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APPLICATIC 1 FOR CONSTRUCT' )N PERMIT - <br />TO BE COMPLETED IN BLACK INK -PLEASE PRINT <br />BUILDING DEPARTMENT HEATING SYSTEM.) WAS J ELECTRIC J _ -- <br />I <br />259.8810 <br />I DEMOLITION COMBINATION I I BUILDING - MECHANIICAL ^�CipLUMBING SIGN <br />0 ER MAK ADDRESS`P(_ \ <br />a if <br />, fr(�.0 c�� — I <br />�h 11� n ll J ll IN i_ <br />TEN NN1 MALADDRESS CITY ZIP PHONE — <br />CITY <br />TNERAI 0 <br />NIL ADDRESS <br />CITY <br />21P <br />PHONE <br />SInIE 114VlOt• <br />WL ADDRESS <br />CITY <br />ZIP <br />PHONE <br />STATE LICENSE E <br />RUMB•NO CONTRACTOR <br />MAIL ADDRESS <br />CITY <br />ZIP <br />PHONE <br />STATE LICENSE <br />CDNEgACT PRICE OF WCjqK <br />�CIaL '3D r�.0 <br />DESCRIBE WORK AND 9WARE FOOTAGE INVOLVED <br />CONTACT PERSdI AND PHONE NO <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br />APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT ALL <br />PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br />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 />PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br />OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br />APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />CONTRACTORS LAW 18.27 RCW AND 296200 WAC. <br />PRo ;D 'qpu P'NO <br />�c <br />LEGAL DESCRIPTION OF PROPERTY I5HOWN DEI M OR ATTACH TVO COPIES' <br />LOT— BLDLK OF <br />-- <br />PARCEL TAX I0 NVMPER <br />CONSTRUCTION LOAN LENDER ADDRESS TELEP (NF NUMBER <br />PLUMBING <br />MECHANICAL <br />NO. TYPE OF EQUIPMENT FEE <br />NO. <br />TYPE OF FIXTURE OR ITEM <br />FEE <br />WATER CLOSET (TOILET) <br />_ <br />I <br />A,'C-AHNDLG UNITS-H P <br />BATHTUB <br />LAVATORY (WASH BASIN) <br />SHOWER <br />KITCHEN SINK 8 DISP <br />FORCED AIR SYSTEMS-B.T.U. M E.A. <br />_ <br />UNIT HEATERS-B T.0 M <br />CLOTHES DRYERS <br />_ <br />_ <br />_ <br />I <br />VENTILATION FAN <br />DISHWASHER <br />LAUNDRY TRAY <br />CLOTHES WASHER <br />URINAL <br />DRINKING FOUNTAIN <br />FLOOR DRAIN <br />BACKFLOW PREVENTERS <br />ROOF DRAINS-RAINLEADERS <br />RANGE HOOD _ <br />WATER HEATER <br />WOOD STOVE <br />METAL FIREPLACE (WOOD BURNING) <br />' <br />_ <br />_ <br />�1. <br />_ FIREPLACE INSERT <br />_HEAT PUMP <br />_ <br />GAS PIPING <br />IXHAUST FAN <br />SINK ISERVICE-BAR. ETC.) <br />-_ <br />-- <br />SUB TOTAL 8 <br />__ SUB TOTAL $ <br />PERMIT $ <br />' <br />PERMIT <br />_$ <br />TOTAL FEE $ <br />TOTAL FEE 5 <br />FOR OFFICE USE ONLY: <br />FRONT SETBACK <br />REAR SETBACK <br />SIDE sruwY <br />PLANE.HECKNUMBER <br />L <br />FFE <br />USE ZONE <br />LOT AREA <br />VACANT SITE <br />FEES <br />13UILDING <br />-- <br />PLUMBING <br />'-I YES ! NO <br />TYFE IS CoNsr <br />NO OF STORES <br />P[rW.Atr <br />"'T"" <br />pIwA11Im; WPN <br />SIZE OF BLOC <br />FIRE SPRINKLERS READ <br />BASEMENT <br />MECHANICAL <br />CI YES NO <br />— <br />ADDITIONAL PLAN CHECK <br />OCCUPANCY IOAI <br />HRE ALARM REOD <br />HEKiHT IIMIUT10N <br />OTHER <br />REASON <br />STALE BUILDING SURCHARGE <br />NTAKEBY PLANSAPROVEDDY CITY OFEVERETT PUBUCWORKS <br />LOCAL SALES <br />DA,F TAX CODE IS 3105 TOTAL <br />