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-� <br /> APPLIC/L`i'IC ; FOR CONSTRUCT'`1N PERMIT � <br /> TO BE COMPLETED IN BLACK INK—PLEASE PRINT <br /> BUILDING DFPARTMENT HEATING SYSTEM: U GAS ❑ELECTRIC O <br /> 259•8810 <br /> G DFRSOLITION ❑ COMBINATION ❑ BUILDING ❑MECHANICAL ❑PLUMBING ❑ SIGN <br /> OPINER IAAILAD�RE55 dTV ZIP � P ON� <br /> :;OLBY CENTER 2825 COLBY AVFNfiF. r•vFRF,� 9820� <br /> TENANT MAILAUORE55 GITY ZIP PHOtIE <br /> FRONTIER BANK lsT Fr.onu TFNLNT rnnpRrlVEM$t�T <br /> AR�Hi1ELTORDE5IGNEF MAILAD�RE55 GITY 21P PHCNE <br /> GENEflALCANiRAGTOR 1AqILADDRE55 qTY ZIP PMONE STATELICENSEI <br /> MECHRNICAL CONTRAGTOR IAAtI ADORESS qTY ZIP PHONE STATE IIGENSE 11 <br /> COMMERCIAL FIRE PROTECTrON rtu� nunrnnmr.c <br /> PWMBINGCONTRAGTOR MFIIADDflE55 . qTV ZIP PND <br /> 1 <br /> CONiRRCT PRILE OF WORK <br /> y DESCRIBE WORK AND SCUARE FOOTAGE INVOWED LONTACT PEFSON AND PMONE NO. <br />� �/� <br /> '.e/� �� fd('A��y' <br /> I HEREE3Y CERTIFY THAT I HAVE READ AND EXAMINED THIS <br /> PROPOSEDUSEOFe�yy1oir;c APPL�CATION AND KNOW THE SAME TO BE TRUE AND CORRECT.ALL <br /> V'�"'C� PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br /> lEG1LLDE5CRIPT10N0(PPOPE(1TY(SNOWNBELOWORATTALNTWOCOPIES) WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br /> NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br /> �or BLOCK-- OF AUTHORITY 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 /> PARGELTA%I.D.NUMB[P APPLICAT�ON IS MADE AND I COMPLY WITH THE STATE <br /> CONTRACTOflS LAW 182 RC A b 296.200 WAC. <br /> :.ONSTRUCi�ON LOAN LENDEF,ADDRE55,TELEPHONE NUMBER ' <br /> � � l.�-�'�Q -/v _ <br /> PflOJECT ADDRESS � sr.N� ne �.� �- oere <br /> / / i <br /> �� (J�/ / Gi BU51 LIGENAENO <br /> PLUMBING MECHANICAL <br /> HO. TYPE OF FIXTURE OR ITE FEE NO. TYPE OF EUUIPMENT FEE <br /> WATER CLOSET(TOILET) � NC—A/HNDLG UNITS—H.P. � <br /> --� <br /> BATHTUB ; �FORCED AIR SYSTEMS—B.T.U. M E.A. ; <br /> LAVATORY(WASH BASIN) � UNIT HEATERS—B.T.U. M ; <br /> T <br /> SHOWER � CLOTHES DRVERS � <br /> KITCHEN SINK 8 DISP ; VEPJTILA710N FAN ; <br /> DISHWASHER � RANGE HOOD —� <br /> LAUNDRY TRAY ; WATER HEATER ; <br /> CLOTHES WAShIER � WOOD STOVE � <br />' URINAL ' METAL FIREPLACE(WOOD BURNING) ; <br /> ORINKING FOUNTAIP! � FIREPLACE INSEFT � <br /> FLOOR DRAIN HEAT PUMP <br /> BACKFLOW f�REVENTERS i GAS PIPING � <br /> ROOF ORAINS—RAINLEADERS EXHAUST FAN <br /> SINK(SERVICE—BAR,ETC.) <br /> FIRE SPRINKLERS q p _ � <br /> , <br /> PLAN REVIEW 2000 <br /> - SUB TOTAL $ ; SUEI TOTAL i ; <br />� PERMIT $ PEHMIT $ i <br /> i <br /> TOTAL FEE $ ; TOTAL FEE $ � <br /> FOR OFFICE USE ONLY: <br /> FRONTSETUACK REARSETUACK SIDESETD�CH PLANCHEG NIIMBER fEE RECEIPTNO. <br /> 7� � J / _ � <br /> USE 20NE �or aaen vncnHr sire FEES VALUATION FEE <br /> ❑ YES ❑ NO pUILDING � <br /> 1Yi'EOFfANSi NO.OFSTORIES n[tumxtr MambnfuixGUNii3 � <br /> '�_I � 5 I �" R � PLUMBING � - <br /> SRE OF BLDG. FIRE SPRINNLERS REO'D � EMENT-j� �� �,�ECHANIC�L � <br /> �v �.� y�> � YES � No - ; <br /> OCCUPANCVIOAD FIBEALARMREOU HEIGHTLIMII�TION AD�ITIONALFLl�NCHECK � <br /> ��l1 y��> � _oT�.�— '.,,, , 1 :, � D; <br /> HEASON <br /> �(� (��� �';'�� STATE 6UILDIN SURCHARGE i <br /> INTANEBY PlANSAPp[iQVEO�Y CITYOFEVERETT PUBLICWORKS � <br /> v°'� LOCAL SALES <br /> oarE ���� TAX COUE IS 3705 TOTAL i <br />