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_ r. :. _�s <br /> APPLICATIQ"� FOR CONSTRUCT'-1N PERMIT � <br /> TO BE COMPLETED IN BLACK INK—PLEASE PRINT <br /> BUILDING DEPARTMENT HEATING SYSTEM: ❑GAS ❑ELECTRIC U � <br /> 259-6810 y', 's;�' <br /> ❑ DEMOUTION ❑ COMBINATIOI� ❑ BUILDING ❑MECHANICAL ❑PLUMBING i � SIGN <br /> CWNER IAAILADDRE55 CIiV ZiP PNONE �. �, • `� <br /> s���/ ��� �a aa ,� s z� � r x�� /� ����� � 2 �-s���3.s� � :.��,} <br /> TENANT/' / MFRADDRESS CITY 21P PNONE . +���' <br /> t'1b n.hn f,Q��c. :':;w.�, . <br /> �RCHITECTORDESIGNEF MAIlAUOFESS GTV 21P P110NE '���il��.� <br /> � 1 . <br /> '�`. <br /> GENER�L CONTRAC10fl MAIL ADDRE55 CITY 21P PHONE STAT�IICENSE t <br /> MECNANICAL CONiRACiOR h1AIL AD�RE55 GITV LP PHONE STATG UGcNSE a <br /> PWMBINGCONTRACiOR MpiLADORESS QTY ZIP PNONE SiATEUGENSEe <br /> � .�, � �G4 ��> > ��RTs�/-iz�a/� <br /> CONTFA.CT PRIGF OF WORK � <br /> yv�v - <br /> �ESCRIBE WORK AND SOUAPE FOOTAGE INVOL\'EO CONTAGT PERSON AND PHONE NO. <br /> �.� <br /> � S6�- Y�3 . <br /> �s,g� �, �t,i� �°�u� <br /> 5: <br /> I HEREBY CERTIFY THAT I HAVE READ Air'0 EXAMINED THIS <br /> NeoPotEousEOFem�oiNc APPLICATION AND KNOW THE SAMS TO BE TFUE AND CORRECL ALL <br /> PROVISIONS OF LAWS AND OflDINANCES GOVERNING THIS TYPE OF <br /> 1EG11L0E5CNIPTIONOFPROPEFTY�SMOWNBEIOV�ORATfAGHiWOCOPIES� WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br /> NOT. THE GRANTING OF A PERMIT UOES NOT PRESUME TO GIVE <br /> �or e�ocrc �F AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY ! <br /> OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br /> PERFORMANCE OF CONSTRUCTII'.`:.THAT I AM AUTHORIZED�Y THE <br /> OWNER OF THIS PROPERTY T'� PERFORM THE WOAK FOA VJHICH <br /> APPLICATION IS MADE ".�JD I COMPLY WITH THE STATE <br /> PRRCEI TAX I.D.NIIMBER CONTRACTORS LAW 18.27 HCW AND 296.200 WAC. �i <br /> CONSiRUCTION LOFN LENDER.ADORESS.TEIEPHONE NUTABER - � I <br /> ���� (,JD/�� �-2Jr-�7 <br /> PRQIECT AODRESS , scxnune ' °"�E _ <br /> � �' � aV cnvousim[saur.[xSFr+o <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIl(TURE OR ITEM FEE N0. TYPE OF E�UIPMENT FEE <br /> WATER CLOSET(TOILET) NC—A/HNDLG UNITS—H.P. � _ <br /> BATHTUB ; FORCED AIA SYSTEMS—B.LU. M E.A. � <br /> LAVATORY(WASH BASIN) UNIT HEATERS—B.T.U. M � <br /> SHOWER CLOTHES DRYERS ' _ <br /> KITCHEN SINK 8 DISP � VENTILATION FAN <br /> DISHWASHER RANGE HOOD ' <br /> LAUNDRV TRAY ; WATER HEATER ' � <br /> CLOTHES WASHE(i tNOOD STOVE <br /> URINAL METAL FIREPLACE(WOOD BURNWG) ' �, <br /> DRINKING FOUNTAIN FIFiEPLACE INSERT � <br /> FLOOR DRAIN HEAT PUMP <br /> BACKFLOW PREVENTERS ; GAS PIPING <br /> ROOF DRAINS—FiAINLEADERS � EXHAUST FAN ' I <br /> SINK(SERVICE—BAR,ETC.) I <br /> I ' <br /> � <br /> � <br /> T <br /> � I <br /> SUB TOTAL S / � � SUB TOTAL 5 � O v <br /> PERMIT S O � ' PERMIT S " <br /> TOTALFEE $ � TOTALFEE $ ' ' � <br /> FOR OFFICE USE ONLY: <br /> FBONTSETBPCK REAiiSETBACK SiDESETBACN PIANCH GKN4MBER FEE �[GEIPTNO <br /> \ <br /> S–`r 3c� <br /> ❑SE ZONE lOT AREA vncnrvt sire FEES VALUATION FEE <br /> G YES �� N� BUaDiNG <br /> 1YP[OFCONST. NO.OFSiOHIES atut•�ncr xCo�mnwxG�ans � <br /> c9W° PWM�ING <br /> SRE OF BIDG. FIflE SPRINKLERS REO'D BASEMENT MECNANICAL � I <br /> � ves n No � <br /> OCCUPANCVLOAp FIf1EPLARMREOD HEIGHTLIMITATION <br /> ADDITIONAL PLAN CHECK � <br /> i <br /> OTHER i I <br /> RERSON —�— <br /> STA7E BUILDING SURCHAfiGE <br /> INTA1cEBY PIANSAPPROVEDBY CITYOFEVERETT PUBLICWORHS � <br /> LOCALSALFS <br /> DATE TAR CODE IS 3105 TOTAL <br /> — <br />