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� <br />PERNIIT APPLI+CAT��}t� <br />������������������������������t���������c������������� <br />��rr �� ��E�Err ����}� ���v�cEs <br />32�0 Cedar St., E�erett, Wi� 98201 - 425-257-8�1C� — FAX 425-2�i-8857 — www.e�ece�.�rg <br />a�pi�c�-nor�s A�� acc��-r�B ��on� a a�n �ra ��r� <br />A�i�R�SB; FrtigE�€-Y Ti �X � g�t�4i� � <br />1 `�%i � ./% ��:c�eir��c-? � ? �:� :f-�,� .%:'.Pc'i /�'7'� c) � t � V '. : . <br />�.lt`� j C%C� jCs � _ .� _� t� <br />€crr r�edv 4ortstruc#iort: Shart Ptatisu�tr}ivisian Lat �f€r. �atiach cgpy cr€ iar�g iegai d�crt�ficrn} <br />_r �, � ��, -�� L:�>,� /C,���.u� y.. <br />/ 5/��> f117��_�,'s��.� 5 � <br />�������� P�T���T �1��'���0l����� <br />%%� s c�' �� ._ �3-� z. 7 t„• ��...,C�b 1,.�,:!( ��..�rs ��-=.nz <br />�r�.V"G? CL"s // �i J,�/` / ��L.Ci'.� <br />PRICE �E 4�tORlC � <br />t�rg l.is� af Bu"t6ding ife .: z�' HEAT SOi1RCE_ <br />s�ed tlse cf 8uitding�/G� e,Z�� �as� Efectric� C?thte� <br />[ta �j+pe- � Single �ami}y , Duplex Townhouse _ hrtut�i-Fami�y _ Gommercia� <br />�f pr���: _ �tev� _ Aciditss�n � R�rrx€�et _ Re�ir _ T.l. _ S?�n _��r?nk#�r _L�psr�Qti#i�n �it�nge c�f l�ss� <br />ripti�n tif Work (adsfitionat s�azce prtsvid�d on the back) : <br />- /' � <br />,�' �� �`:, � ,^r� � � ' � ..�. - a 7Z<-- • . . 6 ,�. 1�... t r � , <br />`� r.; c�,.t+...." .• T c ,, .._�.E� -L' l�", c R L ,f ._ c;' _, t`'= i' 1 f <br />- � �-� �� ,.�, - � ... y . ,.. <br />� i` . e `."A�:: .�s:..� _ - <br />�� s��c� �f�t�� ��n��t � ��tt� _v�s ��a� <br />MECHA�IICAL PERMi'i APPLI�ATION <br />of Project: �iUew Addn �Aiteration ,�(tepair <br />Show Number (#) of flxiures <br />A/C — air har�dtina uni2s <br />V�ater heater <br />Gas firsplace <br />Gas range <br />Cfoihes dryer <br />ftange hood <br />Eachau�4 f�rt <br />Unit heater <br />Bailer <br />Other <br />SPRiNKLEIt i �UPPRESSION SYSTEM <br />Number af Haads <br />RLU�IIBINC PERMtT AFFLICAT�t3t�1 <br />of Froject: �New,�,Addn ,,�Aiteration _ReQair <br />Shaw lVermber (#j vf fixtures <br />Toiiet <br />� X Kixchen sink & dis <br />. �( i3ishwasher <br />� CioYhes washer <br />Water hea#ef <br />� ' Sink (s�r�ice�barE <br />8ack�F%taet �xevants <br />Unna1 <br />Dr�nk`s€ag Fa:antain <br />�lQor drain <br />Gr�as�; irap <br />Raaf dt-ains <br />Medicaf Gas <br />O#her: <br />t3ther <br />!#tereby certsfy ihat i ttave rsad and sxamisted t#tis applicatton and know the same ta t;� true and ccxre�t. A!# �c�aisi4ns �r€ la.�+s and osdinances gvs;asning <br />this Yype of �nrork wii{ be compiied with wheYner specified herein or not. ihe granting of a permit does not presume to give authoriiy to vioiate or cancei <br />the prov�sipn of any ofner sfate ar iocai taw regufaffng construction or the performance of constru�tion. Tnat � am �uthr�rr�ed by the owner oi this prpnerty <br />io perform the work for which ap�ication is made and S camply v�ith the State Carrtractors Law 18.27 RCV1f and 236.2i1D SNAC <br />� :, ?�,�' , �� `��=% __ � � r �/v ;/ <br />Qwner/Authorized �ent Signature �v ^✓ Date � (Rav�sed 212t}F1} <br />�� <br />