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APPLICATIO�`I FOR CONSTRUCT��N PERN0IT �✓�� <br /> TO BE COMPLETED IN BLACK INK—PLEASE PRIN I <br /> BUILDING DEPARTMENT HEATING SYSTEM: ' GAS ❑ELECTRIC ❑ � <br /> � <br /> 259-8810 <br /> ❑ DEMOLITION ❑ COMBINATI�"1N ❑ BUILDING Cl MECHANICAL ❑ PLUMBING ❑ SIGN <br /> OWNER IAFILAODRESS GI�Y LIP PHONE <br /> /�"�/�r+.--�n�. �x���:�;1,( - Ji: N��� � ysmiz �'BI--OG�oS <br /> TENANT h1AIL A�pRE55 CRY 21P PI/ONE <br /> APCHITECTOflDE/5�L1GN�E/R� MARADD/R�E55 ^1 ) SVq��'�, r qTV ZIP PHONE �/�O <br /> SKuTr�YAn7�J� I�,/�(/514LJi'Cl� . Wa C�� 21P/�� PMO� TATELICEKSEP • <br /> �l E Cu ; )ll s Tap D.� <br /> MECMANICFIWtlTRACTO IAAILADOFESS CRV ZIP PHONE $TATELICENSEs <br /> PlUM91NGCONTRACTOfl MAILADDRESS CITV ZIP PNONE STATELICENSEn <br /> CONTRqCT PPICE OF WORN <br /> �� � <br /> DESCRIBE,4}'OFK AZ U 1 f 'GE INVO�' , ' � � • CONTpCT PERSON AND PHONE NO. /' n ,A � � � S <br /> f_�.MWAA. � // <br /> _f.LJ�S�'L <br /> � ��� L;v; a / ,/d< _ <br /> �AI�P� li�'�"�^ QIr�I `�P�^ I HERCBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br /> �ynoros�FOFs oiNa--- APPLICATION AND KNOW THE SAIdE TO BE TRUE.4ND CORRECL ALL <br /> Si[•td/Q'•�stw� PROVISIONS OF LAWS AND ORDI!JANCES GOVERNING THIS TYPE OF <br /> LEGA O�F:PTIONO PROPERTV(SHOWN�ELOWORATTACHTWOGOPF_5� WORK WILL BE COMPLETEO WITH WHETHER SPECIFI[U HEREIN OR <br /> NOT. THE GRANTING OF A PERMIT DOES NOT PFESUME TO GIVE <br /> . �ot BLOCK oF AUT�iORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br /> OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br /> — PERFORMANCE OF CONSTRUCTION. iHAT I AM AUTHORIZED 8Y THE <br /> OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WH!CH <br /> APPLICATION IS MADE ANO I COMPLY WITN THE STATE <br /> PARCELTA%I.D.NUAIpER CONTRACTORS LAW 18.27 RCW AND 296.200 WAC. <br /> CONSTRUCTIONLOFNLENDEF,AO�PESS.TELEPHONENUMBER <br /> �-.� �� <br /> PROJECTADDR � � � ❑ . �� si rvnroae on�e <br /> � — � ' j CRVOJSINE55LiCEN5EN0 <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FI%TURE OR ITEM FEE NO. TYPE OF EQUIPMENT FEE <br /> WATER CLOSET(TOILET) � AIC--A�HNDLG UNITS—H.P. � <br /> � BATHTUB FORCED AIR SYSTEMS—B.T.U. M E.A. � <br /> LAVATORY(WASN BASIN) � UNIT HEATFRS—B.T.U. M ; <br /> SHOWER ' CLOTHES DRYERS <br /> KITCHEN SINK&DISP � VENTILATION FAN ; <br /> DISHWASHER � RANGEHOOD <br /> LAUNDRYTRAY ; WATERHEATER � <br /> CLOTHES WASHER � WOOD STOVE <br /> UFINAL ; METAL FIREPLACE(WOOD BURNING) � <br /> �RINKING FOUNTAIN � FIREPLACE INSERT <br /> FLOOR DNAIN HEAT PUMP � <br /> BACKFLOW PREVENTERS ; GAS PIPItJG <br /> ROOF DRAINS—RAINLEADERS � EXHAUST FAN � <br /> SINK(SERVICE—BAR, ETC.) ; <br /> -- � <br /> � � <br /> — � <br /> _ ' <br /> SUB TOTAL $ ; SUB TOTAL $ <br /> PERMIT 9 � PERMIT $ � <br /> TOTAL FEE S ; TOTAL FEE 5 <br /> FOR OFFICE USE ONLY: <br /> fRONTSETpAGK AEAqSETBACK SIpE5ET8ACK PLPIJCHE`�Uld�/7 FEE���, /�� �"=�EIPTtI��� <br /> U y <br /> usezot+e LOTAREA vncnr�Tsire FEES VALUATION FEE <br /> �� YEs �� No BUILDING 173,G79.� � :�n <br /> iYPE0FC0I15i NO.OFSTORIES oC[uvACC� r:oorCviELLIqGUxns � <br /> �f,rl /L t� /L PLUA781NG ' <br /> ���ti <br /> SIZEOF�OILOG. FIRESPRINKLERSREO� BASElAENT MECHANICAL <br /> ?J �'G3 ND ❑ YES }� NO � <br /> CCCUPFNCYL0�0 FIREALARIdREOD NEIGHTLIl.71TATION ADDITIONALPLANCHECH i <br /> `i� / G � ' <br /> OTHER ' � <br /> PEASON <br /> /�`,���� STATE BUILOING SURCHARGE ��+ J <br /> ���� <br /> INTAK[OY PLFtlSAPJPq,�UVEDOY CITYOFEVERETT PUBLICWORNS � <br /> tJ/r� LOCAL SALES � <br /> onre 2 TAX CODE IS 3105 T�TAL Z j � � <br />