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APPLICATIO�.�+1 FOf� CON�TRUCTION a�Rlll�O"tl' � <br /> TO BE (,. �dPLETEG IN BLACK INK—PLEASE PRI�„ '��'h rr <br /> �� <br /> BUILDING DEPARTMENT HEATING SYSTEM: ' GAS ❑ ELECTRIC f]_ <br /> --� <br /> 259-8810 <br /> ❑ DEMOLITION CJ COMBINATION ❑ BUILDING ❑MECHAPIICAL ❑ PLUMBING ❑ SIGN <br /> OYlNER MAILADDFiE55 GTY ZIP PHONE <br /> /�� �D a�P1F� ���. I x91� ��u�- Jf- Nw� p !Salv `/8/-fJ�oS <br /> :�iNM` � IAAILAOORE55 GTY 21P PHONE <br /> SKuTr�YE�r. MAIL=D�RES1 L}{(CI� SVf�{ C���„"" �s18'V D�� / /7O . <br /> GENERFLCONTR�CTOR MAILAODRESS �� qTV ZIP PHONE TqTELICENSEp <br /> M eTcu r(t�III F,s Ta�D�,�P <br /> IAECHANICALCONTRqCTO IApILAODRESS CITY ZIP PHOHE STAiELICENSEA <br /> PIUIdBINGCONTR�CTOR MAILA�DPESS CITY ZIP PHONE STATELICENSEp <br /> CONTFACT PRICE OF WORK (�y� � <br /> � YL1� <br /> DESCRiBE ORHAND OUAC AGEIN O—�L —� [ . CONTACTPERSONANDPMONENO. � � � <br /> y " i e � <br /> ��/� �G'$ Li v1 ' rz / lc% <br /> (/ v��(�� L 1�"- elv'iI4� I HEREBY CERTIFY THAT I HAVE READ AND EXAMINFD THIS <br /> �-rqeao.,cvvsFOF�o� owc------ APPLICATION AMD KNOW THE SAME TO BE 1 FUE AND CORRECL ALL <br /> �'�i�� ' 1 PROVISIONS OF LAWS AND OfiDINANCES GOVERNING THIS TYFF OF <br /> L[Gn O.SCRIPiION PpOPERTY�SHOWNBELOWORATTACHTWOCOPIES) WORK WILL BE COMPLETED WITH WHETHER SPECIFIEO HEREIN OR <br /> � . �or s�octi oF - - NOT THE GRAt�TING OF A pERMIT DOES NOT PRESUME TO GIVE <br /> — � /� AUTHORITY TO VIOIATE OR CANCEL THE PRO�'ISIONS OF A^IY <br /> OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br /> � PERFORMANCE OF CONSTHUCTION.THAT I AM AU'i HORIZED BY THE <br /> OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br /> anRce�rnxto.Nur.�Aea APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> CONTRACTORS LAW 18.27 RCW AND 296.200 WAC. <br /> GONSTRUCTION LOAN LENDER.A�ORESS,TELEPHONE NUMBER <br /> -��''� �_ ��7�9Y <br /> � PROJFCT AD S 1 �w 1 1. 1 „ l si rvniune esre <br /> .�� — / 7" I,/� W ,� CrtYB115wESSLILEN5EH0 <br /> . PLUMBING MECHANICAL <br /> . NO. TYPE OF FIXTURE OFt ITEM FEE N0. TYPE OF EOUIPMENT FEE <br /> WATER CLOSET(TOILET) � A/C-A/HNDLG UNITS-H.P. <br /> � 2 BATHTUB FORCED AIR Sl'STEMS-B.T.U. M E.A. <br /> p LAVATORY(WASH BASIN) � UNIT HEATERS-B.T.U. M ; <br /> SHOWER � CLOTHES DRYERS T <br /> KITCHEN SINK&DISP ; VENTILATION FAN <br /> _ DISHWASHER RANGE HOOD —r <br /> LAUNDRY TRAY 2 WATER HEATER � <br /> CLOTHES WASHER WOODSTOVE <br /> URINAL � METAL FIREPIACE(WCOG BUANING) � <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.) � ; <br /> -- i . <br /> ' � <br /> - � � <br /> T <br /> SUB TOTAL 5 ' SUB TOTAL S ' <br /> PERMIT 5 i PERMIT 5 i <br /> TOTALFEE $ TOTALFEE S <br /> FOR OFFICE USE ONLY: <br /> FRONTSET9ACK REMSEi6ACK SIOESETOFCK PLPNCHE�i'Id�/h FEE������ RELEIPTi��� <br /> V/f7 <br /> usEzowe LOTARE� VACAYTSITE FEES VALUATION FEE <br /> f! YES [i NO 6uILDING 7 ,�/ � �j�/ ' <br /> 71PfOFCONSi. NO.OFSTORIES ouurahrv LVorUttiLLurctu'.t5 ��—=— //- � � ��� <br /> .'ry i n c uuP 2 pWM81NG � <br /> 14V L, __��:_ <br /> 512E�OF^plDG. FlRESPRINNLERSREO'0 BASEM1tENT MECHANICAL <br /> `� NU f 1 YES ;2s NO � __ <br /> � <br /> OCCUPANCVL0�1D FIREALARIAPEOD HEIGHTLIMITATION <br /> ADDITIONAL PLAN CHECK ' <br /> ti� � �;- <br /> OTHER - <br /> REAS�ON�y��r�� <br /> (�pVi{A/�'NG� STP.T�BUILDING SUFCHARGE �— <br /> �D :�)CJ <br /> INTAHF�V PLANSA�PFOVEDBY CITYOfEVERETT pU�LICWORKS <br /> .JM LOCAL SALES <br /> I onTe ��q�� TAX COUE IS 3105 TOTAL Z /, � �Q <br />