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APPLICATI��1 FOR CANSTRUC7 )N PERMIT � <br /> TO BE COMPLETED IN 6LACK INK—PLEASE PRINT <br /> �HEATING SYSTEM: ❑GAS ��fLECTRIC ,� <br /> BUII.DING DEPARTMENT <br /> 259 8810 <br /> ❑ DEMOLITION I l COMBINATION �,"_I BUILDING Ci MECHANICAL ❑ PLUMBING ❑ SIGN <br /> OW�ER MAILADDRESS CITV ZIP PMONE <br /> �'�J� Gr00Ds 5�/31 -/,� UJ �=UL.�� i�fh 9��'i <br /> TEIlANT MPILADDRESS GITY ZIP PHONE <br /> ARCHITECTOF�ESIGNEP MAILA�DFESS CITY 21P PHONE <br /> GENERALCONTRACTOR MAILADDRESS CIiV ZIP PHONE STATELICENSEa <br /> i.l=Gt-kRa1 �lJ��ots[� ➢�r�Q�il�s' �uui�.~r� U-A- 9Sa7s' ��ls��^ Cc6�F�.���G � <br /> MECHANICAL WMRACiOR MAIL HD�RESS CIN ZIP PMONE STATE LICENSE tl <br /> PLU INGCO�N7ppC7p�q1 MAILA�DPESS CITV ZIP PHONE ST�T[LICENSER <br /> �TRAC�iDP.ICE On�ORK I �0�� r � (/^�)� // ��-S�3 S�'� <br /> riJ L�=U' 7U�`N <br /> �ESCRIBE W K AND SOUA E FOOTAGE INV LVED � CONTAQ PERSON�ND PHONE N0. <br /> � <br /> ��l � �L I HEREBY CERTIFY THAT I HAVE READ AND EXAMWED THIS <br /> PROPOSED USEOF BUILDING APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT.ALL <br /> PROVISIONS OF LA1NS AND ORDINANCES GOVERNING THIS TYPE OF <br /> LEGALDESCflIPTIONbFPPOPERTY�SHOWNBElOW9RATiACHTWOCOPIES) WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br /> NOT. THE GRANTING OF A PERMIT UOES NOT PRESUME TO GIVE <br /> �or—� BLOCN oF �j AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br /> _�/T nt //I///nttJ l.���L OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br /> - PERFORMANCE OF CONSTRUCTION.THrS I AM AUTHORIZED BY THE <br /> OWNF.R OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br /> — APPLICATION IS MADE AND I COAIPL ITH THE STATE <br /> PARCEL TAX I D.NUMBER > CONT�TC}�IS LAW 1 B ZBS.QOD W� <br /> 5� �aoo- o /—oDd s �� .< a � '�r�'�� <br /> �r��-r; .� <br /> CONSTRUCTION LOAN LEN�Efl,AOORESS. LEPHONE NUMBER /]� � � � n,.A� <br /> /),.0 Ll� Vlk i ,�l /� JF <br /> /`�P'(�7 ��V/ <br /> �—�w SGN U�E OAiE �(.� <br /> PROJECT A��� � 1� � 1� � <br /> CV U� cirreus�r+essucErvser+o. <br /> PLUMBING MECHANICAL <br /> N0. TYPE OF FIXTURE OR ITEM FEE N0. TYPF OF EOUIPMENT FEE <br /> WATER CLOSET(TOILET) � A/C—AIIiNDLG UNITS—H.P. � <br /> � BATHTUB ; FORCED AIR 3YSTEMS—B.T.U. M E.A. ' <br /> LAVATORY(WASH BASIN) � J UNIT HEATEHS—B.T.U. M /�O � <br /> SHOWER ' CLOTHES DRYERS <br /> KITCHEN SINK&DISP � � VENTILATION FAN <br /> DISHWASHER RANGF HOOD ' <br /> LAUNDRYTRAY ; WATERHEATER ` <br /> CLOTHES WAStiER � WOOD STOVE <br /> URINAL ' METAL FIREPL.4CE(WOOD BUFNING) <br /> DRINKING FOUNTAIN � FIREPLACE INSEFT � <br /> FLOOR DRAIN � HEAT PUMP ' <br /> BACKFLOW PREVENTERS ; GAS PIPING � <br /> ROOF DRAINS—RAINLEADERS � EXHAUST FAN ' <br /> SINI�� ;SERVICE—BAR,ETC.) I <br /> � ' <br /> � <br /> � ' <br /> � ' <br /> SUB TOTAL $ ; SUB TOTAL 3 ' <br /> PERMIT 5 � PERMIT 5 � <br /> TOTALFEE 3 TOTALFEE $ ' <br /> FOR OFFICE USE ONLY: /hGKC /�G7c�G7��S 1 z�U (16�_ <br /> FRONT SETBACH ' REAR SETBACK/ SIDE SET9ALK /. PIAN GMEGK NUMBEF� FEE BEC PT N0. <br /> �; <br /> zd � � � '= �7�2 <br /> USE20NE LOTAREA VACANTSITE FEES VALUATION FEE <br /> �/ r-� ves ❑ No euaoiNc y-�90 / va 'DO <br /> TYPE OF CONSi. NO.OF STORIES oc:uvan[r ii0 C;o'NFwN,uNns _y <br /> aou+ � PLUMBING �_ <br /> ��� �_ I - - <br /> SIZEOFBLDG. FIRESPAINKLERSREO� BASEMENT � � MECHANICAL �S ��-� <br /> Z� SF N O ❑ YES '.l?NO ' <br /> OCCUPANCVLOAD FIREAIAFhIRE�'D HEIGNTLIMITAT(ON AODITIONALPLANCHECK � <br /> A �/1 � � — <br /> OTHER i <br /> flEASON � � <br /> - STATE BUILDING SURCHAFGE � <br /> INTAHEBV PLANSAPRpVEDBY CITYOFEVERETT PUBLICWORKS � <br /> r,T LOCAL SALES <br /> DATE <br /> 6/�Q 3 TAX CODE IS 3105 TOTAL �� ; ��/ <br />