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APPLICATIC J FOR CONSTRUC7 JN <br />TQ-�E COMPLETED IN BLACK INK—PLEASE PRINT <br />PERMIT ���� <br />BUILDING DEPARTMEN�i�� I� HEATIfVG SYSTGM: � GAS p%�LECTRIC ❑ I <br />259-6810 �U <br />! J DEMOLITION �'� I_l COMBINATION I! BUILDING i 1 MECHANICAL l I PLUMBING � SIGN <br />OWNER MAILAODRE55 CIT� ZIP PMONE <br />�stuN c+1�cllFt�1 N�0.THvJES'C 16a1 (1�t�` kUESE 6���EvuE wA 9�a� 646 -3Z6`} <br />TENANT MAILAOUPESS CITV ZIP PHON� <br />13csT�7.1 GNI�kEnl -i�F ��1 FVEKGCL<eN �„iY 9FrZo3 <br />ARCNITECTOqOESIGNER MAILADDRESS QTV ZIP PHONE <br />SAr.n� hc Gv�1iRR<ToQ <br />GENERALCONTRhC;OH MAILA�DRESS CITV IIP PHONE STATEUCENSEtt <br />�EY E R 5 �aN Co I�IC P o P��l �S3"1`i� Scn,Z-� � 9 k I 3] -7743 -�4 cpz�4� <br />MECHANICAL CONTRFCTOR MAIL �OOFE55 CIIY ZIP PHONE STATE UCENSE u <br />PLUMOINGCONTRACTOB MAILADURESS CITY ZIP PHONE MEMER 2�AE " �4 (SC <br />STATE LICENSE p <br />CLASS OF WORK <br />�NEW ; J ADDITION L-I A!TERATION <br />CONTRACT PRICE OF WORN <br />� In, Ooo , 00 <br />DESCFIBE WORK ANO SOUARE FOOTAGE INVO W ED <br />�� 3 �� 2� I�� �I)Zyuus��i2�S�jLS <br />OPOSEO USE OF 9UILOINCa <br />I REPAIR <br />LEGAL �ESCRIPTION OF PROPERTY (SHOWN BELOW OR ATTACH FOUR COPIES) <br />LOT BLOCK OF <br />7R0.1ECT ADDRE55 <br />�`ia % .C,Y/JC �,,�, <br />PLUMBING <br />NO. TYPE OP FIXTURE OR ITEM <br />WATER CLOSET (TOILETj <br />BATHTUB <br />LAVATORY (WASH BASIN) <br />SHOWER <br />KITCHEN SINK & DISP <br />DISHWASHER <br />LAUNDR� TRA1' <br />CLOTHES WASHER <br />URINAL <br />ORINKING FOUNTAIN <br />FLOOR DR.\IN <br />BACKFLOW PREVENTERS <br />ROOF DRAINS—RAi�lLEADERS <br />_� SUB TOTAL <br />PERMIT <br />� TOTAL FEE <br />FOR OFI=ICE USE ONLY: <br />FRONTSETB�CK REAflSETBACK <br />USEZONEr,� �OTAREA <br />�� <br />ttPEOFWNiSALIOWABLE TYPEOFCOIISi.h:IDPL <br />SIZE OF Bf OG. IJO. GF STORIES <br />OCCUPANLYLOAL <br />FEASON FOF SPRINKLEPS <br />INTAKE BY <br />' <br />I I DEh10UTION ! I WOODSTOVE/rRP� INSEHT '�� I BUILDING RELOCATION <br />� CONTACT PCR50N AND PHONE NO. i <br />�$ <br />SIDE SETBACK <br />VACANTSRE <br />occuvnscr xoovn.v[wncuuns <br />cnauv <br />BASEIdENT <br />=1RESPHNKLERGREO'D I HEIGMT <br />PLANS�PPROVEOBY CITYOFEVERETT <br />J ` LOCALSALES <br />rl�_N,G � IA/1 TAX CODE IS 3105 <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 HEFEIN 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 COtJSTRUCTION OR THE <br />PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY l'HE <br />OWNER OF THIS PflOPERTY 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 />X <br />NO. <br />TVpE OF E�UIPMENT <br />FORCC-D AIR SYSTEMS—B.T.U. M E.A. <br />UNIT HEATERS—B.T.U. M <br />CLOTHES DRYERS <br />VENTILATION FAN <br />RANGEHOO� <br />WATER HEATEF <br />WOODSTOVE <br />METAL FIREPLACE & CHIMNEY <br />FIREPLACE INSERT <br />HEAT PUMP <br />GAS PIPING <br />PLANCHECN <br />BLIILDING <br />PLUMBING <br />MECHANICAL <br />AUDITIONAL PLAN CHECK <br />SPRINKLER <br />STATE BUILDING SURCHARGE <br />PUBLIC WORKS <br />TOTAL <br />PERMIT S � <br />TOTAL FEE $ � <br />FEE Os RECEIPTNO <br />///a 3 <br />VALUATION FEE <br />�/ / � � <br />_ i— <br />_ ' <br />i <br />i <br />� <br />i <br />—� i i <br />i <br />i <br />� — <br />