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APPLICATrN FOR CONSTRUC"ION PERMIT <br /> TO BE COMPLETED IN BLACK INK—PLEASE PRINT <br /> 0 S PLAN; ALDER Cit no. 101 ) <br /> RUILDING DEPART"dENT HEATING SYST(M.—INGAS U ELECTRIC U — ___ <br /> 2598810 <br /> i DEMOLITION 110 COMBINATION Il BUILDING I I MECHANICAL l i PLUMBING i SIC <br /> uW1,LR MAR ADDR[SS CITY ZIP PIKFA ---- <br /> CF1.ECT N0MESTTNC_ 917 F.TM ST EVFRETT, WA Q32U3 258-1M <br /> N NAN) MAR ADDRESS CITY 21P —!—PHO — <br /> ANCHITECT 04 DESIGNER MAR ADDRESS CITY ZIP PONE <br /> ..tN(nAL CONTRACTOR MAIL ADDRESS CITY ZIP PNONE STATE LO1.115171 <br /> $E7.ECT--IiOME$F?[Q(' 977 RT.M RT FVFRFTTI WA QR n1 58-110 _ SET�ECH1110KN <br /> NI U,ANICAI CONiNACTON AUK ADDRESS CITY ZIP PHONE S1AlE lO(NSE I <br /> PLUMBINGCONTRACTOR MAR ADDRESS CITY ZIP PWAIE STATE LOEN'.:EI <br /> CONTRACT PRICE OF WORK <br /> 40000 <br /> UE SCRIBE WORK AND SOUARE FOOTAGE INVOLVED CONTACT PEA" PHONE NO <br /> _ Gar K11C 339-0555 <br /> SFR Randy Clark 25B- 0 <br /> I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED T <br /> rRDPoscO USE a BUILDING APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. <br /> PROVISIONS OF LAWS AND ORDINANCES GOVERNING TH:S TYPE <br /> II GAL nE RIPrION OF PROPERTY(SHOWN BELOW OR ATTACH TYq COPIES) WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN <br /> IDT "{ Bt OLK Hanabrook DIV Q NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO G <br /> AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ! <br /> OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR <br /> PERFORMANCE OF CONSTRUCTION.THAT I AM AUTHORIZED BY <br /> OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WH <br /> I'AnCEL TAX I D NUMBER APPLICATION IS MADE AND I COMPLY WITH THE ST, <br /> CONTRACTORS LAW 18.27 RCW AND 296.200 W C. <br /> I ONSTRUCTON LOAN LENIER-ADDRESS.,EIEP/IOmmiumsER It A <br /> PROJECT DDRESS IIAIwrwL A <br /> cnr IIwIA ssiKrKu w <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM FEENO. TYPE OF EQUIPMENT FEE <br /> WATER CLOSET(TOILET) I AC—ARINDLG UNITS—H.P. <br /> BATHTUB ' 1 FORCED AIR SYSTEMS—B.T.U. M E.A. <br /> LAVATORY(WASH BASIN) I UNIT HEATERS—B.T.U. M <br /> SHOWER ' ], CLOTHES DRYERS <br /> —1 KITCHEN SINN d DISP i VENTILATION FAN <br /> DISHWASHER 1 RANGE HOOD <br /> LAUNDRY TRAY 1 WATER HEATER <br /> CLOTHES WASHER <br /> WOOD STOVE <br /> URINAL ' METAL FIREPLACE(WOOD BURNING) <br /> DRINKING FOUNTAIN I FIREPLACE INSERT <br /> FLOOR DRAIN ' HEAT PUMP <br /> BACKFLOW PREVENTERS ; GAS PIPING <br /> ROOF DRAINS—RAINLEADERS I EXHAUST FAN <br /> SINK(SERVICE—BAR,ETC.) ' <br /> I <br /> , <br /> SUB TOTAL S SI IB TOTAL S <br /> PERMIT $ , PERMIT <br /> TOTAL FEE $ ' TOTAL FEE $ <br /> FOR OFFICE USE ONLY: <br /> IrONTSETRACK REARSETTUCK SIDE SETBACK PLAN CHECKCK/HAMPER FEE 1 — RECJAT NO� <br /> 'IA OJr� O I+r <br /> Hstzay� LOT AREA VACANT SITE FEES VALUATION FEE <br /> ES 0 NO BUILDING <br /> IYM DI c ST IKr Of STO TEs p mmumAMIn <br /> 'N 2PLUMBING 17 : <br /> — <br /> Ill Dop FRIE SPRINKLERSAEOD BASEMENT MECHANICAL <br /> iS / Sf YL `10 ❑ YES [g NO <br /> OCCUPANCY LOAD I IRE ALARM REGO HEIGHT LAT TAT�1N ADDITIONAL PLAN CHECK <br /> J <br /> IASOH <br /> STATE BUILDING SURCHARGE <br /> INTAKE BY PLANSA Plpv¢Der CITY OFEVERETT PUBLIC WORKS <br /> lN1 LOCAL SALES <br /> DATE Z TAX CODE IS 3105 TOTAL 7 <br />