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APPLICATIC <br />FOR CONSTRUCT' <br />►N <br />PERMIT <br />TO BE COMPLETED IN BLACK INK —PLEASE <br />PRINT <br />ere/rcrr <br />I HEATING SYSTEM: xGAS <br />J <br />❑ ELECTRIC <br />BUILDING DEPARTMENT <br />259-8810 <br />1 1 DEMOLITION COMBINATION <br />X BUILDING <br />MECHANICAL <br />PLUMBING SIGN <br />DWNET. 1-T�I.�EpRE55 RO <br />617A GLO • C ANZ <br />Wk 1602 <br />77b­74i�)S - -- <br />MAIL ADDRESS <br />TENANT MAIL <br />ZIP <br />PHONE <br />ARCHITECT Oi10E5'NER MAIL ADDRESS&A t / Y 1 <br />�j <br />}4•TSMAL�IL LAADDRESS `J <br />�T� (CITY, ,a ' 1 <br />' JUIN 1f �A,T �NNF+ <br />1 <br />ZIPPHONE <br />�7,j,�' 7 <br />4 "—'1 <br />GERM'RALALL C/ONTRAACT08NIC/7_ <br />CITY <br />ZI'PVL']7/e'^ <br />PHONE <br />GATE K;ENSER <br />�7n�1� Qp• ��� <br />�.lDuo� ��l�a-'I(�o <br />%h'� 19Z5 <br />Cxt�l�ca iolq�- <br />M_CHANICAL CONTRACTOR MAIL AODNESS <br />,CITY <br />ZIP <br />PHONE <br />STATE LICENSE <br />PLUMBING CONTRACTOR MAIL ADDRESS <br />CITY <br />ZIP <br />PHONE <br />STATE LICENSE IT <br />CONTRACT PRICE OF WORK <br />DESCRIBE WORK AND SOUARE FOOTAGE INVOLVED <br />CONTACT PERSON AND PHONE NO <br />�*w <br />&L, Al -1 -Ill <br />Il sr wt* LNLm <br />I HEREBY CERTIFY THAT 1 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 PROPEPTY TO PERFORM THE WORK FOR WHICH <br />APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />CONTRACTORS LAW 18.27 RCAND 296.200 WAC. <br />�►, rs � 93 <br />- <br />PROPOSED USE OF BUILDING <br />(boor_,) <br />LEGAL DESCRIPTIONCF PROPERTY ISHUWN BELOW OR ATTACH TWO COPIESI <br />LOT BLOCK OF [ <br />/ SG <br />� <br />P REEL rAz�/UMBER <br />CONNSTRUC(ION LOAN LENDER. DRESS. TELEPHONENUMBER <br />PROJECT/ADD /EJQS <br />` /l' <br />szu E DAIL <br />PLUMBING <br />MECHANICAL <br />0. <br />TYPE OF FIXTURE OR ITEM <br />FEE <br />NO. <br />TYPE OF EQUIPMENT <br />FEE <br />� <br />WATER CLOSET (TOILET) <br />� <br />A/C-AIfiNDLG UNITS-H.P. <br />I <br />BATHTUB <br />' <br />FORCED AIR SYSTEMS-B.T.U. M E.A. <br />' <br />LAVATORY (WASH BASIN) <br />I <br />UNIT HEATERS-B.T.U. M <br />SHOWER <br />' <br />CLOTHES DRYERS <br />' <br />KITCHEN SINK 8 DISP <br />VENTILATION FAN <br />T_ <br />_ <br />DISHWASHER <br />17,RANGE <br />HOOD <br />LAUNDRY TRAY <br />e7 <br />WATER HEATER <br />' <br />CLOTHES WASHER <br />WOOD STOVE <br />URINAL <br />' <br />-- <br />METAL FIREPLACE (WOOD BURNING) <br />DRINKING FOUNTAIN <br />FIREPLACE INSERT <br />FLOOR DRAIN <br />' <br />HEAT PUMP <br />BACKFLOW PREVENTERS <br />; <br />GAS PIPING <br />' <br />ROOF DRAINS-RAINLEADERS <br />EXHAUST FAN <br />SINK (SERVICE -BAR. ETC.) <br />I <br />I <br />I <br />I <br />I <br />I <br />SUB TOTAL <br />$ <br />SUB TOTAL $ <br />' <br />PERMIT <br />$ <br />PERMIT $ <br />. <br />TOTAL FEE <br />$ <br />' <br />TOTAL FEE $ <br />' <br />FOR OFFICE USE ONLY: <br />FRONT SETBACK l <br />REAR SETBACK <br />/ <br />SIDE SETBACK <br />e' <br />PLAN CHECP NUMBER <br />FEE „,o <br />I Z7�v <br />RECE IPT NO <br />75E ZONE <br />^Z <br />LOT AREA <br />VACANT SITE <br />-' YES '.7 NO <br />FEES <br />VALUATION <br />FEE <br />BUILDING <br />PLUMBING <br />Lr7 'lG <br />! <br />y <br />i <br />TYPL or CONST <br />_pO <br />NO OF STORIES <br />/L <br />aynlwNcr <br />FA <br />No amttu�Ns urns <br />QpF <br />�7y`OL Sf * <br />SrIll GAIL <br />FIRE SPRINKLERS REO'D <br />dfi <br />BASEMENT / <br />11 YES NO <br />MECHANICAL <br />ADDITIONAL PLAN CHECK <br />f <br />OCCUPANCY LOAD <br />fA A <br />FIRE ALARM REO D <br />— <br />HEIOILT�UMITATI <br />STATE BUILDING SURCHARGE <br />L� {_ <br />; <br />REASON — <br />PUOLICWORKS <br />INTAKE BY PLANS APPR./�VIii+Y CITY OFEVERETT <br />M LLOCAL SALES <br />DATI 1 9 TAX CODE IS 3105 <br />TOTAL <br />5 �; <br />