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_ APPLICATIQ"'f FOR CONSTRUCT�'iN PERMIT <br /> TO BE COMPLETED IN BLACK INK—PLEASE PRINT �r <br /> BUILDING DEPARTMENT HEATING SVSTEM: O GA£, O ELECTRIC ❑ <br /> 259-8810 <br /> ❑ DEMOLIT10fi ❑ CpMBINATION ❑ BUILDING ❑MECHANICAL ❑p�UMBING �y'SI(iN <br /> OYINER y,�po� �.s <br /> �� C�e n�n�-�:;� >���c, �c am _n —�`^��„�//�' r�ane so '7 ,f'' S')7 D <br /> �— �.�-e <br /> TENANT L//l C L/F77f ^^AESS CRY ZIP VMONE <br /> f' 2a -t e 6 �a .-$ . <br /> ' ARCMIfECTOppESNiNER WILADDRE55 ��7y nP P�E <br /> qs'' � y3 ^a4 Oovc G l.M 11 i 8'T <br /> aEt1EMLCONTMCTOR IMRMORE55 CITV LP PHONE STATELIC�1 <br /> �o.wg �. nt.i-,;y Mc ,r .�wa�� a-44�o lf� S e,.��-EvJ lor,(� Q,i1 �0.1_�..�ron� <br /> MECMAN CONTRAC Ml.k+�oDRE55 � <br /> C�T�' ZIP� PIqNE STATELICOISE� <br /> _ . PLU!lqCdRMC10R M�ADORE83 CITY ZIP P110NE STATELICEl6E1 , <br /> � CONTHACTPRILEOFY�OIIK � <br /> � p,OC� <br /> � DEBCRlEWOIII(NIDBOUAREFOOLWEINVOIVED COHi RSONA'ID HONE1�. <br /> (� f <br /> , .� d�.�o, K ,a L �C.z 3 <br /> �, , IO R�bo am o'mTa+ i HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS � <br /> nnoros�o us�°F euwrq APPUCATION AND KNOW THE SAAAE 7p gE TqUE AND CORRECT.ALL <br /> � , ����C�P110NOFPIqPENN�BMOWIIBELOWORATfACH1M/OCOPIE6) PROVISIONSOFLAWSANDORDINANCESOOVERNINOTHIS7VPEOF <br /> � � , WORK WILL BE COMPLETEO WITH WHE7'NER SPECIflED HEREIN OR . <br /> �or �� � NOT. THE GRANTINQ OF A PERMIT DOES NOT PRE3UME TO OIVE ' <br /> i � AUTHORITV TO VIOLATE OR CANCEL THE PROVISIONS OP ANV <br /> �' . OTHER STATE OR LOCAL LAW REOULATINp COWSTRUCTION OR THE � <br /> - ` �. PERFORMANCE OF CONSTRUCTpN,TW►T 1 AM AUTHORRED BY THE � <br /> i � OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICM <br /> . , i PARCk1TAX1.D.lN1MlER APPLICATION IS MADE AND I COMPLV WITH THE STATE ' <br /> � CONTRACTORS LAW 18.27 RCW AND 298,2p0 WAC. <br /> i � CONBi1N1 q LWN lF1O R.ADOBE9l&IElEP110NE NUMBER � . <br /> , I �P � � <br /> I ADDIIEt6 s�t� 2 <br /> /— 4�„ "���—T�3 I <br /> � I cmeusr<nuccraero , <br /> ~'�b MECMAIACAL <br /> , M0. TM�E OR FlXTUIIE OR REM FEE N0. TYPE OF EGINPIIEIR � <br /> . WATER CLO$ET(TOILET) � /V�qR{NDLG UNITS--H.P. � <br /> ' ��UB ' FORCED AIR SYSTEMS—B.LU. M E.A. � <br /> . � LAVATORV(WASH BASIN) � UNR HEATERS—B.T.U. M ; � <br /> . , I SFpWER ' CLOTHES ORVERS � � <br /> � j KITCHEN SINK 8 OISP � ; VENTIUTION FAN � � <br /> ' . DISHWASHER � RANOE HOOD , �, <br /> ' LAUNDRY7AAY ; WATERHEATER r <br /> CLOTHES WASHER � WOOD STOVE ' <br /> �R� ' METAL FIREPLACE(WOOD BURNIN6) � � <br /> DRINKINQ FOUNTAIN � FIREPIACE INSERT ; <br /> ���N ' HEAT PUMP , <br /> ' BACKFLOW PREVENTERS ; GAS PIPING � <br /> I � ROOF DRAINS--RAiNLEADERS � E%HAUST FAN , <br /> SINK�SERVICE—BAp,E?CJ ; , <br /> ' � <br /> — 1 i <br /> � � <br /> i � , <br /> I � , � <br /> � SUB TOTAL S ; SUB TOTAL S ' <br /> PERMIT S � PERMIT s ; <br /> � TOTAL FEE S ' TOTAL FEE s � �. <br /> FOR OFFICE USE ONLY: `�yt,�7 �,.t o� c <br /> ,� FIqMT SET�CK 11EM SETBACK SIOE SEigACN PI,/W CHEyN NUMBER FEE RECEAT NO. <br /> t 4�bA�D p <br /> � v�rsite FEES VALUAiION FEE <br /> 3 n vEs � �,�a�� 5 �� <br /> , <br /> rn[atox5t no.oFsronies oauMxcr xo.auwun�cwirs <br /> cnwr pLUMBIN(i � <br /> 5����� FlXESPpNIftEpSREOD eASEMEN7 MECHANICAL i <br /> ❑ VES ❑ NO � -- <br /> � OCCUPANCY LOAn Flne AuqG pEOD MEqN7 LwiiATION ADDITIONAL PLAN CHECN ' S' <br /> � �� ! <br /> REASON OTHER i i <br /> STATE BUILDING SURCHAR(3E �� <br /> INTNCEBY PUNSAPpROVEDBv CITYOFEYERETT PUBLICWORNS � <br /> NA LOCAL8ALE8 ' <br /> w�re y� 3 TAX CODE 18 9105 mvu �� <br />