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APPLICATI�.* ,�1 F013 CO�ISTRUCT"-ON PERMIT �✓�� . <br /> TO BE CJMPLETED IN BLACK INK—PLEASE PRINT <br /> BUILDING DEPARTMENT HEATING SYSTEM: GAS ❑ELECTRIC ❑ <br /> —� <br /> 259-8810 <br /> ❑ DEMCLITION ❑ COMBINATION ❑ BUILDING ❑ MECHANICAL ❑ pLUMBING ❑ SIGN <br /> OWNER IAAILADDRE55 ,7ITY <br /> J'9E7c0 /-lni1F,7 ,i�.k. I R913 �n�u� -F�tNw� p�,� 1��sDlz PHyBI—/�(,�/��_ <br /> IENRNT � MAILA��RESS �ITY ZIP PHONE <br /> ARCHITECTOR�ESIGNER AIAILA�ORESS 5V�'� f.ITY ZIP PMONE �/�O <br /> sKuTr�cYAS�o� i9ss� ��;f,�1�y �: ��rr� �si8� $��— . <br /> GENCRAL CONTRACTOR MAR��DRESS � CITV 21P PHONE � ���T�NSE N <br /> ��Crcu rlr�rlFs p , <br /> M[CHANICIL CONTRACTO MAIL FD�iiE55 �ITV ZIP PHONE STATE LICENSE a <br /> PWMBINGCONTRFCTOR MAILAOOfiE55 CITV ZIP PNONE STATELICENSE> <br /> LONTRACT FPICE OF WORK <br /> =�+�/�Q[�- / �{� <br /> OESCRI�E��I ORH�S�O FR F T-GEINVOL�' _ , ��,Z-hF�(. CONTACTPERSONANDVHONENO. �'1.� � "n' �I��1!/I/IS <br /> ii i Y <br /> <.•�x� <br /> �7 - ��$ Li v; �.�_ / .�lc�'� <br /> �� L �" �Q'mlI C�� i HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br /> �11BP05 lUSFOF'�IJ�OING <br /> i � APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br /> ���"�' Ju' PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br /> �ecn D[SCR'ITIONO PROPEFTV�SNOYlIIBELOWOflATTACHTWOCOPIES) WORK WILL BE COMPLEI'ED WITH WHETHER SPECIFIED HEREIN OR <br /> �oi-- B�ocK oF NOT. THE GFANTING OF A PERMIT DOES NOT PRESUPAE TO GIVE <br /> AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br /> S�/�� ����� PERFORMANCE�OF OONSTRUCT ON.THAT I AM AUTHORIZOED DY THE <br /> �� '�J OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br /> APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> PARCEL TA%LD.NUMOEF I CONTRACTORS LAW 7827 RCW AND 296.200 WAC. <br /> CONS'RUCTIONLOANlENOER.A0DflE55,lELfJ IONENUlADER / <br /> �Jp�.� � ��'� � �F�7�9 <br /> �I � O DRESS h� /� si�rvntune oerE Y <br /> _ L CilY0U9NE5SULENS[!:O <br /> PLUMBING MECHANICAL <br /> N9. TYPE OF FI%TURE OR ITEM FEE N0. TYPE OF EOUIPMENT FEE <br /> WATER CLOSET(TOILET) A/C—NniJULG UNITS—H.P. <br /> BATHTUB ; FORCED AIR SYSTEMS—B.T.U. M E.A. <br /> LAVATORY(WASH BASIN) � UNIT FIEATERS—B.T.U. M <br /> SHOWER � CLOTHES DRYERS �—`— <br /> KITCH�N SINK 8 DISP ; VENTILATION FAN � <br /> DISHWASHER RANGE HOOD <br /> LAUNDRYTRAY ; WATER HEATER � <br /> CLOTHES WASHER � WOODSTOVE <br /> URINAL ; METAL FIREPLACE(WOOD BURNING) ,� <br /> DRMKING FOUNTAIN I FIREPLACE INSERT ' <br /> FLOUR DRAIN � HEAT PUA1P �— <br /> BACKFLOW PREVENTERS ; G.4S PIPING � <br /> ROOF DRAINS—RAINLEADERS � EXHAUST FAN ; <br /> SINK�SEflVICE—BAR,ETC.) � ��—" <br /> � <br /> _ ; — � <br /> � <br /> SUB TOTAL 5 ; SUB TOTAL 5 <br /> PERMIT $ PERMIT 5 � <br /> TOTAL FEE $ _ TOTAL FEE 5 <br /> FOR OFFICE USE ONLY: <br /> FRONTSETBACK FEARSETAALH SIDESETBACI: PLANGHE`��ti1B� /� FEE���, /�� REGEIPTtI`��� <br /> C/ <br /> (/!'Tl � <br /> usezor�E LOTAPEA VAC4NTSITE FEES VALUATION FEE <br /> !� YES f l NO BUu.DING 1(�"7 LZ) y/, <br /> iYPE(IfCUII$7. NOAFSTOflIE$ OLCUrld:fY !;UolO:Ifu��ri6uun5 ---�J-�T s� <br /> �J �Z �f� ���I PLUMBING <br /> SREOFBIDQ FIRESPRIFI(LERSREO'0 BASEAfENT MECHANICAL //�%1i <br /> G�u� I�JQ ❑ YES �CNO ( / _ <br /> � <br /> OCCt/PANCVLOAD fIREAlAR1ARG0� HEIGHTLIMITATION ADDITIONALPLANCHECK � <br /> ���s��� <br /> `1� �- �AI�J 2� � <br /> ��`���,� STA7F BUILDING SURCHARGE ' —^ <br /> �J!/ <br /> INT�KL�V PtAIlSAPPROVEDBY CITYOFEVERETT PUBLICWORKS i <br /> I �IM LOCAL SALES ' <br /> onre 2/���5 TAX CODE IS 3105 rora� / ?DZ' � <br /> i V � <br />