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APPLICATiO" FOR CONSTRUCTI"'N PIERMIT �� <br /> TO BE COMPLETED IN BLACK INK—PLEASE PRINT Ew7r�T <br /> ` <br /> _ .-- -----_. <br /> BUILDING DEPARTMENT HEATING SVSTEM: ,�Q GAS J E�ECTRiC J <br /> 259-8810 -- -- — ---- — -- _ <br /> DEMOLITION COMBINATfON BUILDING MECkANICAL PLUMBING S!rN <br /> OWNER 1lAi�pL[1:�65 (rtv r�r�—'--- �---� -- - <br /> PM04C <br /> � �}}-N/-1J,4 Y 1 Z ll �(1�L-,1 hUc �vcfr? `�K O.� 3��=03G `� <br /> iENANT MAIIRODRF55 Gt1 IIP PIpNE <br /> 11P4HITFC10RpESIGNF.R MAII�GDFESS CItY piP pNON[ <br /> GENiR�ICONTRACTOq MMl�00RE55 CIiV 21P VMONE STQELiCENSE• <br /> • <br /> IAECHANICAL GONTR�GTOR MML ADOFESS CIIY ZiP PNONE $T�iE IiCCNSE• <br /> ����A c�r7' iNc z.Z; i� �� �"`� �J �NG.L ii'uZ� 7���o�F7.(' E���cZ'norn,� <br /> PWMBINGCONiP�.^.TOR M�ILADDRE55 Ciiv ZIF PNONE SIATELICENSkI <br /> LONiR�CT PRirE OF WORK ----" <br /> 3s RO, OV <br /> OESCRIBE WONN�ND SOURRE FOOTAGE INVOIVED LOIrf�CT PERSON AND PNONE NO <br /> �Q�1�/Ll')M �ll / fw nf L�.( �Z�n� k ,/ <br /> ��V C�'1�IM�� I�i��J ��p_J' � HEREBV CERTIFV THAT I HAVE READ AND E%AMWED 711�5 <br /> PROPOSEO USEOF BIULDINO '� APPLICATION AND KNOW iHE SAME 70 BE TRUE AND COFRECT AI i <br /> PFOVISIONS OF L.aWS AND ORDINANCES GOVERNING THIS TYi� Crt- <br /> LEGALDESCRIPLqNUfPROPEFTY�SHpWNBElOWO'I�tTAC1/iWOCOPIE51 WORK WILL BE COMPLETEO WITH WHFTHER SPEqFlED HERFM Of�. <br /> NOT. THE GFANTING OF A PERMIT DOES NOT PRESUME 10 G".'! <br /> ior BLOCN ov qUTHORITV TO VIOLATE OR CAf-�EL THE PROVISIONS OF �Id'; <br /> OTHER STATE OR LOCAL LAW fiEGULATING CONSTRUCTION OR T i i�. <br /> - PERFORMANCE OF CONSTRUCTION THAT I AM AUTHORIZED BV IH! <br /> OWNER OF THIS PROPERTV TO PEFFORM THE WORK FOF WHICH <br /> -�--- APPI ICATION IS MADE AND ! COMPtY WIThI THC STAiC <br /> P11RLE�UX 10 NUMBIn CONTRACTORS LAW 18.27 RCW AND 29G.200 WAC. <br /> CONSTRUCTIONlOANI[N�ER.�DORESS TEtEPNONE NUMBER <br /> � � � <br /> �_ � L` _�i�_L� `� <br /> PROJECT ADDRE6S �.�:meu,�u � �n.n - --- <br /> � � l`IG —,��,, .,,�,. , — -- --- __ __ <br /> PLUMBINO MECHANI(:AL <br /> N0. TYPE OF FIXTURE OR ITEM FEE NO. TVPE OF EOUIPMENT FFE <br /> WATER C�OSET jTOILET) A�C-ArHNDLG UNITS-H.P. � <br /> _ BATHTUB ' 1 PORCED AIR SYSTEMS-B,T.LL !d E.A. � <br /> LAVATORV�WASHBASIN) T UNi?NEAIERS-B.TU. M � <br /> SHOWER CLOTiIESDRVERS --T � <br /> KITCHEN SINK 3 DISP ; VENTILATION FAN � <br /> DISHWASHER FANGE HOUD —T— <br /> LAUNCFV TfiAV WATER HEATER J � <br /> CLOTHES WASHER WOOD STOVE <br /> URINAL METAL FIREPLACE(WOOD BURMING) �— <br /> DFiINNING FOUNTAIN _ +- FIREPLACE INSERT <br /> FLOOR DRAIN HEAT PUMP �— <br /> BACKFLOW PREVENTERS ,'J GAS PIPING <br /> ROOF DRAINS-RAINLEADERS EXHAUST FAN -T- <br /> SINK(SERVICE-BAR.ETQ) I <br /> T <br /> SUB TOTAL $ SUB TOTAL $ (f O � <br /> PERMIT $ PERMIT $ �� <br /> TOTAL FEE $ ' � TOTAL FEE� $ 1 � <br /> FOR OFFICE USE ONLY: <br /> FRONiSEIAACn REAfISEiyAf,N glpFtiC10�CN PIANLH �Nil PFn fFE �'(Cfrt'INO <br /> ��� �r� � <br /> _� <br /> use tone ior�Re� vncaNr srte FEES VALUATION FEE <br /> VES NO <br /> BUILDMG ' <br /> IYPFOiCONSi �OFSTORIFS xr,ir�y�r qno�owi�i�qr,iyne -- ----- ----�'—i_. <br /> r����� pWM01NG <br /> i <br /> "__ _ -- __—_�_ <br /> SiZEOP8lD0 FlRESPR1NhlEH5RE00 B�Sf.MENi MF.CHANICAL <br /> � YES - NO ------._ . ._-- - <br /> -- — -- , <br /> OCCUPANCYIO�D FlPE�L�RMR[UO NEif��iliMiUtlpl AODITIONALPLANCHECN � <br /> i <br /> _ OTHER i <br /> nensorv <br /> __ -..._-_ _._—____�r-- <br /> S7A7[BUILDING 5UFCHARGE <br /> _ _-___ . ___ __._ _' __--__ ._ _ - <br /> _' ._...__ _. . _.... __ ___..—__''_._ <br /> winrrnr -� i�inNs�vvnovennv C,ITY�FEVERETT PUOLICWORNS <br /> LOCALSALES <br /> nnre TAX CODE IS 3105 rotai I <br />