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APPLIC�T10 . FOR CONSTRU�T�^`N PERMIT � <br /> TO BE COMPLETED IN BLACK INK—PLEASE PRINT � <br /> BUILDING DEPARTMENT HEATING SYSTEM: ']GAS J ELECTRIC J I <br /> 259-8810 � � <br /> ❑ DEMOLITIVN e� COMBINATION I ; BUILDING ;_1 MECHANICAL J PLUMBING ❑ SIGN <br /> �O R cG �AAILA�ORE LC�V ,�,C 21P PHONE <br /> �T o.J/�(i//�/1� �iS��J.r `�IG% ri✓Y/!�// Gl�ir i�� �.� ('1 �y.�S j� <br /> TENAhT IAAILFDOPESS CITV 21P PHONE <br /> Fi�9r1/%1`/ti'f�/'r�%� o;�3l C�/ly �.r'7f /%r�- %d11� .y</7"f�,00 <br /> ARCHITECTOFDESIGNEP �AAIL�DORE55 � GITY 21P PHONE <br /> �Y�Er�a aJ ���yy�i,T .s.��y� .��r� G�ii- �s y .3, E�/ <br /> GEN L CON�/L'�f�TRALiOfi ^MAIL A�DPE55 CITY ZIP PHONE STATE UCENSE� <br /> X//lT �/C��`!/�L� __ <br /> MECNRNiCALCONTRPGTOR MAILADORESS CITY ZiP PNONE STFTELICENSEt <br /> PLUMBING CONiRACTOR MAIL AO�RE55 CITY 21P PHONE STAiE UCENSE Y <br /> GONTRACT1 PPICE OF WORN <br /> Y �5 ���� _ <br /> UESCRIBE WOFK RND SOUANE FOOTAGE INVOLVED GONTAC� E SON AND PN�±E NO <br /> T �+K1�i T�.'�L� <br /> o E�oo�' e�/'.'o�� r, ,sl, <br /> i HEREBY CERTIfY THAT I HAVE READ AND EXAMINED THIS <br /> PROVOSED USE OF BWLDING APPLICATION AND KNO`N THE SAME TO BE TRUE AND CORRECT.ALL <br /> �AN� — t�C t T/i'i-�— PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br /> LEGRLDESCRIP110NOFPROPERTY�SHOWNBELOWORATTACHiWOGOPIFS� WORK WILL dE COMPLETED WITH WNETHER SPEGFIED HEREIN OR <br /> NOT. THE GRANTING OF A PEFMIT DOES NOT PRESUME TO GIVE <br /> �ot e�ocK aF qUTHOP.'TY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br /> OTHER STATE OR LOCNL LAW REGULATING CONSTRUCTION OR THE <br /> PERFURMANCE OF CONSTRUCTION.THAT I AM AUTHORRED B1'THE <br /> OWPiER OF THIS PROPERTV TO PERFORM THE WORK FOR WHICH <br /> APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> PAFLEL TA%ID.NUMBEF CONTRACTORS LAW t827 RCW AND 296.200 WAC <br /> CONSTRCT�CA/LENDER.ADDRESS.TELEPNONENb�IBER X �/� �//�� — <br /> C/ ✓ <br /> PROJECT ADDRESS �/� s'�"+�u"� n"�E _ <br /> Z�Z S �..�y /'� QiYBU5ML55ULCN5Cry0 � <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM FEE NO. TYPE OF E�UIPMENT FEE <br /> WATER CLOSET�TOILET) � A'C—A�HN�LG UNITS—H.P <br /> BATHTU6 FORCED AIR SYSTEMS—B.T.U. M E.A. <br /> —+-- <br /> LAVATOP.Y(WASH BASIN) UNIT HEATEPS—B.T.U. M � <br /> �T <br /> SHOWER ' CLOTHES DRYER.i � <br /> KITCHEN SINK 8 DISP VENTILATION Fl�N ' <br /> DISHWASHER RANGE HOOD —� <br /> LAUNDRV TRAY ; WATER HEATER <br /> CLOTHES WASHER � WOOD STO:�E <br /> URINAL � METAL FIP.EPLACE(WOOD BURNING) ' <br /> DRINKING FOUNTAIN FIREPLACE INSERT _ � <br /> FLOCR OHAIN HEAT PUi�1P _ ' <br /> BACKFLOW PREVENTERS GAS PIPING _ � <br /> ROOF ORAINS—RAINLEADERS � EXHAUST FAN _ _ <br /> SINK(SERVICE—BAR,ETC.) � <br /> I _ � <br /> i <br /> � SUB TOTAL 3 ; SUB TOTAL $ <br /> � PERMIT 5 PE-RMIT S � <br /> if TOTAL FEE S TOTAL FEE $ ' I <br /> FOR OFFICE USE ONLY: ��`�� >�=' I <br /> �� FRONTSETBAGtt R[AFSETBAGH SIDESEiBnCK PLAN�I�ECKNUMBER F RECEIPT O I <br /> ; ,�r� ,��� �Lo�.� ioa�s�aa � <br /> � /JJ- <br /> usezorve iornaen vncnNrsire FEES VALUATION FEE I <br />� '] YES C NO yUILDWG �,Cj95 �0� � <br /> iVttOFCONSi NOOFSTORtES ectvr�va imorCwuuNeudrs <br /> � � up —�^ reo�r PLUMBING : i " <br /> m_r.t I :i\ / 1��• � !. � . <br /> Ii��"RJE Of BLDG. FIRE SPRUINKLEPSREO'0 6ASEh1ENi MECHANICAL 371 ��� � � <br /> . �• �� T I. i�9 �YES �.:J NO _� i <br /> OCCUPANCY LOAD FlRC�LR(FM pEGD H@IGHT LIMITATION �DDITIONnL PV�N CHECK _ 4'�3 ;?� <br /> �(y'L.I ZILTi . fL� OTHER � <br /> — — � <br /> REASON � � <br />� �zi���� '�+�f-„�,E �pry����� STATEBUP_DINGSURCHARGE � � I <br /> '�wf'"1 'y+i �.t.� ' � <br /> MTAKEBY LANSAP OVED�V CITYOFEVERETT PUBLIC'.YOFKS � 1 <br /> LOCAL SALES 2�72�_ � <br /> onre 9� c� TAX CODE IS 3105 T�TA� '� <br /> ��� I�i�� <br />