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APPLICATIC'1 FOR CONSTRUCY�"1N PERMIT � � <br /> TO BE COMPLETED IN BLACK INK—PLEASE PRINT <br /> BUILQING DEPAR?MENT HEATING SYSTEM: O GAS ❑ELECTPfC ❑ <br /> 259-8810 <br /> L] DEMOLITION �COMBINATION I_I BUILDING I�MECHANICAL f 7 PLUMBING �l SIGN <br /> pW[�IEg. L���u E1AllADDFE55 CITv 21P PHONE <br /> Cls�l 2 7 Z Z. GOI.fbY `I.OJE�-' l.�V��� <br /> M6a D�»f:11.. <br /> TENANI MRILFDORE55 GiY Z�P ?HONE <br /> GITY or- Ev_rzErT - �o��cE t��'c�zas <br /> ARCHRECTORDESIGNEH NRIIADDAE55 CITY ZIP PNONF <br /> c.�T'1 c� E�i��;^l ?�fbl CF.DQ�: Ev�¢G7Y 44� 1 Zo� 25`� 8�'yd' �.�'z,) <br /> GENERAL GONTRACTOR MRIL ADDRESS CITv 21P PNONE STRTE LICENSE� <br /> OW�F_fL <br /> MEGNANICAICqNTR4GTOfl MRiIADDRESS CITY ZIP PHONE SUTELICENSE• <br /> PLUMBING GONTRACTOR MML ADDRE55 QTV 21P PHONE STATE LICENSE r <br /> fAN'RAGiPRICEOf WOHK y �Q/ QOQ <br /> Y Q <br /> DESCPIOE WOPK AN�SOURRE FOOTAGE�NVOIVE� CONTnCT PEPSON AND PMONE NO. <br /> i HEREBY GERTIFY THAT I HAVE READ AND EXAMINED THIS <br /> PROPOSED tISE OF BUIl01NG APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECL ALL <br /> PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br /> LEaFLDESCRIPTIONOFPROPEPTY�SNOWNBELOWORRTfACMTWOCOPIES� WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEPEIN OR <br /> NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br /> �oT� eiocK oc AUTHORITV TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br /> OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br /> PERFORMANCE OF CONSTRUCTION.THAT I AM AUTHORIZED BY THE <br /> OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br /> APPLICATION IS MADE AND I COMPLV WITH THE STATE <br /> PRRCEI TA%10 NUMBER CONTRACTORS LAW 78.27 RCW AND 296�00 W C. <br /> tONSTRUCTION LORN IENDER,ROORESS.IELEPHONE NUM�BER ��'��`� 3'� <br /> PROJECT ADDRESS s uai � � o�*c <br /> on euswrss ucrr�sE r+n _ <br /> PLUMBING MECMANICAL �.��, <br /> NO. TYPE OF FlJ(TURE OR ITEM FEE N0. TYPE OF EOUIPMENT FEE <br /> — WATGR CLOSCT(TOIIET) � A/�A/HNDLG UNITS—H.P. � <br /> BATHTUB ; FORCED AIR SYSTEMS—B.T.U. M E.A. ' <br /> -- LAVATORV(WASH BASIN) � UNIT HEPTERS—B.T.U. M � <br /> 1 SHOWER ' CLOTHES ORYERS <br /> — KITCHEN SINK 8 DISP V[NTILATION FAN ' <br /> � <br /> — DISHWASHER RANGE HOOD <br /> — LAUNDRY TRAV ; WAT[R HEATER <br /> CLOTHES WASHER � WOOD STOVE � <br /> — URINAL ; METAI FIREPLACE IWOOD BURNING) <br /> DRINK�NG FOUNTAIN � FIREPLACE INSERT � <br /> — FLOOR DRAIN HEAT PUMP ' <br /> BACKFLOW PREVENTENS ; GAS PIPING � <br />��y-f ROOFDRAINS—RAINLEA�ERS _�_ EXHAUSTFAN <br /> i'����,i '� 3 SINK(SERVICE—BAR,ETC.) ; <br /> I , ; <br /> � <br /> '1 T <br /> I�. � � <br />� � SUB TOTAL $ SUB TOTAL $ <br /> PERMIT $ PEPMIT $ <br /> TO1"ALFEE $ ' TOTALFEE $ <br /> FOR OFFlCE USE ONLY: <br /> FRONT SEYBnCN REAP SETB�CK SIDE SETBACK PUN CHECK NW.18ER FEE RECEIPT NO. <br /> USEZONE LOTAREA vacnNrsire FEES VALUATON FEE " <br /> i- YES C i NO BUILDING <br /> TYPEO�CON5i NO-OfSTORIE9 accimm[r NOIXmv[wN�Uxns � <br /> � �, ; `^ qaur} JJ 7'; pLUMBING �_ <br /> a � / . <br /> � <br /> SIZ'_OFBL FIFGSPRINKLERSREO'D BAS@MENT � MEGHFNICAL � <br /> � ` � �i•, ' CY"YES Sl NO � <br /> OCGUPANCV IOAD FlRE AIARM RE00 HEIGHT UTAITAj N ADD1110NAL PLAN CMECK i <br /> y / OTHER i <br /> REASON <br /> STATE BUILDING SURCHARGE � <br /> i <br /> INTAKBBY P1.hN5APPFOVEDBV CITYOFEVERETT PUBUCWORNS � <br /> LOCAL SALES <br /> oqTE TAX CODE IS 3105 TOTAL ' <br />