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T T _ - <br /> APPLICATYp�I FOi; CON�TRUCT�ON PEf;MIT � <br /> TO BE (,�MPLETED IN BLACK INK—PLEASE PRI�.� <br /> BUILDING DEPARTMENT HEATING SYS i EM: ' IGAS O EI.ECTRIC ❑ __� <br /> 259-8810 <br /> ❑ DEMOLITION ❑ CUMBINATION ❑ BUILDING ❑ MECHANICAL ❑PLUMBING f_1 SIGN <br /> OWIJER MAILP�OqESS CITV ZIP PHONE <br /> �' cD c�1 � �ia: I 13 `1,� �FJI- Nw� �� '� y�0/z 5'�l-�J(��S <br /> TENANT MAILA�DRESS CITY ZIP PNONE <br /> ARCHITECTORDESIGNER `�LP�JAESS � SV�' r CIiV ZIF PHONE �/�O , <br /> s Ku�r�Y h5�� i rSsU P�;���� � ��rr�" l8� �-�— - <br /> GENERFL CONTRACTOR M�IL aDOflESS GTV ZIP PMONE TATE LICENSE a <br /> /l-�CTCu rl[J/l(F5 TDy�'.�""�B <br /> ldECN�NICAL f.ONTRACTO lAAIL ADDRE>5 CIiY ZIP PMONE STATE LIGENSE a <br /> PLUM�INGCONTFACTOR MAILA�DFESS pTV ZIP PHONE STATEIiCENSEN <br /> CONTRACT PRICE OF WORK <br /> ,I� <br /> DESCFIBE ORN AND$OUA."F AGE INVOL ,_� , ' � R[ � COMTACT PEPSON ANO PHONE N0. /' n , ��� /�/���� <br /> ' S v � 'Ti5 <br /> `b�S Li�; a / .1d� <br /> � '� (i ���e'I��I �J� I 4ERFBY CERTIFY THAT I HAVE RE,\C AND EXAMINED THIS <br /> oPos FOFeir owa--- APPLICATION AND KNOIV THE SAME TO Bk �'RUE AND CORRECT.ALI_ <br /> ��� � J PROVISION�OF LAWS AND OFDIN4NCES GOVEFNING THIS TYPE OF <br /> �ecn DESCRIPTIONO PROPERTY�SHOWNBELOWOqATTACHTWOCOPIES) WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIPI OR <br /> NOT. THE GRANTING OF F �ERMIT DOES NOT PRESUi�AE TO GIVE <br /> �or BLOCK oF AUTHORITY TO VIOLATE OR CANCEL THE PFOVISIONS 0�= AMY <br /> OTHER STATE OR LOCAL LAW RE6ULATING CONSTRUCTION GR THE <br /> PERFOHMANCE OF CONSTRUCTION.THAT I AM AUTHOfiIZE^ dY THE <br /> OWNER nF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br /> APPLICATION IS MADE AND I COMPLY WITH THE STRTE <br /> PARCEL TA%1.0.NUMBER CONTRACTORS LAW 1827 RCW F.ND 296.200 WAC. <br /> CONSTPUCTIONLDANLEN�EP,FDDRESS.TELEPNONE NOMBEF <br /> ��--� �' -��-7�9y <br /> PROJECT A RES �� o r�>r+Arun=_ oArE <br /> —7�� d — / � r ci*rouswessucenseuu. <br /> PW ING MECHANICAL <br /> N0. TYPF OF FIXTURE OR ITEM FEE N0. TYPE OF E�UIPMC•NT FEE <br /> , WATER CLOSET(TOILET) A/C—A/HNDLG UNITS�—H.P. <br /> BATHTUB ; FORCED AIR SYSTEMS—B.T.U. M E.A. <br /> LAVATORY(VJASH BASIN) i UNIT HEATERS—B.T.U. M i <br /> �-T- <br /> SHOWEF ' CLOTHESDRYERS <br /> KITCHEN SINK 8 DISP i V�NTILATION FAN ; <br /> DISHWASHER � � RANGE HOOD T <br /> LAUNDRY TRAY ; WATER HEATER <br /> CLOTHES WASHER WOOD STOVE <br /> UFINAL ; METAL FIREPLACE(WOOD BURNING) . � <br /> DRINKING FOUNTAIN I FIREPLACE INSERT ; <br /> T <br /> FLOOR DRAIN � HEAT PUMP <br /> BACKFLOW PREVENTERS � GAS PIPING ; <br /> ROOF DRAINS—RAINLEADERS � EXHAUST FAN <br /> SINK(SERVICE—BAR,ETC.) ; <br /> , <br /> � <br /> —' ' _ i <br /> SUB TOTAL 5 ' SUB TO�fAL 5 ; <br /> PERMIT S � PERMIT $ � <br /> --�-- <br /> TOTAL FEE S ' TOTAL FEE $ � <br /> FOR OFFICE USE ONLY: <br /> FRCUT5ET8FCK REAf75ETBACK SIOESET�ACN PLAN�E���l6B�q PEE���, /�� RECEIPTII��D <br /> U <br /> ra <br /> usezor+e �ori,nEn VACANTSITE FEES VALUATION FEE <br /> I I YES I ! NO p��ILDING �u ZZ� 70_ � � � i — <br /> IYPEOICONSi. NO.OFSTOFIES nccurn9cr Y.onrmvn�iu,u;ns �— <br /> � ^ sn.iv ^ pWh181NG <br /> G � ' ;— <br /> SIZEOFBLDQ FIRESPRINY,LERSREOD 845EMENT MECHANICAL �?/> <br /> 3�3 Np ❑ ves k No - �, <br /> OGGUH�NCV LOAO FIRE ALARfd//-REO'D H[IGHTLIlAITATION �DDITIONAL PLFN CHECK i <br /> YL'J OTHER /j'� �T <br /> REASON '�"'� <br /> .rPhn/�/1�� STATE BUILDIfdG SUFlCHARGE i/� <br /> //1�1/L /� <br /> MTANE�Y PLFNSAPPROVEOBY CITYOFEVERETT PUBLICWORKS i <br /> JM LOCAL SALES <br /> onre q/���� TAX CODE IS 3105 TOTAL � <br /> ti� <br />