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APPLICATIO;� FOR CONSTRUCTI �N PERMIT � <br /> TO BE COMPLETED IN BLACK INK—PLEASE PRINT <br /> BUILDING DEPARTMENT L HEATING SYSTEM_[�GAS IJ ELECTRIC i„J _ � <br /> 259•8810 • <br /> I J DEMOLITION I I COMBINATION I ! BUILDING I I MECHANICAL I I PLUMBING 1 I SIGN � <br /> DYMER MnIL�UDNL55 GIV 11P PNONE � <br /> 3oeir�. �r+�v. PoF�x3�o7����e_���-aao� ,;. <br /> tiNN�t M�ILA00lILSS r.nr m� wia+e — ':� <br /> e�+��o���� 3303 f� ir�S�.�� u,�J <br /> AflC1117ECTONDESIGI�F.11 1AAl1.ADORL55 CiIY (11' PII(NlE �{� <br /> � S:� <br /> GENFMI.CONIMf.TOB IAuI�UUNi'SS -'– - "� --....f,lrv— ---�II' ""-��(N1��'-'---SIAELH:CNSC• ;�' <br /> (.umpka� InC Ilva�- �`��cqkP AvP•t, �actf It 9 /Da �. s� <br /> MEG'�VIN;µ�pNTRAC70R M�IL�WNFSS CIIV ZIP p11pNE STAIEIICEN5E1 <br /> Mc,�+�stn, ('A, no.e�,c a�1�r�� ��It , --��2-.�.�i I Mc�N� 3'�aN�6 � <br /> --- , <br /> %U►101N0 fAlll CTOfi MAL�ODf1C5: CIIY ZIP PIIONC SiPiL LICENSE� � ':�i <br /> 14 l�v <br /> CONTMCT PflIL OF VA{IK -- – j�v�"�� <br /> O�J 'r�i� <br /> � DE6CRIBEW011KM/DSq1A11EFO07�0E1NVOLVED v'� �I I�r C(NlT�CTPEI150N�NDPIqNENO. � • �'�'�'� <br /> : <br /> � '�� <br /> — a3 heads �-(��t-3311 x-�� l�l '� <br /> i _ I HEHEBY CERTIFY THAT I HAVE flEAD AND E%AMINED THIS � <br /> � PIqPOSED USE OF BUILUINO APpUCATION AND HNOW THE SAME TO BE TRUE AND CORRECT.ALL � �:`r� <br /> � PqOVISIONS OF LAWS AND ORDINANCES GOVEflNING THIS TVPE Of . � <br /> LEdLLDESCPIPTpNOiP11q'ERTV}SNOWNBLLOWOR�T7�C11(WOGOPIf51 WORK WILL BE COMPLETED WITH WHEiHEF SPECIFIED HEREIN OR <br /> NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br /> f ��T �� � -- AUTHORITY TO VIOLATE OR CANCBL THE PROVISIONS OF ANY <br /> I _ _ _ _ OTHER STATE OR LOCAL LAW RE6ULATING CONSTRUCTION OR THE <br /> � , PERFORMANCE OF CONSTRUCTION.THAT I AM AUTHORIZED BY THE . <br /> . OWN@q OF THIS PROPERTY TO PEflFOHM THE WORK FOR WHICH ��.. <br /> � ' --- APPLICATION IS MADE AND •I COMPLY WITH THE STATE <br /> P�RCEL TA%I D.NUMBEN CONTRACTORS LAW 1827 RCW AND 296200 WAC. <br /> CON61qUCTION LWH LENDEfI,�WD11E55.TEIEPNJNE NU'AOEF <br /> PIIO.IECT ADOREBS , /,� �� sK:x. �' _ D�B ` �L <br /> '�l- �LnB� W <br /> CIIYIII)SWFSSlCtNS[Iq <br /> PLINMMKI MECHANICAL <br /> . N0. TYPE OF FlIITURE OR ITEM FEE NO. TYPE OF E�UIPMENT FEE <br /> _ WATER CLOSET(TOIIET) � A�C-AMNDLG UNITS-�H.P. T� <br /> ��, BATHTUB FORCEDAIRSYSTEMS-B.T.U. M E.A. � <br /> LAVATORY(WASH BASIN) � UNIT HEATERS-B.T.U. M <br /> I SHOWER CLOTHES DRVEFS -�— <br /> � KITCHEN SINK E DISP VENTILATION FAN ' <br /> i DISHWASHER pANGE HOOD ---� <br /> i IAUNDRY TRAY ___ ; WATER HEATER <br /> ' CLOTHES WASHER � WOOD STOVE ; <br /> URINAI METAL FIREPLACE(WOOD BURNING) —�— <br /> DRINKING FOUNTAIN � FIHEPLACE INSERT ; <br /> FLOOq DRAIN �— I1EAT PUMP � <br /> BACKFLOW PREVENTERS ; GAS PIPING � <br /> ROOF DRAINS--RAINLEADERS � [XHAUST FAN —T <br /> SINK(SERVICE-BAq,ETC.) <br /> � --- --- � <br /> - — � — --'— <br /> - — — --- ; <br /> � <br /> SUB TOTAL S ; SUB TOTAL 5 ' <br /> PERM�T S PERMIT S � <br /> � TOTAL FEE S ' TOTAL FEE S � <br /> � FOR OFFICE USE ONLY: <br /> ! <br /> ' FIqNTbETBACN REAflSE�WGN SIDBSFTWCN VLNICIIE NU 1 iEE OE I NO <br /> t ✓� �� 3/� . <br /> p useza+e �ornau vncu�rsrtr. FEES VALUATION FEE <br /> f) YES I.7 NO BUILDING � <br /> � lYPFOiCpISf ND.OFSTqiIES ocfi+NN[r �qaUwllln�tUMns <br /> �� ` �� PLUMOING _ <br /> � <br /> i <br /> BRE OF BLDO. FI11E SPBINNLE11517E0'0 OASEMENT MECNANICAL <br />� . f 1 YES (l NO - - <br /> . OCCUP/Nf.YLOAD FI PYPEO'0 �IEIGNTLIMIIATION ADOITIONA�PLANCHECK <br /> t <br /> � _ – OTHER ' <br /> ��i' REA60N --� <br /> � STATE BUIIDW(i SURCHARGL' i <br /> � WtN(EOV %AlI5APP1i0VEDIIV CITYOFEYERETT PUOLICWOqHS � <br /> �I LOCAL SALES <br /> ue,� ZZ TAX CODE IS 3105 TOTAL I <br />