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APPLIC/lTIC 1 FOR CONSTRUCT' 1N PERIV�IT � <br /> TO BE COMPLETED IN BLACK INK—PLEASE PRINT <br /> - - -- <br /> BUILDING DEPARTMENT HEATING SYSTEM: J GAS J ELECTRIC �(J _{�ONG <br /> 259-8010 j <br /> DEMOLITION COMBINATION BSIILDING MECHANICAL PLUMBING ' SIGN <br /> OWNER MNl n[�[�n65 --- (i�-- Zi�--- �-- r���NF. <br /> 771-E ao�i�r� C� . , P.o. (;nx 370� �uj5 �K=iG� .��� ,ri�c��n 4111zy ZGr�-3.1"6� I <br /> iEN�Nt MAR AODRF.SS � GtY ]�� P�iUHE I <br /> ���6 Ps o�,.rniEti-. <br /> PPCNILECTORpE51GNER MRIIRD�RE55 CItY liP PHONF <br /> 1�1/A ` AJn,[a-��w�r3T /NC . ,$n2 E • SPP.AG��� ��o�cH� �u.t A S�i '14�- �53'� -- <br /> ❑CNE�ALCONiR�CTOR MAIt��DRE55 C�iV—{ ZiP PMONE STREUGENSEI <br /> MEGN�NICALCCWiq�GT�R MM��DDRESS CI1V ZIP PMONE 5*QEIICENSEI <br /> PWMBiNGCONiR�GTOR MAII�DORESS COV 21C PNONE STqTELICENSEI <br /> CONTFAGT PRICE Oi WOgK <br /> � l.S � �iV CI <br /> �FSCRiBE WOBN�NO crv�mc vmrer.c iNVOlVEO CONiALT P[H;UN ANO P�qNE MJ <br /> ��n �F� <br /> ibn.,EoK STvP-�-nC G�un.�Aii,i� /^-/�T�.7'�^�,n?�k I 2C6-�1( � <br /> -- -- � ---!-=-- <br /> ._._ - I HERE�V CERTIFV THAT I HAVE READ AND ExAMINED THIS <br /> rnoi�osm us[or puiioMc APPLICATION AND I<NOW THE SAIAE TO BE TqUE AND CORRECT. ALL <br /> %7�OL STv/�-�-�lr PROVISIONS OF LAWS AND Oii�INANCES GOVERNING THIS TVPE OF <br /> uc;nio[scnmraNtsPaovenrr�sHovmiee.u•nonert�:HTwocoriesi WORKWILLBECOMP!ETr-DWITHWHE-iHERSPECIFIEDHEREINOR <br /> NOL THE GRANTING OF A PERM!T DOES NOT PRESUM[ TO GIV[ <br /> inr - eiocK or -------- AUTHORIiY TO VIOLATE OA CAIJCEL THE PROVISIONS OF ANV <br /> OTHEF STAT[ OF�LOCAL LAW REGULATING CONSTRUCTION OR THE <br /> --�— — �- --�-"-� PERFORMANCE OF CCINSTRUCTION.THAT I AM AUTHOR12ED BY THE <br /> OWNER OF' THIS PROPERTV TO PEiRFORM THE WORN FOR WHICH <br /> - APPI.ICATION IS IAADE AND I COMPLV WITH iHE STATE <br /> ��nnC(l TA%I.0 Nl1M0ER CON7 RACTORS LAW 1827 RCW�ND 296200 WAC. <br /> CONSTPUCTION IOAN lFI1DF.R.A�[1RFS5.TELEPMONE NUMOFR n �- / <br /> <irr,� ..l �. l�:✓It,,,./�� .7�y/Jl <br /> PROJECTADDRESS XF.�"- -�--�------ -„-^r�- -- —� <br /> ��00'3 w G ��,.,o Rn 'S�'�-�%U --- --------- - --- <br /> .�;�, <br /> PLUMBING MECFIANICAL <br /> NO. TYPE OF FI%TURE OR ITEM FEE NO. TVPE OF EOUIPMENT FEE <br /> WATER CLOSET(701LET) A C-�A�HNDI.G UNITS--H.P <br /> BATHTUB � FOR';ED AIR SYSTEMS-B.T.U. M E.A. <br /> LAVA?ORV�WASHBASIN) —T UNI7 HEATL'RS-B.T.U. M ; <br /> __— __ ._ T__ <br /> SHOWER CLOiHES JRVERS <br /> KiTCHEN SINK 8 DISP VE�TILAT ON FAN <br /> __ ' -__ _--_r—. <br /> OISHWASHEFi RAIIGE HOCD � <br /> LAUNDRVTRAV WAfER HEATER <br /> CLOTHES WASHER WQOD STOVE <br /> � URINAL ' MI°�AL FlFlEPLACE(WOOD BURNING) � <br /> DRINKING FOUNiAIN FIREPLACE INSERT i <br /> T <br /> FLOOR DRAIN HEAT PUMP <br /> BACKFLOW PREVENTERS GAS PIPING � <br /> ROOFDRAINS-RAINLEAOERS �- E%HAUSTFAN <br /> � SINK(SERVICE-F3AH.ETC.) <br /> ..._. - --_ __—_ —�'-- <br /> _ <br /> _ _ -_ _ i <br /> ._ _. -- —._ -_ _ ..-__ �—. <br /> SUB TOTAL $ SUB TOTAL $ <br /> PERMIT $ —1 PERMIT $ <br /> TOTAL FEE S 70TAL F[E $ <br /> FOR OFFICE USE ONLY: <br /> IROqiSEiBACN fIF�R5F1p4C✓ —r5�0E5Eifl4CN PIAHCHECtNVMOGR IfF H[CHPiNO <br /> �-j l��G_3 <br /> nsi vor+e iorneee vnc�Nrsrte PEES VALUATION FEE <br /> !�I yES NO �uaoiNc <br /> irr�oi r.axst ra or sroaies rc��wxc. wa n r.+,�.,�"��,�; �-- �-- ��-- <br /> �"""° PWMNMG <br /> ✓ - �✓ �-_ _. -r-- <br /> S!!Of BlDO FIRE SPBINNlPRS PEO'D B�SEMFNT M[CHANICAL <br /> 1 60 '.Q F 1 - ' VES '�NO - ---- -- - <br /> OCCOP�NCVL0�0 FIRE�URMRE00 HEIGNiLIMIT�➢ON ADDITIONALPLANCMECK _ / l � L1 <br /> � N � <br /> _ OTHER <br /> W ASJN - � — —T— - <br /> STATf BUILDING SURCIIARGE <br /> —_. _ . _ _-- __--_ _ <br /> ��anKr nv runs v+ovcn i�r CITY OF EVEHETT i�unuc wccvks � <br /> ��lu LOCALSA�.ES � <br /> o,,,� o �� q + ?AR f OOE IS 3105 70TAL '�ZC� {,3C� <br />