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APPLICATIC ] FOR CONSTRUCT�7N PERlIRIT �� <br /> TO BE COMPLETED IN BLACK INK—PLEASE PRINT <br /> HEATING SYSTEM: O GAS ❑ELECTRIC ❑ <br /> BUILDING DEPARTMENT <br /> 259-8810 <br /> DEMOLITION COMBINATION 6UIlDING �CJ�AECHANICAL , PLUMBING ' SIGN <br /> �7 R M�ILA�OFE55 CIiY ZIP PMONE <br /> �uv� '�c��(`f' �y� ''3 r'�Ci� S�- SF �v�ct�4-� 9' g`dC�s <br /> TENANT MAILRDDRESS CIi`.' ZIP PHONE <br /> �mAx 2qn PPc�c�� PYE_ �t-r�T <br /> NRCHITELTORDESIGNER MAILADDRESS CITv ZIP PHONE <br /> GEhERRLCONTPRCTOR M�ILADDRESS GITY ZIP PHONE STATELiCENSEt <br /> - MECHRNIC4ICONTRAC70R Ml�IIADDRE55 C�TY ZIP PNONE STATELICENSEs <br /> IR� SYS. W. 2��1 F�ourwc�� P_o. N�-e PAc���c, �p. 533-�zq-a Pj�svu's�•�eB1 <br /> PLUMBI�G CONTRFCTOH MAI�ADDNE55 GITY 21P PMONE STATE LICENSE t <br /> C1�550F WORk <br /> !_! NEW I. ' ADDITION �LTERATION �: REPAIR I i DEMOUTION � � WOODSTOVE/FqPL INSERT i.� BU�LDING RELOCATION <br /> CONTACT PEfl50N AND PHONE NO/.� �/ <br /> GONiAACT PRICE OF WORK ��Z�� �1 � Y�F� 833-1248 <br /> DESGRBE WORM AND SOUARE FOOTAG INVOLVED <br /> KEWo� Spc�N1u��S HvuT <br /> PROPOSEDUSEOFBUIL�ING I HEIiEBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br /> oFFtt�r "j APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT.ALL <br /> LEGAL DESCRIP110N OF PRV�'EfiTY�SNOWN BELOW OR ATTAGH FIXIR COPIES) PqOVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br /> WORK WILL BE COMPLETED WItH WHETHER SPECIFIED HEREIN OR <br /> �or BLOCK _ 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 /> PERFORMAtJCE 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 1827 RCW AND 296200 WAC. <br /> 2�ti-I PPG� rF�C. AY� x �/ G 3o q 3 <br /> � PR0.IECTADDRE55 SroN O ��iE <br /> C USMESSIIG[NSENO <br /> PWMBINfi CHANICAL <br /> NO. TYPE OF Fl7(TURE OR ITEM FEE NO. TYPE OF EOUIPMENT �E <br /> WATER CLOSET(TOILET) � A/C—A/HNDLG UNIT^--H.P. � <br /> BATHTUB ; FORCED AIR SYSTEMS—B.T.U. M E.A. ' <br /> LAVATORV(WASH BASIN) � UNIT HEATFRS—B.T.U. M _ � <br /> � SHOWER CLOTHES DRVFRS _ � <br /> KITCHEiV SINK 8 DISP � VENTILAI::.N FAN I <br /> DISHWASHER RANGE HOOD _ � <br /> L4.UNDRV TRAY ; WATER HEATER ' <br /> CLOTHES WASHER � WOOD STOVE __ <br /> � URINAL ' METAL FIREPLACE 8 CHIMNEY <br /> DRINKING FOUNTAIN FIREPLACE INSERT � <br /> FLOOR DRAIN � HEAT PUMP ' <br /> � BACKFLOW PREVENTERS ; GAS PIPING ' <br /> T <br /> � ROOF DRAINS—RAINLEADERS � E%HAUST FAN � <br /> _ SINK(SERVICE—BAR,ETC.) __T SP Iw1K-L�SLS ?A � <br /> � � <br /> � � <br /> � <br /> � <br /> � <br /> SUB TOTAL $ ; _ SUB TOTAL $ ZO � <br /> PERMIT $ PERMIT S � � <br /> TOTAL FEE $ TC)TAL FEE $ (00 � '� <br /> FOR OFFlCE USE ONLY: <br /> FRqIT SETBALK RERR SETBACN SIDE SFTBACK P.AN CHECK NUM R FEE _ REC 'T JNJ.} <br /> I� Oi�J /I J� <br /> use zr�e LOT RRER vncnNr sire FEES VALUATION FEE <br /> BUILDING ' <br /> iVYEU�CONTS.RLIOWABLF r1'PEOfCONST.PGTIIAL oCGuol,NCr xOa�VMwMGUertS � <br /> GPOUv PLUMBIIJG � <br /> � <br /> SIZEOFPLOG. NO.OFSTGRIES BASEMENT MECHANICAL <br /> — i <br /> OCCUPANCY�OA� I FIi�ESPRNHLER'iREO'D HEIGNTLIMITATION ADDITIONALPLAIdGHECK I — <br /> SPRINNLER � <br /> REASON FOA SPRINKLERS � <br /> ^TATE BUILDING SURCHARGE � <br /> -- <br /> INTAKEBV PL�NSAPPROVED9Y CITYOFEVERETT PUBLICWORNS � <br /> LOCAL SALES � <br /> 7/��� JM TAX CODE IS 3105 ror�� ; <br />