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APPLICATIC�I FOR CONSTRUCT'-lN PERMI': � <br /> TO BE COMPLETED IN BLACK INK—PLEAS� PRINT <br /> HEATING SYSTEM� ❑GAS ❑ELECTRIC ❑ <br /> BUILDING DEPARTMENT <br /> 259-8810 <br /> ❑ DEMOLITION CI COMBINATION ❑ BU��DING ❑ MECHANICAL � PLUMBING ❑ SIGN <br /> OWNEH ' MAIL��ORESS CITV ZIP PNONE G <br /> •���S �lY .�i"�L ��J �L' � � CITY�r'1'�\\ZIP lA.l �� nON�'�- ��4ZU 1� — <br /> TENANT /� ��� /� / <br /> ���� �� � <br /> ARCHITECTORDESIGNER MFIIADURESS <br /> CITY ZIP PNONE <br /> GENEFALCONTB�CTOR <br /> MAIL AODRESS CITY ZIP PHONE STATE LICENSE M <br /> ���, Z�p PHONE STATE LICENSE X <br /> MECHANICALCONTflACTOR MAILAD�RESL <br /> PLUMBINGCONTRACTOR lAAILADORESS CITV ZIP PHONE STATELICENSEM <br /> CONTPACTPRICEOFWORK �� <br /> ! <br /> � CONTPGT PERSON AND PHONE NO. <br /> OESCRIBE WORK ANO SOUARE FOOTAGE INVOLVEO �_ S�J <br /> �7�[�(OVE ItPP2 <br /> '� U'c� 'c v�'�ooS� S '�tt.�c� itrlCst��- `��+'7-(O'77 <br /> �'7Pj 54�� � HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br /> PROPOSEDl1SEOFBUILDING APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT.ALI. <br /> PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br /> LF.GALDESCRIPTIONOFPROPEFTY(SHOWNOELOWORATTACHTNOCOPIES) WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br /> NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br /> �oT BLOCK — OF AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br /> OTHER STATE OR LOCAL LAW R=GULATING 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 /> PARCEL TA%I�.NUMBER CONTRACTOFS LAW 18.27 FCW AND 296.200 WAC. <br /> GONSTRUCTIONLOANLENDER,ADDRESS.TELEPHONENUMBER � /f a`� ) -y <br /> � � V / J <br /> ontE <br /> SIGNF*UFlE _ <br /> PROJECTA DRES.� O <br /> nA �� Q�(�i CiiVBU5WE55L�LEN5EN0 <br /> .Y/I i--• <br /> PLUMBING MECHANICAL <br /> FEE N0. TYPE OFEOUIPMENT FEE <br /> NO. TYPE OF FIXTURE OR ITEM p�C-A/HNDLG UNITS-H.P. ' <br /> WATER CLOSET(TOILET) , FORCED AIR SYSTEMS-B.T.U. M E.A. ' <br /> BATHTUB ' ' <br /> LAVATORY(WASH BASIN) � UNIT HEATERS-B.T.U. M ' <br /> � CLOTHES DRYERS . �— <br /> SHOWER . � VENTILATION FAN ' <br /> KITCHEN SINK 8 DISP ' � � <br /> - DISHWASHER � RAN6E HOOD <br /> WATER HEATER � <br /> LAUNDRYTRAY ' ' <br /> CLOTHES WASHER � WOOD STOVE —�— <br /> � METAL FIREPLACE(WOOD BURNING) ' <br /> URINAL � FIREPLACE INSERT ' <br /> DRINKING FOUNTAIN , HEAT PUMP � <br /> FLOOR DRAIN � GAS PIPING �— <br /> BACKFLOW PREVENTERS � — ; <br /> ROOF DRAINS-RAINLEADERS � EXHAUST FAN � <br /> � <br /> SINK(SER�'ICE-BAR,ETC.) � ; <br /> � � <br /> � <br /> � <br /> � <br /> SUBTOTAL 5 ' SUBTOTAI. S � <br /> PEFMIT S � <br /> PERMIT 5 ' TOTAL FEE 3 <br /> 1�TAL FEE 3 <br /> FOR OFFICE USE ONLY: FEE RECEIPTNO. <br /> REAR SETBACK SIDE SETBACK PLAN CHECK NU BEfl_� <br /> FRONTSETBPCK / �� <br /> FEES VPLUATION FEE <br /> USE ZONE LOT AREA VACANT SITE i <br /> ❑ YES � N� BUILDING � � U� <br /> � <br /> NO.OFS70RiE5 occuvwcr �:oormv[wx.ururs i <br /> TVPEOFCaxsT caouv pLUM81NG ' <br /> i <br /> 52E OF BLOG. FIPE SPRINRLERS REO'D BASEMENT MECHANICAL _ � <br /> ❑ YES ❑ NO � <br /> ADDITIONAL PLAN CHECK ' <br /> OCCUPANCVLOAD FIREALAPMREO'D HEIGHTLRAITATION � <br /> OTHER <br /> , REASCN STATE BUILDING SUfiCHARGE ' �-� <br /> i <br /> INTAKEOV PLANSAP�fiOVEDBY , CITYOFEVERETT PUBLICWORKS � <br /> ,?)�'v LOCAL SRLES 3 G ; .SU <br /> � TAX COUEIS 3105 rorn� <br /> OFTE ' � ' <br />