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APPLICATI�..� FOR CANSTRUC7 .JN PERMIT � <br /> TO BE COMPLETED IN BLACK INK—PLEASE PRINT �j,.��i�FE,r <br /> ��—- <br /> BUILDING DEPARTMENT HEAT�NG SYSTEM: []GAS ❑ELECTRIC ❑ <br /> 259-8810 <br /> ❑ DEMOLITION I J ^•QMBINATION i I BUILDING i i MECHANICAL L I PLUMBING �SIGN <br /> OWNE � MAILAUIlRE55 CITY ZIP PNONE <br /> �itrShnk� a41S Cor.KyM�E E►��f r✓,� 4YZo� z sf-y�� <br /> iENANT MAILADDRE55 CITY ZIP PHONE �5����D <br /> _P��� .�i�AYin��. 29zo �ouSvA�vE �►�tEff c✓g 99zo, <br /> ARCMITECTOR�ESIGNER MAILPDDRESS CITY ZIP PMONE <br /> CENEMLCONTRRCTOF MFILAD�PE55 CITv IIP PNONE ST�TELICENSEI <br /> �v,M.n�4�i sisi✓ �o�O �zs�i�sftAXfA��v s�fif2E,Mf 9�ro9 2�1-orc0 N�oSC53sOZ <br /> MECH�NICALCONTRACTON MAILADDRE55 CITY IP PHONE STATEULENSEI <br /> PLUMBING CONTFlRCTOR MAIL AUDRE55 CITV ZIP PHONE S7ATE LICENSE 1 <br /> CLA55OF WORK <br /> �NEW ❑ AODITION I J ALTERATION I I REPAIR I I DEMOLITION I I WOODSTOVElFRPL INSERT I I BUILDING RELOCATION <br /> i <br /> GONTRRCT PRICE OF WOqK <br /> OD� �OMACT PERSON�PIIONE NO. �� <br /> DESCRIBEWORKANDSOUARE TAGEINVOLVEO <br /> L� / 6l.F� f /LluMl /�fEjr 0/✓ �1� �SG/ <br /> PROVOSEDIISEOFBUILDING I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br /> APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT.ALL <br /> LEGALDESCflIPTIONOFPPOPERTY�SHOWNBELOWORATTFCNFOUflCOP1E5� PROVISIONSOFLAWSANDORDINANCESGOVERNIN��THISTYPEOF <br /> WORK WILL BE CCMPLETED WITH WHETHER SPECIFIEO HEREIN OR <br /> �or BLOCK oF NOT. THE GRANT�NG OF A PERMIT DOES NOT PRESUME TO GIVE <br /> AUTHORITY TO VIOLATE OR CANCEL THE PfiOVISIONS 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 FOA WHICH <br />� APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> CONTRA ORS LAW 27 RCW AND 296.200 WAC. <br /> X iz-�9y <br /> PR0.IECT ADDRE55�n�� ��B� NN[. S�N^ oATE <br /> Y <br /> Giv BUSMESS IiLENSE <br /> PLUMBING MECHANICAL <br /> N0. TYPE OF FIXTURE OR ITEM FEE N0. TYPE OF E�UIPMENT FEE <br /> WATER CLOSET(TOILET) � A/C—NHNDLG UNITS—H.P. , <br /> BATHTUB ; FORCED AIR SYSTEMS—B.T.U. 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 /> LAUNDRY TRAY WATER HEATER � <br /> CLOTHES WASHER � WOOD STOVE ; <br /> URINAL METAL FIREPLACE 8 CHIMNEY � <br /> DRINKING FOUNTAIN i FIREPLACE INSERT ; <br /> FLOOR DRAIN � HEAT PUMP i <br /> BACKFLOW PREVENTERS ; GAS PIPING ' <br /> ROOF DRAINS—RAINLEADERS � EXHAUST FAN � <br /> SINK(SERVICE—BAR,ETC.) ; <br /> � , <br /> SUB TOTAL $ ; SUB TOTAL $ � <br /> PERMIT $ � PERMIT 5 ; <br /> TOTAL FEE $ ; TOTAL FEE $ � <br /> FOR OFFICE USE ONLY: <br /> FRONTSETB�CK R ARSETBAC SIQ�SETB K �� PLNICNEGKNUM�ER � FEE RECEIPTNO. <br /> � pg �— <br /> usEzon �ornnen VACANTSIIE FEES VALUATICN FEE <br /> - � BUILDING �� '� i ���� <br /> TYPEOFCONTS.ALLOWABIE 1YPEOfLONSi.AC1UAL aCWrentv AnoiV�FuiucV4n5 � <br /> caWP � PWAIBING ' <br /> SIZEOFBLDG. NO.OFSTOFlIES DASEMENT h1ECHANICAL � <br /> OCCUPANCY LOAD FIRE SPRNKLERS REO'D HEIGIR LIMITATION ADOITIONAL PLAN CHECK i <br /> SPRINKLER � <br /> RE�SON FOR SPRINNLEPS � <br /> STATE UUILDING SURCHARGE � i j D <br /> INT�NEBY P SAPPqOVEDBY CITYOFEVERETT PUBLICWORH$ i <br /> ��{q LOCAL SALES <br /> ��� TA7(COOE IS 3105 TaTa� �J(� ;SD <br />�� <br />