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APPLICATIG .J FOR CONSTRUCT _ �N PERMIT � <br /> TO BE COMPLETED IN BLACK INK—PLEASE PRINT <br /> HEATING SYSTEM: U GAS ❑ ELECTRIC ❑ <br /> BUILDING DEPARTMENT <br /> 259•8810 <br /> I DEMOLITION COMBINATION BUILDING xMECHANICAL PLUMBING SIGN <br /> °�a�r'rsf &���,�A����.5�3ox3�fo33 s"T�r/jfe 98�r2� 2CY�=3s8-�o2�1 <br /> TEyqNi� A�� ry _ �.1Aj�ADDFESS�� qTV ZIP PHONE <br /> � j� �l![�% Jl/� <br /> AFCNRECT OR DESIGNER ` MAIL ADDRE55 LITV 2�P PNONE <br /> GEtlEFALCONTRACTOR MFILADDRESS CITV 21P PHONE STATELICENSEN <br /> ,.�1'l��T�ii� � ��rofEs�l$l2 N, C�2P/�-�wy#lo`� ��l 1`�IIP��2-b3�13 S�,�CIFAG230P8 <br /> PlUMOINGCONTRACTOR MAIL�DORESS CITY ZIP PHONE STATELIC[NS@q <br /> CLASS OF WORN <br /> . NEW . ' ADDITION X ALTERATION REPAIR DEMOLITION WOODSTOVE/FRPL INSERT BUILDING REIOCATION <br /> CONTPACiPRICEOFWORN � SOO CON�PERSOt�AqpPHp)1�!OS �-��Z-6�3 <br /> �Y% VG�%�K '! <br /> /�/Vlll RNI.[�^I./IM// !\EIN�LVE�_/,/� //��� A�G GlGli��'( <br /> � I <br /> P os���eoFewtmNc i HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br /> APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT.ALL <br /> IEGAtDESCRIPiIONOFPNOPERTYISHOWNBELOWORATTACHfOURCOPIES� PROVISIONSOFLAWSANDORDINANCESGOVERNINGTHISTYPEOF <br /> � WORK WILL BE COMPLETED WITH WHETHER SPECIPIED HEREIN OR <br /> u�t BLOLK oF NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br /> � AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br /> �{� OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br /> PEflFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br /> OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br /> APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> CONTRACTORS LAW 18.27 RCW AND 296.200 WAC. <br /> X�:�' � (o--Zl-4� <br /> PPpIECT ADD$ESS ^ ,_ �� s-t,��tur.� � Os�[ — <br /> f'`�i�%l G.�r�r �/3 7 <br /> (/a/• � �� • rnrei6vcs�¢:rNse�O <br /> PLUMBING MECHANICAL <br /> N0. TYPE OF FIXTURE OR ITEM FEE N0. TYPE OF EOUIPMENT FEE <br /> WATER CLOSET(TOILET) A,'C—A�HN�LG UNITS—H P. <br /> BATHTUB ; FORCED AIR SVSTEMS—B.T.U. M E.A. <br /> LAVATORY(WASH BASIN) � UNIT HEATERS—B.T.U. M <br /> SHOWER CLOTHESORYERS <br /> KITCHEN SINK 8 DISP VENTILATION FAN <br /> DISHWASHER � RANGE HOOD <br /> LAUNDRYTRAY WATER HEATER ' <br /> C_OTHES WASHER � WOOD STOVE <br /> URINAL ; METAL FIREPLACE 8 CHIMNEY � <br /> DRINKING FOUNTAIN � FIREPLACE INSERT <br /> FLOOR DRAIN � HEAT PUMP � <br /> BACKFLOW PREVENTEflS � GAS PIPING ; <br /> ROOF ORAINS—RAINLEADERS � EXHAUST FAN <br /> SItJK(SERVICE—BAR.ETC.) ; <br /> � � <br /> � — <br /> � <br /> SUB TOTAL 5 ; SUB TOTAL S /D ; �� <br /> PERMIT 5 PEFMIT 5 / �� - <br /> TOTAL FEE S ; TOTAL FEE 5 /,'"��—' " <br /> FOR OFFICE USE ONLY: <br /> PROtR5ET9AGK REARSETBRCK SIDESETBACK PLANCHECHUUlABER FEE RECEIPTtJp <br /> </���i,''!� <br /> uSEZONE LOTAflEA VALANTSITE FEES VALUATION FEE <br /> BUILOING � <br /> :��E0iL0�T5kLOWABIE 1YVfOiCOMI.ALNA: 0'^..��udr ryodVAtm;:tv'S <br /> �p° � PLUMBING <br /> SiZEOFBLDG. NO.oFSTOF�ES BaSEMENT MECHANICAL <br /> OCWPANCYLOAD FIRESPRNNLEflSREOD HEIGNTIIMITATION ADDITIONALPLANCHECK i <br /> SPRINKLER <br /> REASON FOR SPRINK�EFS �— <br /> STATE BUILDING SURCHAFiGE <br /> INTAK[BY PLANSAPPROVEDOY CITYOFEVERETT PU9lICWOfiHS � <br /> LOCAL SALES <br /> TAX CODE IS 3105 rora� <br />