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rm <br />APPLICATIO'" FOR CONSTRUCT►"IN PERMIT u <br />rl�; .+•1n��P TO BE COMPLETED IN INK —PLEASE PRINT <br />CIIA GF <br />everett HEATING SYSTEM: UGAS UELECTRIC U _ <br />BI ILDING DEPARTMENT -- - — -- <br />010 <br />DEMOLITION I I COMBINATION BUILDING I I MECHANICAL PLUMBING SIGN <br />ONTIF.R MAIL ADDRESS qy gllY ill' PLAGUE <br />--�'aAr, <br />TIME LICENSE F <br />IA f 114 AlnCAL CONT"ACIOn MAA ADDRESS CITY ill' PDONC LICENSEE <br />rJ T- <br />I'L MBINOCONInACTOn MAR ADOnESS CITY TIP PHONE LK:ENSEF <br />u .. I oebA.M I 1 nrunl ITInN I wnnn3TOVElFRPL INSERT ' BUILDING RELOCATION <br />CONTACT PERSON MIDP ME 110 <br />DONInACI PrucEa V/OnK �) (/ (/o:✓ <br />-_._ --_ <br />RESCniBF WORK AIID SOIIARE FOOIn E,�ED i <br />I HEREBY CEnT1T`Y THAT I HAVE READ AND EXAMINED THIS <br />PnorvSFn USE Of AUK GRID <br />APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />PROVISIONSOF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br />WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br />i LGM. RESCnIriKFla PnOPEBTY l9T1OWN DELOWOR ATTACNFOURCOPIEST <br />lGl TBMA Of <br />NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br />AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br />Da ir�t -1` <br />r OTHER STATE OR LOCAL LAW REGULAI ING CONSTRUCTION OR THE <br />J PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br />�+ <br />OW14ER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br />C_ c} <br />APPLICATION IS MADE AND 1 COMPLY WITH THE STATE <br />CONTRACTORS LAW 10.27 RCW AND 296.200 WAC. <br />\ v <br />O ` ��'`�l� �c <br />_— <br />slr,Ilmm�cacLwTnnclnn rnT nunlrnTVFnnrfNT lun <br />X <br />- <br />o _ <br />—_—_--_--_.— _--.— <br />PROJf CT ADOTESS^ /// 1^0( n/ <br />6;'05 V_Ll� �� <br />—_ <br />AFPI CANTS CITY OI I'INFSSIK:FTlSP 110 A11G nUSMf SS NAM[ <br />PLUMBING <br />MECHANICAL _ <br />NO. <br />OF FIXTURE OR ITEM <br />FEE <br />NO. <br />IYPE OF EQUIPMENT <br />FEE <br />_ <br />_TYPE <br />WAI ER CLOSET (TOILET) <br />I <br />A/C—A.MF:OLG UNITS—H.P. <br />�_- <br />BATHTUB <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 />i <br />SHOWER <br />1 <br />CLOTHES DRYERS <br />' <br />KITCHEN SINK & DISP <br />_ <br />_ <br />VENTILATION FAN <br />DISHWASHER <br />RANGEHOOD <br />_ <br />LAUNDRY TRAY <br />—I— <br />WATER HEATEn <br />CLOTHES WASHER <br />WOOD STOVE _ <br />1___ <br />_ <br />URINAL <br />METAL FIREPLACE 6 CHIMNEY <br />_ <br />DRINKING FOUNTAIN <br />FIREPLACE INSERT <br />T— <br />FLOOR DRAIN <br />HEAT PUMP <br />1 _ <br />_ <br />BACKFLOW PREVENTERS <br />GAS PIPING <br />1 <br />T— <br />ROOF DRAINS—RAINLEADERS <br />! <br />EXHAUST FAN <br />! <br />SINK (SERVICE —BAR. ETC.) <br />— <br />_ <br />i <br />1 <br />1 <br />1 <br />SUB TOTAL $ <br />SUB TOTAL $ <br />_ <br />-- <br />-- PERMIT $ <br />---�— <br />PERMIT $ <br />~ <br />TOTAL FEE S <br />_— <br />TOTAL FEE $ <br />FOR OFFICE USE ONLY: 6y 3s <br />fnONI SEIBACK <br />_ <br />REAn SEIBACK <br />SIDE SETBACK <br />RAMCDECK NUMBE�n <br />FEE_ / <br />BECEMI NO <br />USE70NE <br />T-�QQ 3 <br />LOTH <br />vAPANTe TE - <br />FEES <br />VALUATION <br />FEE <br />BUILDING <br />PLUMBING <br />I <br />1 <br />TITT CONTS AILOWAIRF <br />�rr�77--' <br />IYRd CORSI MnOAt <br />txr,,t <br />I an"OMWMII"KS <br />MECHANICAL <br />' <br />SIZE OF BLDG <br />A' 6*0'M�15- <br />NO, OF STORIES <br />BASEMENT <br />ADDITIONAL PLAN CHECK <br />F--_ <br />�CCMIPAN�CA�Y LOAD mrsPnNn EnSBEOO IIEIn1111MITAA"m <br />M' GT7M1IYi1% NV �X SI `�L' <br />nEAsoNFort srniNKLEnS <br />OHIEFI <br />-- <br />---- <br />- <br />STATE BUILDING SURCHARGE <br />1 (� <br />INTAKE BY <br />RANSAPPROVEDBY <br />3�i��'fZ 1)�I/) <br />CITY OFEVERETT <br />LOCAL SALES <br />TAX CODE IS 3T05_ <br />ru1BICWORKS <br />IOIAI. <br />1 <br />