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APPLICATIC�N FOR CONSTRUCTION PERMIT �����" <br /> TO BE COMPLETED IN INK—PLEASE PRINT � II <br /> tna Evcrgrcen I <br /> Ceverett HEATINGSYSTEM• ❑GAS ❑FLECTRIC U I <br /> BUILDING DEPARTMENT <br /> 259-8810 <br /> DEMOLITION COMBINATION �BUILDING : MECHANICAL PLUMBING SIGN <br /> MRIL ADDliESS 4 PMONE <br /> OWNE f L� I �fI �' f UP�O3 Z �Z�� �,� <br /> CO ��d'Q.� .7�0� 1�1�1�.y Q <br /> � MAILRDDRE55 Cltt 21P PHONE I <br /> TENANT , <br /> . C��— GITY 21P PMONE <br /> ARLMIiECTOROESIGNER MAILADOFESS <br /> , C <br /> L NERR C t A S GTY ZIP PNC4E UCENSEt S <br /> ��'� B 61.,,,., l.J 1. z3 !�f s� l rx. ��� � 6�(3-93i ��E � 0 9�2 <br /> AIECHANiGRICONTR GTOR MRILADDRESS <br /> QiV 21P PMONE LICENSE� <br /> ��H <br /> '.1.' ��Ty ZIP PNONE LICENSE• <br /> L'^� H PLUMBINGWNTRRCTOR M�ILAD�NESS <br /> ayti <br /> H �3� cussoF�waK `/ �� <br /> y �~ �. �: NEW �._�, ADDITION . ALTERATION J�REPAIR ��. �' DEMOLITION � � WOODSTOVE/FRPL INSERT � BUILDING FiELOCAT10N <br /> � H]� /J � C NT Ci PERS'ON`AND PIIONE ND <br /> yy� � (/V �' � W 64 :;-4s�3 <br /> GONTRACT PRICE OF WORN <br /> �ESCBIBE WORK AND SOIIRRE FOOUGE It VOLVEO <br /> � x� <br /> Hl7 ROPOSEDUSEOFBUIIDING I HEREBY CERTIFI THAT I HAVE READ AND EXAMINED THIS <br /> O 1-�� . APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT ALL <br /> LEGRLDESCHIPiIONOFPROPENT'ISNOWNBELOWORATTRCMFOIIRGOPIES� PROVISIONSOFLAWSANDORDINANCESGOVER�INGTHISNF..OF i, <br /> �,~j�n WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR . <br /> � H� �oT g�p�K oc NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE I <br /> AUTHORITY TO VIOLATE OR CANCEL THE PFOVISIONS OF ANY <br /> y y OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br /> H H PERFORMANCE OF CONSTFUCTION.THAT I AM AUTHORIZED BY THE <br /> gy OWNER OF THIS PROF'ERTV TO PERFORM THE WOFK FOF WHICH . <br /> H <br /> n dy APPLICATION IS MADE AND I COMPLY WITH THE STAT <br /> � S"� CONTRACTORS LAW 18.27 RCW AND 296.200 WAC. <br /> �'� SIGN RE CONiR TORORRUTHORIZE�r1GENi FTE <br /> x y v, -�n,r�a� bw�- Cau t� ��..`�e�W <br /> y o v, x L��s.,c� xL 3 r�37 _ �zl� �°l <br /> � � <br /> PRO�JE^CTRDORE S f ppp��p �T � USINESSU NSENO.ANDBUSINESSNRI.IE <br /> V/0 � n � <br /> PLUMBING MEC AN AL I <br /> � NO. TYPE OF FIXTURE OR ITEM FEE NO. TYPE OF EOUIPMENT FEE <br /> WATER CLOSET(TOILET) A1C—A/HNDLG UNITS—H.P. <br /> '�� BATHTUB FORCED Alq S`!STEMS—B.T.U. M E.A. <br /> '�� LAVATORY(WASH BASIN) UNIT HEATERS—B.T.U. M <br /> SHOWER CLOTHES DRYERS <br /> KITCHEN SINK 8 DISP � VENTILATION FAN <br /> �1°`� RANGE HOOD <br /> I� � DISHWASHER <br /> LAUNDRY TflAY WATER HEATER <br /> � � WOOD STOVE � <br /> CLOTHES WASHER I <br /> '!� URINAL METAL FIREPLICE 8 CHIMNEY <br /> �! DRINKING FOUNTAIN FIREPLACE INSERT i <br /> FIOOF DRAIN HEAT PUMP I <br /> BACKFLOW PREVENTERS GAS PIPING <br /> Ia'+I AOOF DRAINS—RAINLEADERS EXHAUST FAN �, <br /> SINK(SERVICE—BAR,ETC.) , <br /> ��9� — <br /> � � SUBTOTAL S PERMOTAL 5 � <br /> I ' � � FcRMIT 5 TOTALFEE 5 <br /> TOTALFEE S <br /> FOR OFFICE USE ONLY: <br /> `r; PECE�PT NO <br /> FRONTSETBRCN REAPSETBALN S�OESEI9RGK PIANCNECNNUMOER FE� /�� <br /> us�zor+e IOTAREA VAL�NTSITE FEES VALUATION FEE <br /> BUILDiNG � Z�P� LO / ��� <br /> IM[OfLONLSAIOW�"Lf iYPEOiGON51.AC1U0.l aGp�pi xOIXmvUu+�c��.i�5 i . <br /> � PLUMBING <br /> SIZEOFOLDG 'IOAF510 ES BASEA�[Ni MECHANICAL <br /> u CNG ( A � <br /> E��57' ADDITIONALPLANCHECN � I <br /> UCCUPANCYLORD FIRESPP NLERSREO'U NEIGNILIIATSJON i ��. <br /> i <br /> �7 OTMER \ <br /> RFRSONfORSPRINNlERS �� <br /> STATE BUILDING SURCHARGE , <br /> INIRKEBY PlAlIS�PPR.. _DBY CITYOFEVEREIT PUBUCWOFHS � <br /> f,� LOCALSALES f ; . <br /> c1 � 11/y,� TAX CODE IS 3105 '�'^' _ �' ' , <br />