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APPLICATIC�l FOR CONSTRUCT"1N PERMIT � <br /> TO BE COMPLETED IN BLACK INK—PLEASE PRINT <br /> BUILDINCi DEPARTMENT ,�"�Q�4�t � ; 'HEATING SYSTEM: 0 GAS O ELECTRIC O <br /> 259-8810 <br /> ❑ DEMOLITION O COMBINATION ❑ BUILDINa O MECHANICAL �LUMBIN(i ❑ SICiN <br /> OWIER 1MLMMIE66 CITY 21P PIIONE <br /> �� �a �6X 3707 .SF.trru� 9g��_�7 <br /> TENN/T WL�OOIIE68 CITY 21P PIIONE <br /> �c�v ��—ar �4r(o Fuerr . cec cu►�� s s-G � <br /> ANCINfECTORDEBIONER ANLAODRE68 ITV ZiP PIIONE <br /> • pE/EW1lCp/TpI1�Tpp yµApp11E89 Lltt ZIP PIIONE BT�TELILENBE� � <br /> IECN�NICKCdITMGipI IMLIIDp1EB8 CITY ZW PIIONE BT�TELKENSE� <br /> id1 WL 68 CIiY ZM o110NE BT�TELICEMBE� <br /> m 7 � sL � � <br /> camu�ernMaorwowc ,M/ � <br /> �0 . <br /> o�.w..wow�wo.a,�. �oe.rvavco E �� wr�T�cTr�Rso��wv�a�w. — `� <br /> � <br /> ' .� T 'I� <br /> � �� I HEREBY CERTIFY THAT I HAVE READ ANO E%AMINED THIB <br /> ao ur a�uanra �/� APPLICATION AND KNOW THE SAME TO 8E TRUE AND CORRECT.ALL <br /> 1"T'1 ' PROVISIONS OF LAWS AND ORDINANCES(30VERNINp TMIS TYPE OF <br /> �aao[sewrtqMaF��orcnn�pqwx��awan�n�Twoca�s� WOpK WILL BE CAMPLETED WIiM WHETMER 8PECIFIED HEREIN OR <br /> aT K� a NOT. THE GRANTINO OF A PERMIT DOES NOT PRESUME TO fiIVE <br /> AUTHORITY TO VIOLATE OA CANCEL THE PROVISIONS OF ANV <br /> OTMER STATE OR LOCAL LAW REOULATIN(3 CONSTRUCTION OR THE <br /> PERFORMANCE OF CONSTRUCTION.THAT I MA AUTHORIZED BV THE <br /> OWNER OF THIS PROPERTY TO PEHFORM THE WORK FOiI WHICH <br /> �MCfLTiYl4D.MM�E11 APPLICATION IS MADE ANO I COMPLV WITH THE STATE <br /> CONTRACTORS LAW 18.27 RCW AND 288R00 WAC. <br /> coNsr1111CTI0M101IMIE 11ooNEt0.rElEn�arlENlMEl1 <br /> w�tczs .a�. • c�o ' - ���ll ,. J�• <br /> i � o.n <br /> o -a .���� � <br /> K{�q MECMAIMCAL <br /> N0. Trr!0//IRTINI[011 REM FEE N0, TtlrE OF EOUMIIENT RE <br /> WATEN CL06ET(TOILET) � NC�AMNOLQ UNITS—H.P. � <br /> �►TMT�9 ' FORCED AIH SVSTEMS—B.T.U. M E.A. � <br /> LAVATORV(YIIASH BASIN) � UNIT HEATERS--B.T.U. M � <br /> gMpWEp � CLOTMESDRVERS � <br /> KITCHEN SINK i DISP � VENTIUTION FAN ; <br /> � DISNWASMER � RANGE MOOD � <br /> LAUNORV TRAY ; WATER HEATER ' <br /> CIOTNES WASHER � WOOD STOVE � <br /> UqR1AL ' MF.TAL FIREPLACE(WOOD BUHNIN(i) � <br /> DRINKINO FOUNTAIN �� FIREPIACE INSERT � <br /> FLOOR ORAIN HEAT PUMP � <br /> � BACKFLOW PREVENTERS ; GAS PIPIN6 ' <br /> ROOF DMIN�MINLEADERS � E%HAUST FAN � <br /> SINK('SERVICE—BAR,ETC.) '�"' ' <br /> _ , <br /> i � <br /> � � <br /> � � <br /> � � <br /> SUB TOTAL { ;� SUB TOTAL S ' <br /> PERMIT t � � PERMIT f � <br /> - TOTAL FEE f 'r- TOTAL FEE 3 ' <br /> Fon o�ce use oN�r: <br /> F�pqT 9(iMCI( REM BETMCN 6DE BEiBhCN PIAN EGt NUMBER FEE PECEIVT NO. <br /> ,t� � <br /> uscmr� wr� wcunwre FEES VALUATION FEE <br /> ❑ YES ❑ NO BUiLD�N6 � <br /> m[aarr. ra.ocsion[6 ox�rur.. wawwucuxn i — <br /> °"PM PLUMBINO � <br /> yltEy�lpp. FWE8ppY11QEN8NE0'D BASEMENi MECHANICAL � <br /> ❑ YES ❑ NO , <br /> p�y�p�p FpEUMWRE09 NEqNTL41�tAT�ON ADDITIONALPUNCHECN � <br /> O7HER � <br /> i <br /> IEABOM � <br /> StATE BUILDIN6 SUHCHARGE i <br /> «r��r wws�rrnoveoar CITYOFEYERETT Vl1BLICWORNS � <br /> LOCALSALES � <br /> wtE TAX CODE IS�105 *ot� ' <br />