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APPLICATIC l FOR CONSTRUC? �N PERMIT �i <br /> TO BE COMPLETED IN BLACK INK—PLEASE PRINT ����''t�� <br /> HEAiWG SYSTEM�. J C;AS J EI EC fRIC J � <br /> BUI�DINGDEh'AHIPJE.NI �-�� � - �----- - -� - � - -- � <br /> 259-8R10 <br /> : � PLUMBING SIGN <br /> --- � - .. , .�;�,... -� ,�. �:- - --- ------ ._ . _---�- � <br /> DEMOLITION COMBINATION BUILDING MECHA <br /> ., .n, . .�. . . ��x:� <br /> 6'..s/rdf�� N�'tl+Civ NrP ot 90� q�+l� E�E,w..tT 9810/ 206 - �t,f9 96Y6 <br /> .�.�qr 11�t.. . .�� PNONE � <br /> s�vnat /.�J A6n..d ----- -- — <br /> � .:wiF:.tJRlc+r..,. ��,�. �.. +. JIiV 4P PHONE <br /> �"�" �� . �LFiAICONiqq�vOn ��- MAIL4U�HESa ���_� CITV ZIP PHONF. STATEL�rENSE4 <br /> .� <br /> [� /.������'t-� <br /> Q�� '.�tinrlNICRL CONTHACTOA MMl ApORE55 QTY ZIP PHONE STAiE LICENSE N • <br /> 9 M-1 <br /> H C/� ` <br /> ['� 'xy '..MBIN6CONTPACTOR MAi�ADDRE55 GTV ZiP PHONE STPTELICENSEx . <br /> H Z3 I <br /> K y� .>i50F WORN <br /> p� H p� NEW ADDITION �ALTERATION REPAIF DEMO�ITION WOODSTOVBFRPL INSERT BUILDWG RELOCATION i <br /> ��„� _ CONtACT YERSON�W D PHONE NO p <br /> � _� _ONiFACiPRICEOFWOflH `J ` VV.f //Vl /��'��k�/�/�� Z�6 ��` �/ 9sY6 ��. <br /> p JESGPIBE WORN FND S�UARE k;;�iqGc INVOLV W <br /> p ry+d ADO Twe offic�c ; Go4FRtiNc! R.e--. �� <br /> � �O PaoroseooseoFaui�oiNc , i HEREBV CERTIFY THAT I HAVE READ AND EXAMWED THIS : <br /> O t <br /> p• O ��p , O{F�C�! FeR S4,p]' O fl-1/'1'T��hJ APPLICATION AND KNOW THE SAME TO 8E TRCE AN�CORRECT ALL . <br /> H '-' - PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TVPE OF <br /> .fGAI OESCBIP*L'\OF PROPERtV�SNOWN BELOW OF PttACM�]UR GOPIES) <br /> H <br /> WORK WILL BE COMPLETED WITH WHEIHER SPECIFlED HEREIN OR <br /> �.9. y z , eiocrc o� _ . NOT THE GRANTING OF A PERMIT DOES NOT FRESUME TO GNE <br /> � y�'7 AUTHORITY TO V�OLATE OR CANCEL THE PFOVISIONS OF ANV � . <br /> H OTHER STATE OR LOCAL LAW REGULATING GONSTFUCTION OR THE <br /> ("] �U1 PERFORMANCE OF CONSTRUCTION.7HAT I AM AUTHORIZED BV THE ��, <br /> OWNER OF THIS PROPERTY -i0 PERFORM THE WORK FOR WHICH <br /> � [rsJ APPUCATION IS MADE AND I �OMPLV WITH THE STATE <br /> y HO� WNTRACTORS LAW 1827 RCW AND 296200 WAC. <br /> x �(oR �'"`�(aa��w- !(- 30-9.2 <br /> �4wE�l aDDn[SS '7 (� scrlAJae o��`- . <br /> I <br /> G y� G� J� 1YBJSNE59LILENSE�O � <br /> PLUMBING MECHANICAL <br /> NC. TVPE Of FI%TURE OR ITEM FEE NO. TVPE OF EOUIPMENT FEE <br /> WATER CLOSET�TOILET) A,C—AlHNDLG UNITS—H.P. � <br /> �_ _� — — <br /> 6ATHTUB FORCED AIR SVSTEMS—B.T.U. M EA. <br /> _ � LAVATORV(WASH BASIN) UNIT HEATERS-8 T.U. M <br /> SHOWER CLOTHES DRVEFS <br /> � .� KITCHEN SINK 8 DISP VENTI�ATION FAN � <br /> . � DISHWASHER RANGEHOOD <br /> LAUNDRVTRAV WATER HEATER ' <br /> CLOTHES WASHER WOODSTOVE <br /> �g '' URINAL _ METAL FIREPLACE 3 CHIMNEY <br /> ` � DRINKING FOUNTAM RREPLACE INSERT <br /> FLOOR DRAIN HFAT PUMP <br /> i�- � BACKFLOW PREVENTERS _ _ GAS PIPING . <br /> d. � ROOF DRAINS—RAINLEADERS _ EXHAUST FAN <br /> SINK(SERVICE—BAR ETC.) � <br /> �, � — —' <br /> SUB TOTAL $ ' SUB TOTAL $ <br /> �.,,a, � PERMIT $ PERMIT $ <br /> �� TOTALFEE $ � � <br /> �- TOfALFEE S <br /> FOR OFFICE USE ONLY: <br /> - ---.. .--- -.____-- —_. _ -- — <br /> FqOMT5ET2p4v � RE/�RSFiBACK SIDESETBALN PLANCNECFNUMBER FEE A6GEiPTNO <br /> .3 ' �- 3 <br /> L,ezoNe �ornaen vncnNrsire FEES VALUA710N FE€ <br /> BUILDING �-,�%•'" 7�- <br /> '�PEOFLOMS.PI10WA9LF iVGEOFCONSIqCIUAI accua+nc+ xaorowewueuNi�S - - i <br /> r,noiin PLUMBING � <br /> SiJc.pFBLOG. NOOFSTOPIES BFSEMENi MECHANIGAL 'I <br /> OLCUPANCVLOAO FlRESPRNNLERSREOD H[iGHTUMIiALON ADDITIDNALPLANCHECK � <br /> ��� �� �� � .. . - � �iA�F�B�UII�[;IN6 SURCHARFE _ _ _ _ � � <br /> FlfASON FOP 5GRINNLERS I, <br /> rtIfAKF1�I �PI.�SFPPR(1VCDF,V � � I I <br /> CITY OF EYERETT i�u�uc wor�Ks <br /> ��,_ LOCAI SALES � <br /> ! TAX LODE IS 3105 To*A� , , , <br />