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APPLICATIC 1 FOR CONSYRIIC�' il`rl Pi�ir�Yi(��T � <br /> TO BE COMPLETED IN BLACK INK-PLEASE PRINT <br /> LHEATING SYSTEM• U GAS ❑ELECTRIC U � <br /> �UILDING DEPARTMENT <br /> 59•8810 <br /> DEMOLITION � COMBINATION X 9UILDINO i I MECHANICAL i i PLUMBIN(3 SIGN <br /> NNER MAIL��ORE55 GIT 21P PHONE <br /> � Qo���4 t 3Yz-7?39 <br /> �o pe l�ax ?707 r� so� �t, sE��Ls' w�• 9li Y <br /> ���� z�p PHONE <br /> -N�Ni MMUODRCSS <br /> SA�rv►6 AS 6wN�rt� <br /> aGM1iEL70�0E9GNEI1 M�II�ODRl55 <br /> CIiV 21P PIIONE <br /> 1K({ S��"� GG ��t� Z�P PNONE STATELICENSE� <br /> FNER/�LCONI/R��'CT�OR /�M��IL�DORE55 <br /> '�,(' /�v�'I N w' P110NE ST�TE IICENSE� <br /> J_.L�—�+ CITY 21P <br /> cCH�NICALGONTN��TOR MAL�D�RE55 <br /> Ct� Z�P p�E SiATEIILENS@� <br /> UMBINGGONTNAGTOA MAIL�UDRESS <br /> �— <br /> ASiOFVPONK I i DEMOUTION i I�WOODSTOVE/FRPLINSERT I I BUILOIN4RELOCATION <br /> NEW I I ADDITION ' � ALTERATION i � REPAIR <br /> CONT�_GT P:SON/�N�PNO�E NO � O�.J' �'w J� <br /> 1NiRACT PRICE OF WOPN <br /> (p7 OCO �d ivi`ii..y ,�r f�I <br /> :SCP'BE WORII�NDSWARE F007� E INVOL ED <br /> �o/r�oseouseaveunort+a i HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br /> RSI NRO�LGr �YS f�S _ APPLICATION AND KNOW THE aAME TO BE TRUE ANU CORRECT.ALL <br /> PROVISIONS OF LAWS ANO ORDINANCES GOVERNIN6 THIS TYPE OF <br /> �MDESCNIVTIONO�PHOPENTY�SNOWNBEIOWORATT�CMFWRGOPIES� yyORK WILL BE COMPLETED WITH WHETHEfl SPECIFIED HEREIN OR <br /> T _ ai«K or NOT. THE GRANTIN6 OF A PERMIT DOES NOT PRESUME TO GIVE <br /> — AUTHORITV TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br /> OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br /> PEHFOHMANCE OF CONSTRUCTION.THAT I AM AUTHORI2ED 8V THE <br /> OWNER OF THIS PROPEHTY TO PERFORM THE WOflK FOR WNICH <br /> APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> CONTRACTORS LAW 1827 RCW AND 29fi,200 WAC. <br /> x �.^.,�� ��/y/�- <br /> WIF <br /> 6iGN E <br /> IPIECi/�DOAESS <br /> W, IAs�I✓O�I � �Q`�� tnreusw[esi�ccxsewo <br /> �r, <br /> PLUMlINO ����A� fEE <br /> N0. TYPE Of FIIfTURE OR ITEM FEE N0. TYPB OF EGU�PMENT <br /> WATER CLOSET(TOILET) � NC—NHNOLd UNITS—H.P. ' <br /> � FORCED AIR SYSTEMS—B.T.U. M E.A. ' <br /> BATHTUB ' � <br /> LAVATORY(WASH BASIN) � UNIT HEATERS—B.T.U. M <br /> SHOWER ' CLOTHES DRYERS � <br /> ; VENTILATION FAN ' <br /> KI7CHEN SINK 8 DISP ppNGE HOOD � <br /> DISHWASHEfl � yJATER HEATER � <br /> LAUNDRV TFiAV � y,/ppD STOVE ' <br /> CLOTHES WASHER , METALFIREPLACEBCHIMNEV ' <br /> URINAL FIREPUCE INSERT ' <br /> DRINKING FOUNTAIN ' —'_�— <br /> � HEATPUMP � -- <br /> FLOOR DRAIN � dqg pIpING ' <br /> BACKFLOW PREVENTERS ' <br /> i EXHAUST FAN � — <br /> qOOF DRAINS—RAINLEADERS � <br /> SINK(SERVICE—BAR.ETC.) � ; <br /> � � <br /> � <br /> � <br /> � ' <br /> � <br /> � <br /> _ � <br /> SUB TOTAL S ' SUB TOTAL S ' <br /> � PERMIT S � <br /> TOTALIFEE S ' TOTALFEE S ' <br /> OR OFFICE USE ONLY: PELEIPT NO <br /> iONTSEiB�CR RE�RfiE7BACN &UESETBACI( <br /> PIANCHECKNUMBER FEE <br /> FEEB VALUATION iEE <br /> IEZOME LOTARE� V�C�NT611E � <br /> � BUILDINO 7COG � �v ' <br /> i <br /> PEOfCOHIS�IIOWMIE TYPEOfCOHSI�CNAI otcuVu[� Noalw.'tluNG�Mit! i <br /> �w� PLUMOIN4 � <br /> i <br /> LE OF BLDO. NO OF STOH�ES BASEAIENT MECHANICAL ' , <br /> i <br /> pBDN16/1AL PLAN CHECN .�6 b� i %� <br /> :CUP�GY�0�0 FIRE SPflHMIEHS REGO HEIGMi IIMITAiION , i, <br /> i <br /> SPRINKLER ' <br /> �SONFONSPPINRlERS � � `� <br /> STATE DUILDIN6 SURCHAHGE ' <br /> LAKE BY PL S�PPFOVED BY CITY OF EYERETT PUBLIC WORNS � <br /> � LOCALSALES ; <br /> TAX CODEIS 3105 TOTAL � <br />