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��. <br /> APPLICATIC��l FOR CONSTRUCT"�)N PERMIT � <br /> TO BE COMPLETED IN BLACK INK—PLEASE PRINT <br /> HEATING SYSTEM: U GAS ❑ELECTRIC � �TWO� 'a � <br /> BUILDING DEPARTMENT <br /> 259•8810 <br /> ❑ DEMOLITION CI COMBINATION ❑ BUILDING I�MECHANICAL I J PLUMBING ❑ SIGN <br /> OMMEH MAR�DOREfiS CITV 21P PIpNE <br /> $oE�n� �o . 3ao3 w. cs�s�No ko_ Ev�67'r w�4 9�204 <br /> TEIUNi M�0.AW11C65 CITY IIP VIIONE <br /> 5A-rv�6 <br /> -,YNWN�M�/lRDESIGNEfl MI�LAUDNEbS GiY 21P PHONE <br /> N1 L�'�N�.TGL� �.O I _ <br /> 6ENEMLCONTMCT011 ��DD�S �� J,! s. ��,tr/,�' 2�u.� �n/� '�=.'�IISTAT�E���373ND <br /> rvit�KiNSTP�y MT/ �i% Cl <br /> �'{'�G/✓�NL�(,� ����Qaq� �"V'7V� 5��� ���a� PIqNE ST�TELICENSEI <br /> PLUMBWOGONTRACTON WKMOIlE65 GITY 2IP P1qNE 6TATELICENSE� <br /> CONTMCTPRILEOFWORN � I,^,DOD <br /> 7v <br /> OEBCi118E Wpll(N10 SOUARE FOOTA6E INVOLVED p�.Ob �� J/ GONT� �PSON ANO P �/�.1 D�Cµ .Z� '�(.JZ�33�� <br /> O <br /> FkW au�ST CBtLE�-T10J 5�(� <br /> IN <br /> I HEHEBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br /> vnoroseouseoFeu�owo APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT.ALL <br /> PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TVPE OF .�,� <br /> LEd40E6CPIPT10NOFPROPERTV�61qWNBELOWOi1ATT/iCNiYIOfAPiE6� WORK WILL BE COMPLETED WITH WHETHER SPECIFIEU HEREIN OR ,1�; <br /> NOT. THE GflANTING OF A PERMIT DOES NOT PRESUME TO fiIVE �,t,�. <br /> �or e�acK � AUTHORITV TO VIOLATE OR CANCEL THE PROVISIONS OF ANY �� <br /> OTHER STATE OR LOCAL LAW HEGULATING CONSTRUCTION OR THE <br /> PERFORMANCE OF CONSTRUCTION.THAT I AM AUTHORIZED BY THE � <br /> OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH . <br /> APPLICATION IS AOE AND I COMPLY WITH THE STATE � <br /> PIWCEI TA%I.D.NUAIBER �ONTRACTORS LA ,18.27 RCW AND 296200 WAC. <br /> t,bi. do•31 oD 3 W, c��Nv Ra io�2��9�4 ° <br /> PR0.IECTADDRESS Tr �� wa ��������, <br /> � cnr as�rsHSEw E'� <br /> .:a <br /> p�����p MECHANICAL � � ;;� <br /> Np, TYPE OF FlXTURE OR ITEM FEE N0. TVPE OF EOUIPMENT FEE � ��e+� <br /> WATER CLOSET(TOIIET) � A/�A/HNOLG UNITS—H.P. � :1 <br /> BATHTUB ' FORCED AIR SYSTEMS—B.T.U. M E.A. ' � <br /> .I <br /> UVATORY(WASH BASIN) � UNIT HEA7ERS—B.T.U. M � �};; <br /> SHOWER ' CLOTHES DRYERS ' t; <br /> KITCHEN SINK 8 DISP � � VENTILATION FAN � <br /> � DISHWASHER � RANGE HOOD � <br /> LAUNDRYTRAV ; WATER HEATER ' " <br /> CLOTHES WASHER � WOOD STOVE � <br /> URINAL ' METAL FIREPLACE(WOOD BURNING) ' <br /> DRINKIN6 FOUNTAIN � FIREPLACE INSERT � <br /> FLOOH DRAIN <br /> � HEAT PUMP ' <br /> BACKFLOW PREVENTERS ; GAS PIPING � <br /> p00F DRAINS—RAINLEADERS � EXHAUST FAN � <br /> SINK(SERVICE—BAR,ETC.) � �` � <br /> � <br /> � ' <br /> � ' <br /> � ' <br /> � ' <br /> SUB TOTAL S ' SUB TOTAL S ' <br /> PERMIT S � PEHMIT S � <br /> TOTALFEE S ' TOTALFEE S ' <br /> FOR OFFICE USE ONLY: <br /> Ff10NT6ET&1CK REM6ETBACK SIOESETBAGN PIANCHECKNIlMOER FEE RECE�PTIq. <br /> ���"7 C <br /> ur�ia+e �orut� VAGANT6ITE FEES VALUATION FEE <br /> CI YES f7 NO OUILDINO J �u� ' <br /> rvrcacoxsc �+o.oFsroa�s «c�w�c� waunwxcwns � <br /> . �"'� PLUMBING � <br /> 512EOiBl00. FIRE6PRWKLEHSNEO'0 BASEYENT � <br /> MECHANICAL ' <br /> ❑ YES CI NO � <br /> pLCUpAN%YLW1D FIREILLARMREO'0 HEIGNiLWITATION ADDITIONALPLANCHECN i <br /> i <br /> OTHER i <br /> flEA50N � <br /> SiATE OUILDING SURCHAHGE � <br /> WTAICEBY PUNSAPROVEDBY CITYOFEVEflETT aueucwoRKs i <br /> �� LOCAL SALES � <br /> o„ m TAX COOE IS 3105 TOTAL , <br />