EPHONCNUMdEF � v /J� �J <br /> J l(l� O �T /%" <br /> PROJECTADDRESS s:c .une o�re <br /> ar ousrvcssueeuse �o <br /> PLUMBING M CHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM FEE NO. TYPE OF EOUIPMENT FEE <br /> � WATEfl CLOSET(TOILET) A/C—A/HNDLG UNITS—H.P. <br /> � BHTHTUB ; FOFCED AIR SYSTEMS—D.T.U. M E.A. � <br /> LAVATORY(WASH BASIN) � UNIT HEATERS—B.T.U. M <br /> SHOWER CLOTHES DRYERS --r <br /> Y.ITCHEN SINK 8 DISP ; VENTILATION FAN ; <br /> � DISHWASHER � RANGE HOOD �— <br /> LAUNORYTRAY WATER HEATER � <br /> CLOTHES WASHER WOOD STOVE ; <br /> URINAL METAL FIREPLACE(WOOD BURNING) � <br /> DRW4:ING FOUNTAIN � FIREPLACE INSERT ' <br /> i <br /> FLOOfl DAAIN � HEAT PUMP � <br /> BACKFLOW PREVENTERS ; GAS PIPIN� ; <br /> ROOF DRAINS—RAINLEADERS � EXHAUST FAN � <br /> SINK(SERVICE—BAR, ETC.) ; ' <br /> � <br /> � <br /> � <br /> —. <br /> SUB TOTAL 5 ; SUB TOTAL $ ' <br /> PERMIT S PERMIT $ � <br /> TOTAL FEE $ TOTAL FEE $ � <br /> FOR OFFICE USE ONLY: <br /> FRONTSETBACN REARSET84CK SI�ESETBACK PLANGHECIjNUM8Ef1/) FEE RECEIPTNO. <br /> �t aV0 <br /> usezoNe LOTAREA VACANTSITE FEES VALUATION FEE <br /> � <br /> L YFS NO BWLDING ��-) .yJ i (�C� <br /> TYPEOFCONS� NO.OFSTORIES CC[uvAh[v NOOFDwEwqGUwrS — — <br /> GFWa � <br />, P W MBING <br /> —T— <br /> SILEOFOL�G. FIRESPPINKlEF5RE0'� BASEAIENT MECHANICAL i <br /> ❑ YES ��fl NO <br /> � <br /> OLCUPANCYLOAD FIREALARfAR'c�'D NFIGMTLIMIT�TIGN ADDITIONALPLANCHcCK � <br /> � <br /> OTl1EP � <br /> REASON <br /> STATEBUII�INGSURCHIRGE (. i'J'�(� <br /> INTAKEBY PLANSAPPPOVEDBY CITYOFEVERETT PUBLICWORKS � <br /> L�7CAL SALES <br /> oaTe TAX CODE IS 3105 TOTAL !�� �S'� <br />