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E►PPLICATI('�1 FOR CONSTRUC'�''7I+i PEf�IV01`� ���' <br /> TO BE COMPLETED IN BLACK INK-PLEASE PRINT <br /> HEl.TING SYSTEM: �� GAS ❑ELECTRIC ❑ <br /> BUILDING DEPARTMENT <br /> 259-8810 <br /> ❑ DEMOLITION ❑ COMBINATION ❑ BUILDING ❑ MECHANICAL ❑ PLUMBING �1 SI(=N <br /> UWNER MAILAD[1RE55 CITY ZIP PHJNE <br /> /��T� l�'C�Pt ,� , ��. � �ri: Nu� p �IssOl Z S'8l-�,�oS <br /> TENANT MAILADDPESS CITV ZIP PHONE <br /> 'RCHITECTORD'c51GNER AIAILAODiiESS SV�'� � CITV ZIP PMONE L�/�O <br /> s KuTr�Y A55o� I2ssU ��;����� 5 � .�� �slg� $��— <br /> GENENO.LCONTRFCiOR MAILAODRESS CITV ZIP PMONE TATE ICENSEp <br /> �l ETcu ' Il 5 _ Tap V. ,���� <br /> MECNANIpALCONTRALTO MAILADDRESS CITY Zlr PNCNE STATELICENSEN <br /> PLUIdBINGCONTRACTOR MAILAODi7E5S CITV ZIP PNONE STATFLICENSEq <br /> CONTpACT PpICE OF WORH �i <br /> � }�!J G <br /> �ESCRI�E\ OPK AND S AR F TA E INVOLY _ Rc CONTACT PERSON AND PHONE NO. n,/ ' � f __ � � (�f_f�� � S <br /> ;!� � � iul=�lrl <br /> � . �Z$ L, , �t /7�ldr _ <br /> � ' ' � Q� L �� C'Jr�I `1� I HEREBY CCFTIPY THAT 1 HAVE READ AND EXAMINED THIS � <br /> li �noP�s oF-o oiNc----- APPLICATION AND KNOW THE SAME TO BE TRUE ANC CORRECT. ALL <br />'I , , ✓�[,�a -. ' .. , PROVISIONS OF LAWS AND ORDINANCES GOVERNING�i HIS TYPE OF ' <br /> �� <br /> �e,n DESCRIPTION fPOPERIV(SMOWNBELOWORPTTACHTWOCOPIES) WORK WILL BE COMPLETED WITH WHETHElt SPECIFIED HEREIN OR <br /> � NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br /> _ icr o�ocK oF AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br /> � OTHER STATE OR LOCAL LAW REGULATWG CONSTRUCTION OR THE <br /> � PERFORMANCE OF CONSTRUCTION.THAT I AM AUTHORIZED 0Y THE <br /> OWNER OF THIS PROPEHTY TO PERFORM THE WORK FOR WHICH <br /> APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> PARCELTAX:.D.NUh19ER CONTRACTOAS LAW 7827 fiCW AND 296.200 WAC. <br /> CONSTRUCTIONLOANLENDER,A�OPESS,TELEPHONENUMBER � <br /> ' PROJECT ADUR 5 ��y, „ ,� �,✓s�,�.,un� � o"��7 r9 y_ <br /> . � 72 �� - (�T�' � cireouswEssucer+se��o __ <br /> PLUMBING MECHANICAL <br /> N0. TYPE OF FIXTURE OR ITEM FEE NO. TYFE OF EOUIPMENT PEE <br /> WATER CLOSET(TOILET) � AIC—lJHNDLG 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 � L CLOTHES DRYERS ' <br /> KITCHEN SINK 8 DISP VENTILATION FAN � _ � <br /> DISHWASHER � R.4NGE HOUD ' <br /> LAUNDRY TRAY ' WATER HEATEF _ <br /> CLOTHES WASHER WOO�STOVE <br /> URINAL ' METAL FIREPLACE(WOOD BURNING) ' <br /> DRINKING FOUNTAIN � FIREPLACE INSERT � <br /> FLOOR DRAIN � � HEAT PUMP <br /> BACKFLOW PREVENTERS ; GAS PIPING <br /> ROOF DRAINS—RAINLEADERS � EXHAUST FAN <br /> SINK(SERVICE—BAR,ETC J <br /> � ' <br /> — � <br /> � ' <br /> --i— <br /> i ' <br /> SUB TOTAL 5 ' SUB TOTAL 5 ' <br /> PERMIT S � PERMIT 5 <br /> TOTAL FEE b TOTAL FeE _$ <br /> FOR OFFICE USE ONLY: <br /> FRONTSETB4CK FEMSET�ACN SI�ESETBACK PLFt1GHE`�!'dBE��^ FEE�y�[,//�/T REGE:PTI'Q��� <br /> (irU Ci � / L� <br /> usezone tornaen vacnNrsire FEES VALUATION FEE <br /> i I YES I� NO BUILDING ��7,W ___ ��2� - <br /> IYPtUfCOY51. NOAFSTORIES n[c�n'.cCr nnnrUwuWi6u'uls <br /> �1N° ,� PLUMBING __��� <br /> �_ _ 2 R3 <br /> SRE OF OLGG. FIRE SPPINKLERS REO'D � SEIdENT MECHANICAL __�_2 � _ <br /> �✓ ND ❑ YES �CNO — <br /> OCCUPnNCrtono FIREALAF�l.-1`RE0'D HEIGHrurdirnno�� ADDITIONALPIANCHECK � <br /> YL� OTHER � �O � _ �� � � <br /> REASON <br /> �NI� C� STATEBUILDINGSURCHARGE _ � j�J� <br /> (/Kl/L <br /> �MLIXE[�Y PIAHS�PPBOVEDBY CITYOFEVERETT PUBLICWORNS i <br /> JGbI �ocn� sn��s <br /> �„TE 2� �j�. TAX CODE IS 3105 70TA1 ��� '�"�O <br />