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^ �P� APPLICATION FOR CONSTRUCTI�..�1 PERMIT <br /> TO BE COMPLETED IN BLACK INK—PLEASE PRINT � <br /> HEATING SYSTEM: U GAS O ELECTRIC ❑ <br /> BUILOING DEPARTMENT <br /> 259-8810 <br /> ❑ DEMOLITION ❑ COMBINATION �BUILDINa ❑MECHANICAL ❑PLUM8IN(i ❑ SION <br /> �p �,�E� cm zro � <br /> 7,c�r goEi,uy co , � 0 6ox 3707, M�s ��-7� SE,4� w/}• 9R�2� 3�z-s��P <br /> �� µ� � cm aI <br /> OE'/N CO . <br /> u�rtecranoes�n wti�ooncss cm n► �anE <br /> �OCKw00p aG`-CENG� <br /> oer�wucoNm�cron wu�ooaees cm ar nanE'2�-. a�o er�reucEnee� <br /> carosrtiuoris,✓ yeo i�oPLi� R ��'./I �F. � ��ar�:� l^il� . 9Nri�1 231_v( B/LuG(f�«`f�D'� <br /> ����� yµ E� cm zw vNor� et�h tur�� <br /> v�wNnca�m�c�on wt�ooaees cm m v� sr�re��ee� <br /> a a wauc <br /> NEW ❑ ADDRION ❑ ALTERATION ❑ REPAIH CI DEMOLITION ❑ WOODSTOVFJFHPL INSERT U BUILDIN6 RELOCATION <br /> CONfACT iEH80N�ND PIIONE N0. <br /> cwrwic�m�awarc �O n�j-) (90G LL ��N E�'+7 2 C <br /> �.�.���.��T���o ► �G b -31-6 3 <br /> �-�- <br /> (�4NJ/f/Iw/ /f � 'd.?•f�J�B / K + <br /> rnovaeeoueEasu�oNo i HEREBV CERTIFY THA7 I HAVE READ AND E%AMiNED THIS <br /> C(.6R�+ 56At. � f3i�M`/GO�G/LAS/�'� Ca.vT�.aL APPLICATION AND KNOW TriE SAME TO BE TRUE AND CORRECT.ALL <br /> ������'��1 �����n����s� PROVISIONS OF LAWS AND ORDINANCES OOVERNINO THIS TVPE OF <br /> WpRK WILL BE COMPLETEO WITH WHETHER SPECIFIED HEHEIN OR <br /> � kapc a NOT. THE 6RANTIN4 OF A PERMIT DOEB NOT PRESUME TO OIVE <br /> AUTHORITY TO VIOLATE OR CANCEL THE PROVI610NS OF ANY <br /> OTMER STATE OR LOCAL LAW RE4ULATINO CONSTRUCTION OR THE <br /> PeRFORMANCE OF CONSTRUCTION.THAT I AM AUTHORIZEO BY THE <br /> OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WNICM <br /> APPLICATION �S MADE AND I COMPLY WITH THE 6TATE <br /> CONTMCTORS LAW 78.27 RCW AND 298.200 WAC. <br /> x �L.�..�.,1 � /��.,��,...f-��' S�y�y <br /> a� <br /> na�cr,ounEa <br /> 3 W. C�ts��vo �/�-37 �..�,....�..,� <br /> nurwo ' rEc��wc� <br /> N0. ME OF fIIITINIE OII rtEM FEE N0. TYrE OF EOUNIIEqT � <br /> WATER CLOSET(TdLET) � A�C-AMNDL6 UNRS-H.P. ' <br /> �TM� � FORCED AIR SYSTEMS-B.T.U. M EJ1. ' <br /> UVATORV(1NASH BAB�N) � UNIT HEATERS-B.tU. M � <br /> $�Ep � CLOTNES DRYERS ' <br /> KITCHEN S�NK S DISP ' �E����F� � <br /> DISMWASMEN � RANf�E HOOD ' <br /> LAUNpRYTRAY ; WATER HEATER � <br /> CLOTHES WASHER � WOOD STOVE ' <br /> �p�� � METAL FIREPLACE i CHIMNEY ' <br /> pp�►N(INp FOUNTAI � FIREPLACE INSERT ' <br /> FLOOR DRAIN � HEAT PUMP � <br /> BACKFLOW P ENTERS ; 6AS PIPING <br /> ROOF DRAI INLEADERS � EXHAUST FAN ' <br /> SINK(SE ICE-BAfi,ETC.) � ; <br /> � � <br /> � SUBTOTAL f ' <br /> SUB TOTAL S � PERMIT t <br /> PERMIT t � TOTAL FEE 3 ' I <br /> TO?ALFEE i � <br /> Fon o�ce use a+�r: ,����,„,. <br /> REIJiBEtMC1! BIOEBEiMCM RANCNECI(MJ1AlER iEE <br /> F�.� :36 s� � <br /> wcurtsrt¢ FEE8 VALUAf10N � <br /> ueEmr� aT� � <br /> euaon+a o G99 000 � 9 3 9 ' <br /> wao+n�rum ' �' <br /> 7rIE0�CON16.�e TYIEO�WN51.�C7WL aa�'`' . � . <br /> // _ N /I- N _ rwMairw ' '�� <br /> � <br /> e�a rua. �a.a �s e���+T MECHANICAL ' 'j <br /> /� 8 i SQ.Fr. �S �,�puNCHECK a� 9�0 � � � <br /> �yip fpiE BPRNKlER6 REOD NEqMT LMITATION � ' <br /> LIQC7H�. A �� SPRINNLER � �, <br /> i <br /> ����E� STATE BUILDING SURCHARQE i Sa � <br /> Co� ' <br /> wnu�er v�ws� oer CITYOFEVERETf PUBLICWORNS � <br /> LOCAL SALES 7p/ 855� �G 8 <br /> TAX CODEIS 3106 TOTAL <br /> ._— � <br />