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r w APPLICATION FOR CONSTRUCTI�N PERMIT <br /> 1 TO BE COmPLETED IN BLACK INK—PLEASE NRIN. � <br /> G� <br /> HEATING SYSTEM: U GAS ❑ELECTRIC ❑ _� <br /> BUILDING DEPAR7MENT <br /> 259•8810 <br /> I DEMOLITION I I COMBINATION I � BUILDING ��ECHANICAL I i PLUMBINO � ' SIGN <br /> OYME M�IL�DDHESS GTY ZIF PHONF <br /> /�o�ln/C_ Go�a�D.9i-� I� �7��"��. -.�" --- ---- <br /> T�i�i M1111 DNE55 CIiY IIP PHONE <br /> ARCNITECTORDE516NER M�IL�DORE55 CIiV 21P P110NE <br /> OENERALCONiRICTOR M�IL�DDRE55 GTY 21P PNONE STATEIICENSE� <br /> � • l�,�j�i,/ �+.,,,, L12�1-'77` ZW6 -Gcvc� . <br /> �.��...��.�+ <br /> MECNANIC L CONIMCfOR MIII A��R 5 f.1iV ZIP P11JNE SU1E IICENSE� <br /> �'�/NN[ZC. `l�� aTf7�:•,c/ a�F�� 3SS.3h// Gei.w.,�`P�37cF <br /> PLl1N01NOCONTR�GTOR M�ILADDRE55 d7Y IIP P110NE 5TATElICENSE� <br /> CLASS 0�WONN <br /> �EW I I ADDITION I I ALTcHATION i I REPAIR I �� DEMOLITION � I WOODSTOVE/FRPL INSERT I I BUILDIN6 RELOCATION <br /> ��.c..�� � CONT/�T PERSON�NO PHONE NO <br /> CONiR�CTPqICEOFWO{IN -/� . _ �(kC��b`� ����..C�-� 3SS-36/� <br /> DESCRIBE WONN 11NO6dlARE FOOTAGE IN VEC <br /> J-� ' <br /> PROPOSEUUSEOFBURDING i HEREBV CERTIFY THPT I HAVE RISAD AND E%AMINED THIS <br /> � C, APPLICATION AND KNOW THE SAME TO BE TFiUE AND CORRECT.ALL <br /> LEOALDE CRIPTIONOFPROPERtt�SHOWNBELOwORATT�CHiWFf:OPIES� PROVI310NSOFLAWSANDORDINANCESGOVERNINGTH�STVPEOF <br /> ��-- WORK WILL BE COMPLETED WITH WHETHER SPECIFIEO HEREIN OH <br /> �ot oF N07. THE GFA�TIWG OF A PERMIT DOES NOT PRESUME TO GIVE <br /> AUTHOPITV TO VIOLATE OR CANCEL THE PROVISIONS OF ANV <br /> �J OTHEH S�ATE OR LOCAL U1W REGULATING CONSTRUCTION OR THE <br /> PCRFORMANCE OF CONSTRUCTION.7HAT I AM AUTHORI2ED BV THE <br /> OWNER OF THIS PIiOPERTV TO PERFORM THE WORK FOR WHICH <br /> APPLICATION IS MADE AND I COMPLV WITH THE STATE <br /> CONTRACTORS LAW 1027 RCW AND 296.200 WAC. <br /> �- <br /> �2 -� -- ��k�.�;, 7-7-9 -� <br /> P �DflE88 /J 5qx�mNE U��F <br /> QC�� %O� LItYlUSMFBSI�CfMS[M1O <br /> PLUMBINO MECHANICAL <br /> N0. TVPE OP fl1(TURE OR ITEM FEE NO. TVPE OF EOUIPMENT FEE <br /> WAl'ER CLOSET(TOILET) A/C—A/HNDLG UNITS—H.P. � <br /> BATHTUB ' FORCED AIR SYSTEMS—B.T.U. M E.A. � <br /> LAVATORY(WASH BASIN) � UNIT HEATERS—B.T.U. M ' <br /> SHOWER ' CLOTHES DRYEPS �_ <br /> 1 <br /> KITCHEN SINK 8 DISP ; VENTILATION FAN ; <br /> DISHWASHEF � RANGE HOOD <br /> LAUNDRV TRAV ; WATER HEATER <br /> CLOTHES WASHER � WOODSTOVE <br /> URINAL METAL fIREPLACE 8 CHIMNEV � <br /> DFINKING FOUNTAIN � FIREPLACE INSERT � <br /> FLO�R 07AIN � HEAT PI�MP ! � <br /> BACKFIOW PHEVENTERS ; GAS PIPING ; <br /> RC10F DRAINS—RAINLEADERS � EXHAUST FAN � <br /> SINK(SERVICE—BAR,ETC.) ; <br /> � � //L-AD <br /> ' S ,vd iv�J ' <br /> -- � � <br /> SUB TOTAL S 1 SUB TOTAL S ' <br /> PERMIT S � PEPMIT S <br /> TOTAL FEE $ TOTAL FEE S � <br /> FOR OFFICE USE ONLY: <br /> FRONT 6EiB�CN RE�N 6ETBALN SIDE SETB�CN PLAN CHECN NUMBEII FEE RECE�Pi NO I <br /> USE 20NE l0T AREA vec�Nr sire FEES VALUATION FEE I <br /> BUILOING � <br /> IYPE Of tON15.ALLOWABIE tYPF 01 CON51.�LIUU �W�r MU u VM��wG�m'�s — i <br /> �"dO � PLUMBINO <br /> SREOFBl00 NOOF6fORIES BASEMENT MECHANICAL � <br />� ocCUPu�Cr ioeD FIRE SPRNKLENS RE00 HEIAHi LIMIUTION MDDITIONAL PUN CNECK i � I <br /> i — <br /> SPRINKIER ' <br /> REASON FOR SPRINNLERS � <br /> STAiE BUILDINl3 SURCH�RGE i '' <br /> MT/MEBY PU�NS PPOVEDBY CITY OF EYEflETT PUBLIC WORKS i <br /> �h LOCIIL SALES <br /> � TAl(CODE IS 3105 roT�� 3 ; � , <br />