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�� PA'PfOII <br /> APPLICATIOh� FOR CONSTRUCTI�.N PERMIT � <br /> �E c q y, TO BE COMPLETED IN INK-PLEASE PRINT <br /> aTv o� } � �y/ <br /> Ht� O CVCPeI� HEATINGSYSTEM �UGAS �ELECTRIC J _ � _� <br /> py �y BUILDING DEPAFTMENT �--- <br /> 259�8810 � <br /> y y y DEMOLITION _ COMBINATION V BUILDING _ MECHANICAL PLUMBING SIGN <br /> t� ownFn i.Ai�nnUn[ss ci�r tir rnoru <br /> H �� �,yP Y �lNIF4 �r-�./. 7=� �/�/(� /_i=iiC./:/-.`'.+ ����� �_c/iJ_�Y.:C,i .�f-S� -J� <br /> � y[�� 1ENAN1 MMl�ODMI55 Cilv l�� ���ONE <br /> � • `� LItV IIP PNONE <br /> �/J�"' ARCNREGi0R�E51GNER MAil�L1D�f55 <br /> � x3C //'.cr+5 R %N �YNs .i-�n'l U•�f<s A�k 6��,� ��' 9r�ri � sY J.�1 � <br /> [s1 Es� cnv I�r vroHc ucer+se� <br /> nfNEP�ICUNTRALfOR M�II�DDR[55 <br /> oHd , : C/L_dlGiC C[,��,7• .T,.,• `/.Z/[� 6�'/ifc dl,v 4,�/ f'�,c�74« /f'r�7ty ?�S���xn CYc..Nrr_/9'try�. <br /> G-���� PHONF IiCENSE• <br /> �y M g M[C�UNiGL CONiR�GIDF MAIt�L�ORE55 ���� � <br /> (�]Y (] <br /> yHI PIIIMflINdCON1R�GiOH M�IL�D'JMC55 Cliv D� FNONE UCENSE• <br /> t' y� lfAbcl 5�1,Til- / ��7��`•.� `f') Tr ✓FN . Fa s •//C 4•A . `)Y )��, (. S�J-/S'S7 !)'Rt.cn.s /S'� �•C <br /> �y y G1A550f WORN I <br /> � �y ��1VEW ADDI710N ALTERATION REPAIR DEMOLITION WOODSTOVE�FRPL INSERT BUILDING RELOCATION <br /> � � L - C(NIUCLP[PSON�NDFIqNFNO — <br /> � CGNTR�CIFRILEOfV/ORN � /.� UC{l �l�/� C ��(NNC�L ��.j_� 7�n1 <br /> F] DESCRIOEWJRN�NDSOU�11EfOO��GEINVOlVEO <br /> OtA .1;..y/.� 5%!a0 Wcr.! FiCR�-F_ i�., �r� !"n....,� /'osr�(r. r �4�Y=f.f'. co, i 7 7�/ /t��l ti� /-I <br /> vnorosenuseoFe ioi�+c I HEREBV CERTIFV THAT 1 HAVE HEAD AND EXAMINED iHIS i <br /> / APPLICATION AND KNOW THE SAME TO BE iRUE AND CORRECT.ALL , <br /> ��� °' � �f���r� �`�, - - PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TVPE OF � <br /> i[r.eiocscnirriw+orrnqr rvi ��oW � one*inu�rooncoviesi I <br /> � ���77� ,�,.]o oi WORK WILL �E COMPLETED WITH WHETHER SPECIFIED HEREIN Ofi <br /> tptfl./frrL�i E/ nian �'lSL or ✓/•'� G[ �SZN� NOT. ?HE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE i <br /> — I AUTHOfiITV TO VIOI ATE OR CANCEL TNE PROVISIONS OF ANV <br /> I��i L�c�AS A �C' /�< i l� L'✓F?F/� ___ �1THER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br /> PF.RFORMANCE OF CONSTRUCTION.THAi I AM AUTHOR12ED BV THE <br /> OWNER OF THIS PROPERTV TO PEFFORM THE WORK FOR WHICN <br /> _ � D� APPLICAiION IS MADE AND I COMPLV WITH THE STATE <br /> � � CONTRACiORS LAW 18.27 RCW AND 296200 WAC. <br /> SI911FIONE(XCONIR�LtOR00�Ui110Ri1EUAf.fNi UAtF <br /> � ������ �%/9/ <br /> —.�� �� a � � — X i � �---� -- <br /> nnOJEGI�DORFSs --- <br /> f_1 �PPI�C�NIS Lit V NUSMFS>l�CENSE 110 AND BOSMF 55 N�A�P <br /> �/,�'�/Ov/ 5����/ <br /> PLUMBIN6 MECHANICAL <br /> I�' Np, TYPE OF FI%TURE OR�TEM FEE N0. TVPE OF EOUIPMENT FEE <br /> WATER CLOSEi(TOILET) J A�C-A�HNDLG UNITS-H.P <br /> ' ' BATHTUB _ _ �b ; FORCCD AIR SYSTEMS-B T.U. M EA. <br /> LAVAIORV(WASH BASIN) 7 0 � ��^ UNIT HEATERS-B.T.U. M _ <br /> '�I SHOWEF /�� CLOTHES DRVERS <br /> KITCHEN SINN 6 DISP iC VENiILATION FAN <br /> ' t DISHWASHER i 0 T .Z RANGE MOOD _ <br /> LAUNDPV TRAV �YATER HEATER <br /> '�' CLOTHES WASHEq '0 1 _ _ _ _'�v�D STOVE <br /> —1� � <br /> URINAL METAL PIREPLACE 8 CHIMNEV <br /> �1 ; <br /> DRINKING FOUNTAIN FIREPLACE INSERT �_ <br /> ' FLOOR DRAIN _ MEAT PUMP <br /> BAGKFLOYI PREVENTERS GAS PIPING <br /> �' RO�F DRAINS-RAINLEADERS EXHAUST FAN <br /> '� SINN�SERVICF-BAR.ETC.1- � � f, � <br /> � ' / <br /> 1 � _ _ _ _ _ _SU6 TOTAL 5 _ _ Q� I�� __ _ _ SUB TOiAL S _ F� ' - <br /> � PERMIT 5 _ PEPMIT $ <br /> .. - ---- TOTAIFEE E —�- -- - �_ - 10TALFEE S � <br /> FOR OFFICE USE ONLY: — <br /> qFCFIPI NU <br /> fR014GkI4�CN f1E�R5ETMLa r5��f5E1p�Gn �'�����K�;�'j�j ��E � -jL� S 7/`/ f <br /> -L(� ' 2E% � O � Cr <br /> --- — - VALUATION FEE <br /> Us a1c �ot�� �Lp wcua tiin. FEES �—� <br /> z BUII.�ING j/ J✓ / ' �' � ST_ <br /> � _, c <br /> — ..—_"__—'__.. __1-—" . _. - � <br /> IrP[OftON�S�IIOW�&f IvpfOi[UHSII,CIUM n.tur�4o Frniy,��.��.�.�+'� ---'--- . -- <br /> (/ .✓ l N3 PWMAING __ /c _ ._ <br /> SiZEOFBL00 NOOfSTOHifS BASEMCNI MECNANILPL �C/ � �_ <br /> / S 9� rf i ,✓ --- — — <br /> RDOITIONAL PIAN Lh1ECN <br /> OLCUPANGVIO�U FlOES�R1IXlE1i5NE0� N(IGHiUMi��tiON - <br /> �q '✓ �_._ -- --- — � <br /> OTHER <br /> __�__. <br /> �+Fe50rv IOR SnniNq F q5 � .t-P <br /> Si�TE BUILDING SURCHARGE (' __ <br /> -.__—"_______ _—__.'_ <br /> .... _ _____ _ . —_ — — _._ � <br /> wuKem rier�s�rvn�rvtnn. CITYOFEYERETT PUBIICWOPKS .��' � •' <br /> �f, LOCAL SALES <br />— UI IP�Z� TAX CODE IS 3105 roTe� -�5'o I �c <br />