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r/>.� <br /> APPLICATIC�] FOR CONSTRUCT� )N PERMIT Ny��� <br /> TO BE COMPLETED IN Bi_ACK INK—PLEASE PRINT �r <br /> BUILDING DEPARTMENT HEATING SYSTEM: GAS iJ ELECTRIC ❑ _� <br /> 259-8810 <br /> I 1 DEMOLITION COMBINATION I � BUILDING �I1�CHANICAL I I PLUMBING I 1 SIGN <br /> OWNER M�II�DDRFP$ C+ITV IIV P1qNE <br /> ! �iTX/�Y�CNI.tL//✓(� P ..�D�9 /�p�AR dT EVt� 9B�Q[�f�a '.�/G 4� <br /> TEN�NT MMIADORE55 <br /> C�TV z�c p�IONE <br /> �RCNITECT OR DESIGNER M�II�DDRE55 �iTy zip pp�flE <br /> GENERAICONTP�LTOR M�ILADlA1ESS CITY ZIP VNONF SUTEIICENSE• <br /> MECN�NIGILCONiR�CTOR MMLAODRE55 CITV ZIP PNONE St�TEIICENSE� � 1..` � �� <br /> .�t157.L LCN!'7l6Y SVSrsi7fl r /9��i-�s<nu Av�.c.�. .Cy.v.r�eoA q�es L 99�83 i.�= <br /> PLUMBMGGONiH�CTOR MAIL�D�RE55 �ITv 21P PHpNE gTATEI�CENSEIr <br /> � LEfD�ir.Ti4 <br /> f.ONTRACi PRICE OF Y/ORN — <br /> �/DOc� <br /> OESCRIBE WdiK AND SIXURE FOOT�OE IHVOLVED CONUCT PER D P11d1E <br /> 'J�!Y-8�/S <br /> i HEREBV CERTIFY THAT I HAVE READ AND EXAMINEO THIS <br /> rnnvoseo use c� i APPLICATION AND KNOW THE SAME TO BE TqUE AND CORRECT.ALL <br /> PROVISIONS OF LAWS AND OROtNANCES GOVERNING THIS TVPE OF <br /> LEOALDESCPIPiqNOiPROPENTY�5110WNBELOWOR�TTACHTWOCOPIE51 WOHK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br /> �or e�ocK-- oF NOT. THE GRANTING OF A PERMIT DOES NOT PFESUME TO GIVE <br /> AUTHORITV TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br /> OTHER STATE OR LOCAL LAW R[GULATING CONSTRUCTION OR THE <br /> PERFORMANCE OF CONSTHUCTION. THA7 I AM AUTHORIZED BV THE <br /> OWNER OF THIS PROPERTV TO PERFORM THE WOHN FOR WHICH <br /> APPLICATION IS MADE AND I COMPLV WITH THE STATE <br /> P�PCEL T�%I U NUMBEN CONTFACTORS U1W 1827 RCW AND 296.200 WAC. <br /> �11�1- ooi- o3i - 0003 <br /> CONSTRUGTIONLO�NLENDER,�ODRESS,TELEPHONENUMB( 1 <br /> x >�I ._�L�G.ti.��L .�/a�9y <br /> rnaEr.r�ooness <aN..�NE ---�,,,F <br /> �iA cnreusn�rssir.rris�rxi - <br /> PLUMlINO MECMANICAL <br /> N0. TYPE Of flI(TURE Oli ITEM FEE NO. TYPE OF EOUIPMENT PEE <br /> WATER CLOSET(TOILET) NC—NHNDLG UNITS—H.P. <br /> BATHTUB / FORCED AIR SVSTEMS—B.T.U. M E.A. <br /> LAVATORY(WASH BASIN) UNIT HEATERS—B.T.U. M <br /> SHOWER � CLOTHESDRYEHS <br /> KITCHEN SINK B DISP VENTILATIUN FAN � <br /> DISHWASHER RANGE HOOD � <br />. LAUNDRY TRAV ; WATER HEATER <br /> CLOTHES WASHER � WOODSTOVE ; <br /> URINAL METAL FiREPLACE(WOOD BUHNING) <br /> ORINKINO FOUNTAIN FIREPLACE INSERi � <br /> SLOOR DRAIN HEAT PUMP � <br /> BACKFLOW PREVENTEPS GAS PIP�NG ' <br /> ROOF DRAINS—HAINLEADERS � EXHAUST FAN � <br /> 61NK(SERVICE—BAR,ETC.) � <br /> � '— <br /> � , <br /> --- --�— <br /> � <br /> SUBTOTAL S SUBTOTAL S 'O O <br /> PERMIT E PERMIT S �00 <br /> TOTAL FEE S TOTAL FEE S � '00 <br /> FOR OFflCE U8E ONLY: <br /> FRONTBEiB�ICN REIINSETB�CN SIOESETB�CR PL�NCHEf•NUMBEN FEE RECEIPiNO <br /> USE 2d1E LOT ARE� VACAN7 SITE FEES VALUATION FEE <br /> "� vEs f 1 No euaniNc ' <br /> IYPf IX LUNSI MD OF SLOfi1ES oreUwNtr rp p vMuiMauNns <br /> �RO�° PLUMBIN6 <br /> i <br /> i <br /> _ �— <br /> 91ZEOFBLIX3 FINEfiPPINI(LERSPEO'D B�SEMENT MECN/1NICRL <br /> n ves i ! No ' <br /> I <br /> OCCI1P�Nf:V LOhD FIRE I1UFM REOD HEN3NT IIMIT�TqN ADDITIONAL PUN CHECK � <br /> OTHER � <br /> REA90N �— <br /> STRTE BUILDINO SURCHAROE � <br /> INT�RE BY R�NS�PPNOVEO BY CITY OF EVEHETT PUBLIC WORKS � <br /> LOCAL SALEB <br /> o..e TAX CODE 18 3105 Ta*�� � <br />