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APPLICATIO� FOR �ONSTRUCTI�N PERMIT �✓� <br /> TO BE CG�.,PLETED IN BLACK INK—PLEASE PRIN i <br /> � .IUiQ � q � <br /> HEATING SYSTEM: . GAS J ELECTRIC J _ "'"' <br /> __.. <br /> BUILDING DEPARTMENT �- �T` ... <br /> 259-8810 ,, ,r,,.� , RErr <br /> �orks D�pt,. <br /> �:1 DEMOLITION I COMBINATIOh BUILDING XMECHANICAL PLUMBING SIGN <br /> OWNE � �nn nnPPF.�..�G�/L� �/ � '��'i.�• l.•��ZI{o�l / ���) HONJ3y-34�`��"� <br /> ( <br /> �l��/Ql?�, o` <br /> TENANT r � MAI�AODFESS CITY ZIF rnuNE <br /> ARGHITECI7 GESIGNER MAILFDDPE55 Cliv ZIP PHONE <br /> GE ERALCONTRACTUR AIAILADOfiESS � CITY 21P PHONE STATELICENSEa <br /> �,�Ir , � � .�iin�f ll ln f , .J� ��i`�-J33���,^�L���L2s�. ` <br /> �FVI(ilP \11�`V2� V'�¢t i ��� �� ii -r� <br /> IAECNqNICALCONTRACTOR MAILADDRESS CITV ZIP PNONE STATELICENSEe , <br /> PLUMBWGCONTRACTOR MAILPODf1ES5 CITY 21P PNONE SiATELICENSE+ <br /> � �O� �' <br /> C!ONTRFCT PA�CE OF WORK <br /> � -�.C �, n r , _ <br /> �ESCPIBE WORK AND SOUARE FOqTAGE INVOLVED . CONTACI PERSON ANO PNONE NO. <br /> � T <br /> � � _� _i� '�r. l �r�,,�-sL��.`) ! ' `J�� <br /> �� �T <br /> i HEREBY CERTIFV THAT I HAVE READ AND EX�MINED THIS <br /> aaoaoseo us�oF owioinc � APPLIGATION AND KNOW THE SAME TO BE TRUE AND CORAECT.ALL <br /> PROVISIONS OF LAVJS AND ORDINANCES GOVERNING THIS T'!PE OF <br /> LEGFL�ESCRIPTIONOFPROPERTY�SHOWNBEIOWORATTACNTWOCOPIE51 WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br /> NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br /> ;.or— e�ocK oF AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br /> , OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br /> - � PERFOR�IANCE OF CONSTRUCTION.THAT I AM AUTHORIZED BY THE <br /> r�(�_ �y OWNER OF 1'HIS PROPERTY TO PENFORM THE WORK FOR WHICH <br /> �L�?��_ ��'_C_ , L ��—.------ APPLICATION IS M.ADE AND I COA4PLY WITH TH[ STATE <br /> anRce�ran i.o.NUMaea CONTRACTORS LAW 18.27 RCW AND 296.200 WAC. <br /> CO ST UCTIONLOANIEN�ER, DRE�$.TELEPMO�NENUMBEfl � � i <br /> f1� 7� , /q <br /> k,J <br /> ROJECTADDRESS E oA � <br /> ' urv ous�M1ess ucemsc r+o <br /> � PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM FEE NO. TYPE OF EOUIPMENT FEE <br /> 4NATER CLOSET(TOILET) � A/C—A/HNDLG UNITS—H.P. <br /> BATHTUB ; FORCED AIR SYSTEAIS—B.T.U. M E.A. <br /> LAVATORY(WASHBASIN) � � UNIT HEATERS—B.T.U. M � � <br /> T <br /> SHOWER ' CLOTHESDRYERS <br /> KITCHEN SINK& DISP VENTILATION FAN _T_ <br /> DISHWASHER � RANGE HOOD ' <br /> � <br /> LAUNDRY TRAY -WATEfi HEATER � ' I <br /> �—r ' 1N00D STOVE <br /> CLOTHES WASHER � <br /> URINAL METAL FIREPLACE(WOOD BURNING) <br /> DflINKWG FOUNTAIN I FIREPLACE INSERT _�_ � <br /> FLOOR DRAIN � HEAT PUMP <br /> EACKFIOW PREVENTEFS ; GAS PIPiNG _ <br /> ROOF ORAINS—RAINLEADERS EXHAUST FAN — I <br /> ��INK(SERVICE—BAR, ETC.) I <br /> ' , I <br /> � <br /> _ _ <br /> � <br /> SU8 TOTAL 5 __ SUB TOTAL S _ <br /> PERMIT $ PERMIT S <br /> TOTAL FEE S TOTAL FEE $ O_^-- <br /> FOR OFFICE USE ONLY: <br /> FRONTSfTBACK REARSETBACN SIDESETBACH PLANCHECKNUMBER FEE RECEIPTNO <br /> � � <br /> USE ZONE lOT qHEA YACFNT SITE FEES VALUATION F� <br /> YES N� BU�LDING <br /> iYGE0FL011:.'. NOOFSI0RIE5 oCCuvas[v uoa��'N�.:��.��cr.��s <br /> cFv.�v PLUIdBING '. <br /> SREOFBLGG. FlFlESPRINNLERSFiEO'D BASEMENT MECHANICAL <br /> ❑ YES � NO ; <br /> OCCOPPNC"LOnD FIRE ALaPM REO'D HEIGMT UMITATION ADDITIONhL PLAN CHECK __ _ � <br /> n?Hcq � <br /> ' . . _-_ ___'_ ___.__.._. . ____. _—.T <br /> � S7ATE BUILDING SUFCHARGE <br /> i <br /> WTFKEBV PLANSAPPROVEDBY CITYOFEVERETT PUBLICWORKS <br /> LOCAL SALES <br /> onre TAX CODE IS 3iOS . T�TAL <br /> J <br />