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APPLIGAT`IC-�1 FO�i COWSTRUCT"�N PEFiIV19"�' ��� . <br /> TO BE COMPLETED IN BLACK INK—PLEASE PRINT � Tr <br /> BUILDING DEPARTMENT HEATING SYSTEM: GAS ❑ELECTRIC ❑ -� <br /> 259-8810 <br /> ❑ DEMOLITION �] COMBINATION ❑ BUILDING ❑ MECHANICAL ❑PLUMBING ❑ SIGN <br /> JWNER MFILADOFESS CITY ZIP PHONE <br /> /t��Tco N�PtF7 �� � � e - ,ri: N�u� � <<r 9�a��z �l8/—��G�!�S _ <br /> TENANT IdAI�AD�RESS CRY ZIP PHONE <br /> FRCHITECTOFOESIGNEfl MAILAOGRESS S V�' ,L C��Y �IP PHONE �/^O <br /> s K�Tr�Y �_2���tf,�i,� �. �� �ig� g��— l . <br /> GENERALCONTRACTOR MNILA�ORESS CITY ZIP PHONE TATELICENSEN <br /> /� ETCu 't ll 5 T p��� <br /> MECHANICALCONTRACTO IAAILADORESS QTY ZIP PNONE STATELICENSEX <br /> PLLMB'NGCONTRACTOR MFILA�ORES° CITY 21P PNONE STATELICENSEY <br /> CONTpACT PRIC[i.F WORK , _• ,Q <br /> f�V <br /> DESCFIdE ORK FND OUAR F TAGE INVOL' CONTACT PERSON AN�PHONE NO. ' �n �/J���"n` �(���S <br /> ' S � � c � N�i l <br /> � �ZS Z.��; a / ./d� <br /> IJ f/7 '� L t �"L`�- C'I�!I `_1P1% % i HEREBY CERTIFY THAT I HPVE READ AND EXAMINED THIS <br /> ��aoPas oFe ovi� ---- APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br /> `f4 �lu� PROVISIONS OF LAWS AND ORDWFlNCES GOVERNIMG THIS TYPE OF <br /> LEGn DESCflIPT10`!0 PROPERTY(SHOWNBEIOWORATTACNTWOCOPIES� WORK WILL BE COMPLETED WI'H WHETHER SPEGFIED HERE.H OR <br /> NOT. THE GRANTING OF A PERMIT DOES NOT PRESUMG TO GIVE <br /> �or -- s�ceK oF — AUTHORITY TO VIOLATE OR CANCEL THE PflOVISIONS OF AfJY <br /> OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br /> PERFORMANCE OF CONSTRUC'fION.THAT I AA4 AUTHORIZED BY THE <br /> OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br /> APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> PA9CEL TAl I.D.NUMBER CONTRACTORS LAW i 8.27 RCW AND 296.200 WAC. <br /> CONSTRUGTiONLOANIEN�ER.A0DRE55,TELEPHONENUMBER � �� ;�-- <br /> �� � <br /> PROJECTADDRE S _ t � �� /� si rvnruae onre <br /> �— Dr �J }�_ ��,�o�5��E55���E�=E�,o. <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM FEE NO. TYPE OF E�UIPMENT FEE <br /> WATER CLOSET(TOILET) � A/C—A/HNDLG UNITS—H.P. <br /> � B�THTUB ; FORCED AIR SYSTEMS—B.T.U. A1 F.A. <br /> LAVATORY(WASH BASIN) � UNIT HEATERS—B.T.U. M � <br /> SHOWER CLOTHES DRYERS � <br /> KITCHEN SINK&DISP ; VENTILATION FAN <br /> DISHWASHER � RANGE HOOD � <br /> LAUNDFYTRAY ; WATER HEATER <br /> CIOTHES WASHER WOOD STOVE <br /> URINAL ; METAL FIREPLACE(WOOD BURNING) <br /> DRINKING FOUNTAIN � FIREPL�CE ItJSERT � <br /> FLOOR DAAIN � HEAT PUMP <br /> BACKFLOW PREVENTERS ; GAS PIPING <br /> ROOF DRAINS—RAINLEADERS EY.HAUST FAN � _ <br /> SINK(SERVICE—OAR,ETC.) ; � _ <br /> � <br /> � <br /> — ; <br /> -- � ' � <br /> — <br /> � � <br /> SUB TOTAL $ SUB TOTAL S <br /> PERMIT $ � PERMIT 5 <br /> TOTAL FEE 5 ; TOTAL FEE 3 �— <br /> FOR OFFICE USE QNLY: <br /> Ffi0NT5ET8ACK P,EAfiSETBACiC SIOESETBACK PLANCMEiMNUM11tlER/ FEE���, /�� r1ECEIPTi��� <br /> �(� U <br /> ❑$E20NE LOTAREA VACANTSIIE FC-ES VALUATSON FEE <br /> I� YES (� NO /J—� <br /> BUILDING �`'� �' 7�(/U __�J��__ <br /> lYPEOFCON57 NO.OFSTORIES otGN�<ur r,oOrvNrtur:GuanS — � i <br /> `�]� J !L C° p° /7 PLUMBING �/� � <br /> .r�.. /i <br /> EIZEOFBL�G. FIRESPRINKLERSREO'� 9ASEMENT MLCHANICAL ��) <br /> j�GC� NO ❑ YES �GNO — �" " ' <br /> OCCUPANGY 104D FIRE AI�PM pE0'D HEIGHi lI1dITAT10N ADDITIONAL PLAN CHECK <br /> yC�i ���777 ' - <br /> OTHER . ��///i�� �__ <br /> FEASON �-L� <br /> �" `/IA.�/�� S7ATE BUIL�ING SURCHARGE �n w�D <br /> M{ <br /> INTAKE�V PLANSAFPROVEDBY CITYOFEVERETT PUBLICWOPKS <br /> dM LOCAL SALES � <br /> onrE 2 � � TAX CODE IS 3105 ro1A� � ,7��� ; �.� <br />