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APPLICATICII FOR CONSTRUCI^ON PERMIT <br /> TO BE COMPLETED IN BLACK INK—PLEASE PRINT � <br /> BUILDING DEPARTMENT HEATINO SYSTEM: U(3AS 0 ELECTRIC ❑ <br /> 259•8810 <br /> I l DEMOLITION I_I COMBINATION �BUILDINO I I MECHANICAL I 1 PLUMBIN� il SIGN <br /> OVMER IMILMORESS CITY ZIP PNONE <br /> THE �rNH Go. , p. o, QoX 37c7 M�S �f -76 S6�t-�1"'�' !„p 9�lLy ��2-�33y <br /> TEN�lIT WRI1 RESS � CITY IP pyqE <br /> _SA�✓!E /�5 O/.�N�if� <br /> ARLMITECTOIIDEBpNEN WILIIDURE55 CITY =�p P�qryp <br /> 1��s'�K� EnrCort.. CoN57s.�ciO�.S <br /> NEMLCpITMCTOR 4 gg CITY iIP PIqNE SUtE EN <br /> � ��� � � �� S .� 5�d� � <br /> ,,._.zn e 9/.��- / Sn , � ct ti/ /nGb/ /� ec <br /> MECWWICKCONiPACTO(1 MAILADDRE6S CITY ZIP PIqNE BT�iELILENBEI <br /> 7�7� 77CnC �/LSO�� 3(oS l7� <br /> PLUMBMIOCONTMCT011 1M1A00HE68 CITV 11P PIpNE BT�TEIICENSEI <br /> cusa oc waaic <br /> I I NEW I I ADDITION ALTEHATION I I REPAIR ! I DEMOLITION I I WOOOSTOVEIFRPLINBERT I I BUILOINOpELOCATION <br /> CONTACT PENSON AND VIIONE NO <br /> oonrw�c,rnaEaworoc 'Lot� oe0 Ctb,vw��.D c.rM'rQa�lSK. 2Ge_3.rL3 <br /> OEBCRIBE WOIIK/JIO BOUME FO�T/i6E INVOLVED <br /> Tsanrr �MPR.v�mEar <br /> rnoros[ousEOFeuaowo i HEREBV CERTIFV THAT I HAVE READ AND E%AMINEO THIS <br /> / CICNT�:�- APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT.ALL <br /> IEMLDEBCRIFilONOiPROPERTV�&qWN9ElpWpp�T7A�NFWRCOP�6) PROVISIONSOFUWSANDORDINANCES(iOVERNINpTHISTYPEOF <br /> WORK WILL BE COMPLETED WITH WMETHER SPECIFIEO HEHEIN OR <br /> iot eioac ar NOT. THE 4RANTINO OF A PEHMIT DOES NOT PRESUME TO OIVE <br /> AUTHORITY t0 VIOLATE OR CANCEL THE PROVIBIONB Of ANY <br /> OTHER STATE OR LOCAL UW REOULATINCi CONSTRUCTION Oq THE <br /> PERFORMANCE OF CONS?RUCTIOk.THAT I AM AUTHORIZED BV THE <br /> OWNER OF THIS PROPER7V TO PERFORM THE WORK FOR WHICH <br /> APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> CONTRACTORS LAW 18.27 RC W ANO 288.200 WAC. <br /> x � �• Gy�' d/�°� <br /> mo�cr�oonE ww, e o,�, <br /> ?,crr3 w, c,K,�►o e t�, t1_o Y �,n.�.,«.�� <br /> K�MiMMq MECNAIMCAL <br /> N0. TY/[OF flIfTIME OR REM fEE N0. TY�E OF EOINP�IENT FE! <br /> WATER CLOSET(TOILET) � NC�AMNDLO UNIt�H.P. , <br /> BATHTUB ' � fOFCEDAIRSYSTEMS—B.T.U. M E.A. � <br /> LAVATORV(WASH 8A91N) � UNIT HEATERS—B.T.U. M ; <br /> SHOWER � CIOTHES DHYERS i <br /> NITCHEN SINK 6 DISP ; VENTILATION FAN � <br /> DISHWASHER � q�NpE Hppp , <br /> LAUNDRVTRAV ; WATERHEATER �_ <br /> CIOTHE3 WASHER � WOOD S10VE , <br /> UHINAL ' METAL FIREPLACE 8 CHIMNEV � <br /> DRINKINO FOUNTAIN � FIREPLACE INSERT � <br /> � <br /> , FLOOfi DMIN � HEAt PUMP � ; <br /> BACKFLOW PREVENTEHS ; (3AS PIPINO � <br /> HOOF ORAINS—RAINLEADER3 � E%HAUST FAN � � <br /> SINK(SERVICE—BAR,ETC.) ; � <br /> i ; <br /> � � <br /> � � <br /> i � <br /> � , <br /> SUB TOTAL S � SUB TOTAL { ' <br /> PERMIT t � PERMIT S � <br /> TOTALFEE S ' TOTALFEE { � � <br /> FOR OFFICE USE ONLY: <br /> PRONi6CT&1CN flE�R6ETBACK 81DE6ETBACK PLANCMECNNUNBER fEE PEGEIPTNO. <br /> 3� G <br /> use zor+e tot u�e� v�c�wr sit� FEES VALUATION FEE <br /> T <br /> rr�acoura.�u}owrwe nnacoxsi.u�wu oawMcr xoao+n�wawn BUIlDINO oa P+o `�^� �..SU <br /> ` � N � � <br /> PLUMBINO � <br /> � � <br /> � <br /> 612EOFBL00. NO.Of6TOi11E8 BASEMENT MECHANICAL i <br /> OCCUPANCYLWD FIRESPRNNLERSREQD MEIOMTIIIAIT�lION AB�{i1WMlPUNCHECK _3 � a+ _ <br /> QtR�9� r9�'iSA �5 <br /> SPRINKLER � -1� <br /> REASON FOq 6PPINI(LERS <br /> p T <br /> `D�LS S'�Ai�BUILDIN65URCHAROE i� r"'� <br /> IN�111(EBV 9A�PNOVEDBY CITYOFEYERETT PUBLICWORKS ' � <br /> (%� LOCAL SALES � <br /> TAI(COOE IS 3105 rou� 3 ��� <br />