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APPLICATI�1 FOR CONSTRUC'I�N PERMIT � <br /> TO BE COMPLETED IN BLACK INK—PLEASE PRINT <br /> BUILDING DEPARTMENT HEATING SYSTEM: � AS ❑ELECTRIC ❑ <br /> 259�8810 <br /> '�, �� DEMOUTION I ! COMBINATION x BUILDING i I MECHANICAL ❑PLUMBING ❑ SIGN <br /> ownca w,n�oon[ss ci*r ziv Horve <br /> D �l�,iQ.¢� 4�.i -�r.a� � 9R��as9- s9o� <br /> ,Fll„��- �,• ,� oi9 i5 �vl�`�= St ��z c� `3�53- os3 / <br /> m�ne*ecr�mesim�¢n Mniinooaess cirv z�v v�ar+e <br /> �1 <br /> GCNEBM1LC(Ai1P>GiOf1 MRILAppPE55 CItV IIP PNONE SiR1ELIGENSE• <br /> � <br /> ME/C/1n/�R�NIGLCONi9ACiOP RIAILFO�PE55 LIIY 21P PNON[ SiFTELILENSE� <br /> f Ht�� <br /> PIVMpMGCONINACIOR 'MIIRDORE55 CIIY 21P VIIONE SLAIELICENSEI <br /> CONiM�1 PPI� OF Wp{IN <br /> GSv� �/ G:>J <br /> D[SCIiYf WORM AND SOURflE 1�t LE MYMV[U LONiALi PEPSON I.tID I'HONE NO <br /> � .� ,C�u� sa - ��3 <br /> i HEflEBV CERTIFY THAT I HAVE READ AND E%AMINED THIS <br /> vi�ovoseo use eF emmwe APPLICATION AND KNOW THE SAME TO BE TRUE ARD CORRECT.HLL <br /> S�J✓ �ROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br /> iecni oeseruarrorvocaaovearvis�wwneewwonnrrnonwoeowesi WOPK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br /> io* o�aK o� NOT.THE GRANTING OF A PERMI7 DOES NOT PFESUME TO GIVE <br /> Al1THORITV TO VIOLATE OR CANCEL THE PROVISIONS OF ANV <br /> S��Jc,�'p a�'.� OTHER STATE OR LOCAL LAW FEGb�ATING CONSTPUCTION OR THE <br /> "�`�' PERFORAIANCE OF CONSTRUCTION.TMAT 1 AM AUTHORIZE�BV THE <br /> OWNER OF THIS PROPERTV TO PERFORM THE WORK FOR WHICH <br /> APPLICATION IS MADE AND I COMPLV WITH THE STATE <br /> vnncei ux i o rmMeea CONTRACTORS LAW 1827 RCW AND 296200 WAC. <br /> LONSLRpCipNlOA9lENCEfl.AppFE55.iELEPNONENOMBER • / <br /> PflOJECTADUfl SS / s���n�� onC /�—�� <br /> � <br /> �/'— -fl.^< / .zJ �,�.w�sr«„<„•:,�� <br /> PLUMBING MECHANICAL <br /> NO. TVPEOFFI%TUREOfiITEM FEE NO. TYPEOFEOUIPMENT FEE <br /> WATER CLOSET�TOILET) A�C—A'H40LG UNITS—H.P. <br /> BATHTUB FORCEGAIRSYSTEMS—B.LU. M E.i.. <br /> IAVATORY�WASHBASIN� UNITHEATERS—B.T.U. M <br /> SHOWER CLOTHESORVERS <br /> KITCHEN(INK 8 DISP VENTILATION FAN <br /> OISHWASHER RANGE HOOD <br /> LAUNDRV TflAV WATEFi HEATEF <br /> CLOTHES WASHER WO00 STGVE <br /> URINAL METAL FIREPLACE(WOOD BURNING) <br /> DRINKING FI.UNTAIN PIREPLHCi IM.SERT <br /> FLOOfl DRA�N HEAT PUMP <br /> BACKFLOW PREVENTEFS GAS PIPING <br /> ROOF DRAINS—R,11NlEADERS E%HAUS7 FAN <br /> SINK(SEiiVICE—BAR,ETC.) <br /> _ �` <br /> SUBTOTAL 5 SUBTOTNL $ <br /> PERMIT 5 PERMIT $ <br /> TOTALFEE 8 TOTALFEE $ <br /> FOR OFFICE USE ONLY: ,3�f. 3S <br /> iPCN�SEiBALK� PiA�EiBA� SIDESE�C� PLA!1CMECNIlU E� `39a.�� PECEi�NS� <br /> !V f{I� �% 3 <br /> usezorve io*nnee vecnr�rsi*e FEES VALURTION FEE <br /> �' :.. VES '-�. NO BUitDiNG �, � D ��J(p ' G <br /> iVV[OiC0451 NO 0°SiORIES Wxurpp ,mMYUTcux�.�5 � — <br /> _�� 2 ��'3 ' PLUMBING � Dv <br /> '"OFpL� RAES�qINr'.EHSAF'0� BASEMFNi � <br /> �BO6 SF -f� MECHANICAL �`.� i D� <br /> 4yY.Sp q .c I`� ❑ YES ✓NO — <br /> CLLUP:NCVl4R0 VFREAtRqM,BW� NE�GN1lIMIiaAiION AD�ITIONALPLANCHECH y <br /> �� 2v 1 <br /> nEnsou OTHER I� <br /> STRTE BUIL�INC,$UFCHRqGE <br /> itiuncov vu.;n>rnoveoov CITYOFEVEflETT PUBLICWOflKS � � <br /> LOCALSALES <br /> on�c TAXCODE153105 rar�� l�� 1l7 <br /> �� <br />