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APPLICATIO.�1 FOR COI�STRUCTI�N PERN0IT <br /> TO BE CV�dPLETED IN BLACK INK—PLEASE PRIh. � <br /> BUILDING DEPARTMENT HEATING SYSTEM: , ' GAS ELECTRIC ❑ <br /> 259-8810 � <br /> ❑ DEMOLITION ❑ COhABINATION fJ BUILDING ❑ MECHANICAL ❑ PLUMBING CI SIGN <br /> OWNEF l.IAILADDFE55 C1TY ZIGP j� �/ PHONE J <br /> �ENANT� Y ' / �,p�Lppp�3 ' ,rl: Nw� CI� ZIOVI(/ PHY�I'V�1!/I�S <br /> ARCNITECTOROESIGNER MAI�FOORESS �i GTV IIP PHONE <br /> 5 KuTr�Y A550� 1�SsD ��;�;�i�ti 5 SVa�. s��rrc� �slSg S��— y/�O <br /> GENERAL CONTRACTOR l.IAIL ADDRESS dTY 21P PHONE TATE LICENSE a <br /> /IECu 'rlls T�D� <br /> MECHAf�ICALWNTRACTO MAILAODflESS CiTV ZIP PMONE STAiELiGENSEa <br /> PWlA91NGCONTFACTOR MAILA�ORESS CIiV ;;IP PHONE STATELICENSEa <br /> CONTRACT PRICE OF YlORK ` � <br /> �ESCflIBE 1 OflK ANO$OW TAGE INVOI 'S�IQ�Q 4[� . �ONTFCT PEhSON�NO PHONE 1'O, <br /> �r���-1Ilvr�-��' — C,ttr aa /j�i�r�f'z�.¢/ �i5���o.�S <br /> � ��$ Li v; ct _ / 1�1r <br /> �-rqoPos� eoFe oiNc_ �e�// �� � i HEREBY CERTIFY THAT I HAVE REA� AND EXAMINED THIS <br /> � APPLICATION AND KNOW THE SAME TO BE-i P.UE AND CORRECT.ALL <br /> S'�'7r 1 PROVISIONS OF LAWS AND ORDINANCES GOVER.�!NG THIS TYPE OF <br /> LEGA DESCRIPTION PROPERN�SNOWNBELOWORBTTACHTWOCOPIES) WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR � <br /> �or — e�oCK oF NOT. THE GRANTING OF A PERMIT G�ES NOT PRESUME TO GIVE <br /> 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 PERFOP'�. THE WORK FOR WHICH <br /> APPLICATION IS MADE AND I COMPLY WITH THE �TA'fE <br /> PARCEL TA%I.O.NUMBER CONTRACTORS LAW 78.27 RCW AND 296.200 WP.�. <br /> GONSTRUCTION LOAN LENDER,ADORESS,TELEPHONE NUMBER _— / <br /> '��� � �•— /q <br /> PRO� J�EfC-TADDRESS �� '/J� �� si Hmm�E onte �-��— <br /> til e%'3l� - /L/�t' /��� ll ) 1- � urreus:�:essuceriser�o <br /> PLUMBING MECHANICAL <br /> N0. TYPE OF FIXTURE OR ITEM FEE N0. TYPE OF E�UIPMENT FEE <br /> WATER CLOSET(TOILET) � A/C-NHNDLG 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 CLOTHES f 9YERS —�— <br /> KITCHEN SINK& DISP ; VENTILATION FAN � <br /> DISHWASHER RP,NGE HOOD �— <br /> LAUNDRY TRAY ; WATER HEATER <br /> CLOTHES WASHER WOOD S�fOVE <br /> URINAL METAL FIREPLACE(WOOD BURNING) � <br /> DHINKING FOUNTAIN � FIREPLACE INSERT ' <br /> FLOOR D9AIN HEAT PUMP � <br /> BACKFLC�W PRE�cNTERS ; GAS PIPING � <br /> ROOF DRAINS-RAINLEADERS � EXHAUST FAN <br /> SINK(SERVICE-BAR,ETC.) ' i_ <br /> � , <br /> —�-- <br /> ' ' _ <br /> SUB TOTAL 5 ; SUB TOTAL S <br /> PERMIT S �— PERMIT $ ; <br /> TOTAL FEE S TOTAL FEE S <br /> FOR OFFICE USE ONLY: <br /> FRONTSET�ACK REARSETB�CK SI�ESETAACK PLANCHE`�i'h'�n� FEE���, /�` PECEIPTj��� <br /> u �� <br /> ci � / <br /> usezev=_ LOTAf1EA VAGANTSITE FE[S VAWATION FEE <br /> L I YES CI NO Gt� � <br /> B�:ILDING [j/JQ�Z•� /7C�j�,J�� <br /> iYPEOfCOt15TJ NOOFSiCRIES Occurm:tt I:OorcxFwr.su!n's —�'�'=�}- —��L_I__� <br /> �T, I �1� '1J— cFoua � pLUM61NG ' —� <br /> l r- <br /> $REOFpLDG. FlPESPRINKI.ERSfiEO:� 6ASEI.IENT ��ECHFNICAL —T—� <br /> Io,S/v yT y�� n ves ,�cNo -- �— <br /> OCCOPANCYLO�D FiREhLAqMHEO'D MEIGHTLIldITAT10N AUDITIONALPLANCHECK � <br /> A✓A �/ �� (/�.i <br /> �_-1 /� OTHER <br /> ❑EASON _ � -. <br /> ��nf��� STATE BUILOING SLIRCHARGE /�1 ; �/� <br /> INTAKEDY�LqrySAPAROVED�V —L[/�J_L <br /> r CITYOFEVERETT auaucwoaKs __�_ <br /> JM LOCAL SALES <br /> onTe ��� y TAX CDDE IS 3105 TOTAL � ;�[ � C� <br /> :% <br /> _�'_� �' - <br />