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APPLICATICA FOR CONSTRUCT . ,DN PERMIT L'VL'LE'11 <br /> The,Emrprnan <br /> TO BE COMPLETED IN INK—PLEASE PRINT <br /> CITY OF <br /> eve reit I HEA'ING SYSTEM: LI GAS ❑ELECTRIC Ll <br /> BUILDING DEPARTMENT <br /> 259-8810 � <br /> II DEMOLITION COMBINATION b UILDING I ;MECHANICAL I PLUMBING I I SIGN <br /> OWNERMAII ADDRESS CITY ZIP PHONE <br /> �J <br /> ,j /�llS 3 2c,—(cor2, s �/eref a2O3 2s s= 7362 <br /> TENA MAIL ADDRESS <br /> `/-`,' CITY ZIP PHONE r� �'`/ <br /> Cf,Ip��E{C�T O�OE��S�K7�N`ER MYl A00�/s �� u CITY �Ve Pe � q9 tHOH/E `S z-6 91/9 <br /> ' GENERAL CONIRACTOn MAIL ADDRFSS CITY ZIP PHONE LICENSE/ <br /> /pl Q _ <br /> MECIUNICAL CONTRACTOR MAIL ADDRESS CITY 11P PHONE LICENSE <br /> PLUMBING CONTRACTOR MAIL ADDRESS CITY ZIP PHONE LICENSE/ <br /> CLASS OF WORK �'/ <br /> NEW 1 1 ADDITION ifyALI ERATION ! 1 REPAIR I I DEMOLITION I I WOODSTOVEIFRPL INSERT I i BUILDING RELOCATION <br /> �7 I^, C/O�NL�GCI PERSON ANDD PNONE N1I R <br /> i CONTRACT PRICE 7F WGnK L �O , V ` 'V %l< ` ID � 3S�— 3 <br /> DESCRIBE <br /> WORK AND SQUARE FOOTAGE11l V �..-�.�-- <br /> KC IN o„� 3' Y" ionl•.i Lqs'! yy., = 1 <br /> PHOPoSED USE OF BUIIOIN�_ I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br /> .i�� _� O ILIti_��• APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT.ALL <br /> CEDA-i�DJEscnIFIIaNDFPAOPEIITY ISNOWN BELOW On ATTACH Fwn Comm PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br /> LotQ LT�I 3R+3 39OC <br /> LK _ OF WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br /> - � -- NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br /> AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br /> OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br /> u• PERFORMANCE OF CONSTRUCTION.THAT I AM AUTHORIZED BY THE <br /> OWNER OF THIS PRCPERTY TO PERFORM THE WORK FOR WHICH <br /> -- --- APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> CONTRACTORS LAW 18.27 RCW AND 296.200 WAC. <br /> SIGNNAA�TTUnnE�[OFFCCONTRACTOR OR AUIHORIZEDAGENT DATE <br /> nOJECI ADDnESS <br /> APPLICANTS CITY BUST BS LICENSE NO ANDBUSINESSNAME <br /> PLUMBING V MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM FEE NO. TYPE OF EQUIPMENT FEE <br /> WATER CLOSET(TOILET) ' AIC—A/HNDLG UNITS—HP. , <br /> _ BAl-HTUB ' FORCED AIR SYSTEMS—B.T.U. M E.A. ' <br /> LAVATORY(WASH BASIN) UNIT HEATERS—B.T.U. M I <br /> SHOWER ' CLOTHES DRYERS ' <br /> KITCHEN SINK 8 DISP ) VENTILATION FAN t <br /> DISHWASHER ' RANGE HOOD ' <br /> LAUNDRY TRAY I WATER HEATER ' <br /> CLOTHES WASHER I WOOD STOVE <br /> URINAL ' METAL FIREPLACE 8 CHIMNEY ' <br /> _ DRINKING FOUNTAIN , FIREPLACE INSERT <br /> FLOOR DRAIN ' HEAT PUMP ' <br /> BACKFLOW PREVENTERS i GAS PIPING ' <br /> ROOF DRAINS—RAINLEADERS ' EXHAUST FAN ' <br /> SINK(SERVICE—BAR.ETC.) ' <br /> s ' <br /> I ' <br /> SUB TOTAL S ; SUB TOTAL S ' <br /> PERMIT $ ' PERMIT S <br /> TOTAL FEE S TOTAL FEE $ <br /> FOR OFFICE USE ONLY:_ <br /> FRONT SETBACK REAR SETBACK SIDE SETBACK PUN CHECKIUMREn FEE IC CEm1 No <br /> QE ZoF 1 9U aS5"3.� 3f/° y/GGJ <br /> USE ZONE IOTAAnEA VACANT SITE FEES VALUATION FEE <br /> —�— <br /> 0 <br /> n BUILDING �ZSJ <br /> TYT'EG'CBNIS MLDWABIE IYIY III,cbNsT ACTUAL OCGKAYLY NawmIKNwis <br /> p10� PLUMBING ' <br /> 716N.a1tiA- Eralif P. NO OF STORIES BASEMENT MECHANICAL <br /> (FfiYouw� AAja — �— <br /> OCCUPANC/Y�LOAD FIRE SPRNKLERS REOD HEIGHT I IMITATION ADDITIONAL PLAN CHECK i <br /> —A OTHER <br /> REASON OR BPRINKIEnS - r- <br /> STATE BUILDINU SURCHARGE <br /> IRTAVEBY PIANSAPPADveoer CITY OFEVERETT PUBLIC WORKS <br /> DrLI LOCAL SALES <br /> 7 p TAX CODE IS 3105 1DTAL <br />