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APPL,IC�t►TIQN FOR CONS7RUCT!ON PEF�MA'� � <br /> TO BE �,.MPLETED IN BLACK INK—PLEASE PRliv f <br /> 9UILDING DEPARTMENT HEATING SYSTEM:'^GAS ❑ ELECTRIC ❑ � <br /> 259-8810 <br /> ❑ DEMOLITION ❑ COMBINATION ❑ BUILDING ❑ MECHANICAL ❑ PLUMBING ❑ SIGN <br /> OWNER 6�AILADDRE55 CITV ZIP PHONE <br /> I��E�c� (�,r;iFS,��x:. l Y;9 � � Nw� p �Dlz y8l-D �S <br /> TEN.',NT h1AlI.AOI]RES$ CITV 2iP PMOkE <br /> APCHIiECTOR�ESIGNER MAILA�OflESS SV� ,Li UTV ZIP PHONE �/�O <br /> sKUTT�YA�z�C l�lSSJ ��rC�1fu�5 �. ,�s�TTz� `I$lg$ 8�`�5-- _ <br /> GENEFALCONTRhCiOR MAILA��RESS CITV ZIP PHONE �� � ±ATEUCENSEk <br /> ��CTcu rIUdIFs <br /> MECH�NICALCONTRACTO MAILqDORE55 CITV ZI? PHONE STATELn.ENSEp <br /> PWh1�INGCONTRAC70R lAAILA�ORE55 CITV ZIP PHONE STATELICENSEu � <br /> CONipALT PRICE OF WOII <br /> lex <br /> �ESCRIBE OFHAND$OU�R F TAGEINVOL ._� , � � CONTACTFERSONANDPHONENO. ^ /' n ,�J/���� (� � � <br /> 1 C <br /> �' Gj � �! 1 �� C ��N /(� <br /> �%�i Li vi ii. , � ,�C/< <br /> ' �Jli+ ('� v � C'Jr�I Y� i HERERY CERTIFY THAT I HFVE READ A�D EXAMINEO THIS <br /> �-rnar�s oFe oiNc- APPLICATION AND KNOW THE SAME TO BE TFUE AND CORRECT.ALL <br /> ' pt ���, PROVISIONS��F LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br /> � �E�SCf11PT10N PPOPERTY�SHOY/NOE.OWORATTACNTWOCOPIES� WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEflEIN OR <br /> NOT. THE GRANTING OF A PER1+11T DOES NOT PRESUME TO GIVE <br /> � �or BLOCK ��F AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br /> OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br /> PERFORMANCE UF CONSTRUCTION.THAT I AM AUTHOFIZED BY THE <br /> OINNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br /> APPLICATION IS M,1DE AND I COMPLY WITH THE STATE <br /> PARCELTA%I.U.NOMBER CONTRACTORS LAW 18.27 RCW AND 296200 WAC. <br /> CONSTRUCTION LOAN LENDER,A�OFESS,TELEPiIONE NUAIOER ' <br /> P�o�e�non �s _ �'Ji ���it� '•L,� s�.x.,��� o.� l 9_�_ <br /> Ci1V OUSiNE55 LIC[NSE N0. <br /> � PLUMDI G MECHANICAL <br /> - t�0. TYPE OF FIXTURE OR ITEM FEE NO. TYPE OF E�UIPMENT FEE <br /> WATER CLOSET(TOILET) � NC—A/HNDLti UNITS—H.P. <br /> BATHTUB FORCED AIR SYSTEMS—D.T.U. M E.A. � <br /> LAVATORY(WASH BASIN) � UNIT HEATERS—B.T.U. M � <br /> �/ SHOWER � Z CLOTHES DRYERS ' <br /> �� KITCHEN SINK&DISP � VENTILATION FAN ' <br /> T <br /> DISHWASHER RANGE HOOD <br /> LAUNDRYTRAY WATER HEATER <br /> CLOTHES WASHER WOODSTOVE <br /> URINAL ' 7j METAL FIREPLACE(WOOD BURNING) ! <br /> DRINKING FOUNTAIN � FIREPLACE INSERT <br /> FLOOR DRAIN � HEAT PUMP <br /> BACKFLOW PREVENTERS � GAti PIPING <br /> � <br /> FOOF DAAINS—RAINLEADERS EXHAUST FAN <br /> SINK(SERVICE—BAR,ETC.) ; ' <br /> � � <br /> —�— <br /> � <br /> � <br /> —�— <br /> SUB TOTAL $ SUB TOTAL 5 _ <br /> PERMIT S PERMIT $ i � <br /> TOTAL r'EE S TOTAL FEE $ I <br /> FOR OFFICE USE ONLY: <br /> FFONTSET��CK REAFlSET�ACK SIOESEiDACK PLANCHEGKNUTABEF FEE RECSIPTNO. <br /> �,�a�2z- 1077/5� /��,�3C� <br /> USE20t�E LOTAREA Y�C�NTSITE FEES VALUATION FEE <br /> -�_ <br /> f I YES f i NO I �7 � � <br /> DUILDING ����/��� � <br /> IYPL(1fCONSi. NO.OF570RIC5 ucnaar:.r �:uciu'..uua,unus T � <br /> ° 10a PLUMBING <br /> �Z1U 2 � Z <br /> SIZEG�BL�G. FIRESPFINNLERSREO'0 BASElAENT ��ECHANICAL <br /> �� L✓ NO n ves jC No — ��—_ <br /> OCCUPANCVLOAD FIREALFRMPEO'D HEIGHTLIMITATION ADDITIONALPLANCHECK i <br /> y� � <br /> OTHER . _ _��� � <br /> RE�SON <br /> /"h�v�1�/� STATE 6UILOWG SURCHAHGE /� i_�Q ' <br /> �/�ViL/V <br /> INTAKEE7� PLANSAPPFOVEDBV CITYOFEVERETT PUBLICR'OflK$ � <br /> �M LOCALSALES — '�— <br /> onre G �- TAX CODE IS 3105 TOTAL �) <br />