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+ <br /> e <br /> x <br /> APPLICATI�I.`��1 FOR CONSTRUC7�ON PERMIT <br /> TO BE COMPLETED IN BLACK INK—PLEASE PRINT �' <br /> BUILDING DEPARTMENT HEATING SYSTEM: ❑GAS ❑ELECTRIC I] <br /> 259•8810 <br /> I I DEMOLITION I_I COMBINATION i l BUILDING IJ MECHANICAL �PLUMBING 1:1 SIGN <br /> � OWNEfl MAILAU�flESS CITV ZIP PHONE <br /> S\N\ '(�1'f�F��-'rS �'ZC; C-�Yr��,y�_ ` `i'���l�3 35S 521� <br /> .. ( TE AD �' IP O3 PHONE ��� "IZ1 <br /> � YYI� r r l� '�H�P �_\ c�2�S-c s'�03 �5�� ��Lo3 <br /> ARCHITECTORDESIGNEF MAILAD�RESS CITV PHONE <br /> � GEIJERALCONTRACTOF MAILA�DRESS CITY ZIP PHONE STATELICENSEP <br /> � MECHANICFLCONTflAGTOR MAILADDRESS CIN ZIP PHONE STATEUCENSEa <br /> PLUMBINGCONTRACTOfi M�ILADDRESS CITV ZIP PHONE STATELICENSEp <br /> � C SSOFWOpK <br /> ❑ NEW I_I ADDITION iK ALTERATION I. I REPAIR I 1 DEMOLITION I. I WOODSTOVE/FRPL INSERT I 7 BUILDING RELOCATION <br /> CO CyTp TFERSON�PHONENO. ���f "^�� <br /> CONTRACT PRICE OF WOFK <br /> Jvi� ca� o�i <br /> DESCRIBE WORK AND SOUAFIE FOOTPGE INVOLVED <br /> �.� <br /> � OPOSEDUSEOFBl11LDING i HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br /> � �p-0 n�� APPLICATIOIJ AND KNOW THE SAME TO BE TRUE AND CORRECT.ALL <br /> GAL DESCHIPTION OF PROPER �SNow ELOW ORATfACH FOIIR GOPIES) PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br /> WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br /> �oT BLOCK oF _ NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br /> AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br /> OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br /> PERFORMANCE Or CONSTRUCTION.THAT I AM AUTHORIZED BY THE <br /> � OWNER OF THIS PROPERTY TO PEFFORM THE WORK FOR WHICH <br /> �- APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> CONTRACTORS LAW 18.27 RCW AND 296200 WAC. <br /> �%���� � '2 � I`i2 <br /> PRQuIEC�T jADDRE55 — � (�(y�� GHniUn[ oAiE <br /> S�vJ �E��`�,�.1 W�Y�'� {�Vv�c��• LQW� LILYOt151NE55LICENSENO <br /> . PLUMBING MECHANICAL <br /> NO. TYPE OF FI%TURE OR ITEM FEE N0. TYPE OF EOUIPMENT FEE <br /> . WATER CLOSET(TOILET) � A/�AIHNDLG UNITS—H.P. � <br /> � BATHTUB ; � FOFiCED AIR SYSTEMS—B.T.U. M E.A. _ <br /> � LAVATORY(WASH BASIN) � UNIT HEATERS—B.T.U. M I . <br /> � SHOWEfl ' CLOTHES DRYERS � <br /> � KITCHEN SINK&DISP VENTILATION FAN ; <br /> - DISHWASHER RANGE HOOD <br /> � . LAUNDRYTRAY ; WATER HEATER <br /> � CLOTHES WASHEfl � WOOD STOVE i <br /> URINAL ; METAL FIREPLACE 8 CHIMNEY � <br /> �, DRINKING FOUNTAIP' I FIREPLACE INSERT I <br /> � FLOOR DFl^!N � HEAT PUMP � <br /> BACY.rLOW PREVENTERS ; GAS PIPING . �� <br /> ; <br /> '. ROOF DRAINS--RAINLEADERS � EXHAUST FAN � <br /> - SINK(SERVICE—BAR,ETC.) �d0 � <br /> � <br /> � � <br /> � � <br /> � � <br /> SUBTOTAL S ;�� SUBTOTAL 5 ; <br /> - PERMIT $ /Q �Ov PERMIT S � <br /> TOTAL FEE $ / �OG TOTAL FEE $ ' <br /> FOR OFFICE USE ONLY: <br /> FRONTSETBACK REARSETBACN SIDESF.TBACK PLANCHECKNU�� FEE flECEIPTNO. <br /> USEZONE LOTAREA VACANTSITE EES VALUATION FEE <br /> BUILDING � <br /> fVPEOiCONiS.ALLOWABLE TYPEOFCONST.GLiUAL o[CVVANtv Im.oFDwFIuxGUrms i <br /> cnour � pLUMBING �� iGo <br /> SIZEOFBLOG. NO.OFSTORIES dASEMENT MECHANICAL � <br /> OCCUPANCY LOAO FIFE SPRNKLERS flE0'D HEIGMT LIMITATION ADDITIONAL PLAN CHECK i <br /> i <br /> SPRINKLER � <br /> REASONfOPSPflINKLEFS <br /> STATE BUILDING SURCHAFiGE � <br /> INTFKEBV PLANSAPPROVEODY CITYOFEUERETT PUBLICWOflKS � <br /> LOCALSALES � <br /> TAX CODE IS 3105 rorn� ��oa <br />