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AP�LICATIC��'1 FOR CONSTRUCT �7N PERMIT � <br /> TO BE COMPLETED IN BLACK INK—PL EASE PRINT � <br /> — - _ _ — _ __ _ —.__ __ I <br /> BUILDING DEPARTMENT L HEATING SYSTEM GAS� J ELECTRIC J __ . _ _ <br /> 259-8810 _ J <br /> DEMOLITION COMBINATION BGILDING ✓MECHANICAL PLUMBING SIGN <br /> OWNElV� 1.1l�ILPppqFtiS ❑IV <br /> ��� 4 �p�a� --- �.r. r�9eZo3 , 355 -(o4S`J <br /> E'(171 W��7vµ y7"LZ B�Ek�, F��� <br /> *uinNr unuaon��css ur� zir i�.���ru <br /> nRGNP 'tOHDFSiG11ER M�lL�UDF[55 GITV ZIV PHONE <br /> GENCNAICpNIRACipP MNLADDRE55 �ILV �IP PI�UN[ SiRlEUCENSF� <br /> -- --- 1,�E7roµso��vvz <br /> Id(CHANiUI(:MJIRACLOII M/'l•1l�DFE55 CiTV Iu' �NONF SIAi(UCENSE• <br /> GUEs7vu H�e.a-nNv seav�c,r.5 i4oy I°oN, ��r 5w Evr.�ttrT Y9tow �sss-vaoE � <br /> PIUMBiNGCON�BRCiOR MAR�OUBf`i5 CrtV li�� —'--_����rp�E S�ntftilR�SF� <br /> CONiR�Ci PRICE O�WURn <br /> � 'S�0'D D <br /> �ESCRIBE WOIiK AND SOURRE FOOiAG1 tqVOIVE� f.ONIRCT PERSON AFJ PMqNP NO <br /> RE�L4C� 6�EGTRi� FvAN/1 �--- ----��i1i¢TT4 WiwoN ObS'l�459 <br /> CE E w4T� <br /> i <br /> Ff�'rEr� w� 6va 5 NoDF.�S — — <br /> . i HEREBY CERTIFV TNAT I HAVE READ AND E%AMINED THIS <br /> nnoroseo usr or uuno�qc 5�� APPLICATION AND KNOW THE SAIdE TO BE TRUE AND CORRECT. ALL <br /> PRGVISIONS OF LAWS AND ORDIIJANCES GOVERNING THIS TVPE OP <br /> ieceioeseaianor�or�•no�eanisr�owNnc�owon�•ucHrwocoriesi WOFK WILL BE COMPLETED .VITH WHETHER SPECIFIED NEREIN OR <br /> NOf THF GqANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br /> ior B�cen ov AUTHORITV TO VIOLATE OR CANCEL THE PROVISIUNS OF ANV <br /> OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION Ofi ThE <br /> PERFOR�IAN^,E OF CONSTqUCTION.THAT I AM AUTNOR12ED BY THE <br /> OWNER OF THIS PROPERTV TO PERFOFlM THE WORK FOF WHICH <br /> -- APPLICATION IS MADE AND I COM°LV WITH THE STATE <br /> rnacei TeM i o nuunen CONiRACTORS LAW 18.27 qCW AND 296200 WAC <br /> CONSLRlIC1iONlOp9lEN0ER AD�iESS.tiIEPHONE YUMBER <br /> x � � 1,0e� q--a�-yy <br /> PHOJECTADDRESS N�� �QKLR DR �VE ---�-�— --- ��•�� � <br /> �.�•.���,,,�.� <br /> PLUMBING MECHANICAL <br /> T <br /> NO. TVPE OF FI%TUAE OR 17EM FEE NO. TVPE OF F.OUIPMENT FEE <br /> WATEfi CLOSET�TOILETi A C- A HNDLG UNI7S—H.P <br /> BATHTUB PORCED AIH SYSTEMS—B.T.U. M E.A. <br /> _ I.AVATORV IWASH BASIN) UNIT HEATEFS—B.T U. M <br /> SHOWER CLOTHES DRYERS <br /> _ HITCHEN SINK 8 DISP VENTILATION FAN <br /> DIShWASHER RANGE HOOD �— <br /> LAUN�RVTRAV � WATER HEATF.R <br /> CLOTHES WASHER WOOD STOVE <br /> URINAL METAL FIREPLACE(WOOD BURNINGI <br /> OF7INKING FOUN7AW FIREPLnCE INSERT <br /> FLOOR DRAIN HEAT PUMP <br /> BACKFLOW PREVENTERS GAS PIPING <br /> FOOF DRAINS—RAINLEADERS EXHAUST FAN <br /> _ SRJK�SERVICE__BAR,ETC.) � <br /> _ SUBTOTAL $ SUBTOTAL 3 /�� % <br /> — - _ PEHMIT $ ---,_- -- PERMIT $ ---�-t-- <br /> TOTAL FEE $ TOTAL FEE $ � � <br /> FOR OFFICE USE ONLY: <br /> _..— <br /> IlltlfllSllH�:Y f1f�q5f1f14fK ..� ...- ��til[IftiF�114LH PI�NGIIlfNH111A�{[H 1!I I11�fF119Nt� <br /> � �,1 � <br /> u.� io�+t -- ioiuvt.n vec�Ntsire FEES VALUATION FEE <br /> � VES NO eun.rnNc <br /> rvr�n�f,OhSI NUOFSTORIES xruru,�. xoarnvi�inri.4n - - � -- - -. <br /> �Pllut' <br /> °LUMBING <br /> '�VF.OiBlD6 FIRESPRIHNIERSREO'D B�SEMENi MECHANICAL <br /> VESNO -------.—____.__. _- --- �-- ____.__._ i <br /> '�(f,I1P�NCYIOAP FIRE�UqMNFOD ��[iGirtuwurioN .�D�ITIOYALPLAqW1ECN <br /> _ __ OtNER — —.. . <br /> ; <br /> iil 45:ON ----__ .—"__- ___"" __-"_T- . . <br /> i STATE�'UILDING SURClIARGf ; <br /> IfIt4XlBv� .. _.I PIRNtiAPPqrIVFPf1V . . � ... . --.—�' --- __�- .- - `-_ <br /> I CITY OF FVERETT ruc�iic wora.s <br /> LOtAI SALES <br /> _ I , �n TAX COOE!S 3105 toTA� <br />