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� APPLICATIQ�N FOR CONSTRUCTI.QN PERMIT � <br /> TO 6E CvMPLETED IN BLACK INK—PLEASE PRIn� <br /> BUILDING DEPARTMENT HEATING SYSTEM: ❑GAS ❑ELECTRIC ❑ <br /> 259-8810 <br /> ❑ DEMOLITION ❑ COMBINATION ❑ BUILDING ❑ MECHANICAL ❑ PLUMBIMG �SIGN <br /> OWNER MAILA��RESS CITY ZIP PHONE <br /> Q/CLi '�—,�/rJ7 t`-?/G�%FY/�l��`7C-� GL�/ G'ar�l'.-/7 . l�l�'. UJ%^ %�J�i,2_� <br /> �TEN T . MAIL ADDRE55 �/CITY ZIP PHONE <br /> P,) -�l���v-��J ���) /D��r/�/�if�yD/ �o./.lo,rira , ���,�/ _ . <br /> •ARCHITECTORDESIGNER MAILADDiE55 CITY ZIP Pf10NE <br /> -s�.��'�� — <br /> GENERALCONTRACTOfl MAILADDRE55. qTV ZIP PMONE STATCLICENSEi <br /> TU/�.�lr �o mC!-'rl-33� �`i�� . !s/� �.�i�/?� �a��3.//�y ivr'.<;�/�=�aF� �//G�� <br /> MECHANICALCONTP..CTOR MAILAO�RE55 � � CITV ZIP � � PNONB SiATELiCENSEu <br /> PLUMBINGCONTR�CTOR M41lA�OfiC55 ' G�IY IIP I'110I11i St�7CI.ICF.NSC.N <br /> CONTPAp PRICE OF YARN�vG <br /> �/ G� C����y i / <br /> DESCRIBE WORK RND SOUAR FOOTl.iE MV VED )� WMACT PERSJN AND PHONE NO. <br /> �Q/ti7i�l.1J ����:7L /� �'.�'/7l L�l�/19f>? <br /> _��L�if/.UI.1�/ /11!%Jl/i(,!.l�7E:�J���L� .��:i •����— <br /> ��"'�"y i FIEREBY C�:RTIFY THAT I HAVE READ AND EXAMINED THIS <br /> •PROPOSED 11SEOF BUILDIN6 APPLICATION F ND KNOW THE SAME TO BE TRUE AND CORRECT.ALL <br /> �i��'l�C%� ��D�'L� � PROVISIONS UF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br /> LE(ULDESCRIFTIONOFPROPERTV�SMOWNBEL ORRTfACHTYOCOPIES) WORK WILL BE COMPLETED WITH WHETFIEF SPECIFIED HEREIN OR <br /> ' _ �`'�_-�� ��"'���`��''� � NOT. THE GR�:NTING OF A PERMIT DOES NOT PRESUME TO GIVE <br /> �oT � e�ocK AUTHORITY TO VIOLWTE Ofi CANCEL THE PROVISIONS OF ANY , y <br /> ��/�—�''�'- ��� - G/nJ OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br /> ��/� - ��*� - G��-3 - c�.�C-'P� PERFORMANCE OF CONSTRUCTION.THAT I AM AUTHORIZED BY?HE <br /> =��?�/% - �T/�T� " GC�/ - Gd09 OWNER OF THIS PROPERTY TO PERFORM THE WOFK FOR WHICH <br /> PAPGELTAXI.U.NUMBER — O-pyJ � APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> y��'�" - �%C� � �'C�� CONTRACTOR1S LAW iB.27 RCW AND 29Fi.200 WAC. <br /> 5�/C�.� ' %tOi� ' v/7 " O '✓Bv , / <br /> �CON6TBUCTIONL ANIENDEf7,A00f1E55,TELCI'IIUNENUMOCII ,/ <br /> 2/9. � '���'1�.�.,/�--� • l,?l- •9�� <br /> PROJECTA LRIi`SS � sicrv mne - oe*e <br /> �✓C3'ZI�C''.�'�%L� L.:('�� ci?rci�.isu�essucer+ser+o. <br /> aLUM81 G MECHANICAL <br /> � N0. TYPE OF FD(TURE JR ITEM FEE PJO. TVPE OF EOUIPMENT FEE <br /> WAT6R CLOSET(TOILET) � A'C—A/HNDLG UNITS—H.P. � <br /> BATHTUB ; FORCED AIR SYSTEMS—D T.U. M E.A. ' <br /> LAVATORY(WASH BASIM � UNIT HEATERS—B.T.U. M � <br /> _ —T <br /> , SHOWER ' CLOTHES CRYERS � <br /> KITCHEN SINK&DISP � � VENTILATION FAN ; <br /> � DISHWP.SHER � RANGE HOOD �— <br /> LAUNDRYTRAY ; WATER HEATER � " <br /> CLOTHES WASHFR � VJOOD STOVE � . <br /> URINAI ' METAL FIRtPLACE(WOOD BURNING) ; <br /> DRINKING FOUNTAIN i FIREPLACE INSERT i <br /> FLOOR DRAIN � HEAT PUMP � <br /> BPCKFLOW PREVENTERS ; GA` °IPING ; <br /> ROOF DRAINS—RAINLEAGEHS --T EX ��UST FAN � <br /> �SINK(SERVICE—BAR,ETC.) ; ; <br /> � <br /> � � <br /> � � <br /> — i <br /> � � <br /> � � � <br /> SUB TOTFL $ ; _ SUB TOTAL S _ ; _ <br /> PERMIT $ � PERMIT � � <br /> --- — �-- -- _ <br /> � TOTAL FEE S ; TOTAL FEE S <br /> FOR OFFICE USE ONLY: <br /> FRONTS[TOAC REARSETDA SID SELBACK PI.�NCNf:C IA!OER �EE ^0 � flECEIPTNO. <br /> �6 " �d��3 % , <br /> usez LPTAPEA vacnNrsire FEES VALUATION FEE <br /> � ,��Z ❑ YES ❑ NO BUILDING �GC �.11�— <br /> iYPEOFCONST. NO.OrSTORIES o[CUPpxGY NO.ulmvflur�GuwS i <br /> cnour pLUIdBING � <br /> i <br /> S12E OF BLOG. FIR[SPflItIKlERS HEO'D BA;iEMENT � <br /> MF.CHANICAL � � <br /> ❑ ves r_i No - - - ; <br /> OCCUPANCYLOAU FINEALARMFEO'D HEIaNTLIMIiATION �DDITIONALPLANCIIECK i _ <br /> _ i <br /> OTHER ' <br /> i <br /> REASON --' <br /> STAT[D111L�ING SURCHARGE �� <br /> INTAKEBY PLAN�APPPOVEDDY CITYOFEIIERETT PUOLICWORKS � <br /> JI� LOCALSALES <br /> I pA�� 7,� �� TAX COUE iS 31D5 TOTAL �2 J�Cj <br />