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/� -��z- 1 <br /> '�P-� tn�. C,Sk � <br /> APPLIC T10. J FOR CO�STRUC7'� �N PERMIT � <br /> TO BE COMPLETED IN BLACK INK—PLEASE PRINT <br /> HEATING SYSTEM: GAS ❑ELECTRIC ❑ —� <br /> BUILDING DEPARTMEIJT <br /> 259-8810 <br /> � DEMOLITION . � COMBINATION . BUILDING �(J�IECHANICAL u PLUMBING � SIGN <br /> own�n u.n�oon s cirv zic v�ror�c <br /> I..i�Q��., r, . —i'�� . ya^c9G��' �°(Jth,H c,��L3 �'r�- �� <br /> *e�tlli YAllApq1E55 CRY IIp pHONE <br /> �PCNI1ELfOFpE51GNER N�IL��ORESS GiV 31P pMONE <br /> GCNC114LONtP�QOR MAM1A�DPESS CIiY 21P FIpNE SLREUCENSE� <br /> 1AI:CIUNICqCIX11P�ClOfl MAILAppR[55 CIIV ZIP %qN! Si�iEIICENSE• <br /> C��-//��4�IJ�a-�K, 1y�7�,cz�, l�iu��vff 9s��y c��)-C��il�1�'��_��� <br /> P(OYBiNGCp1iRALi N.IM1AODPE55 � CIiY ZIV FIICNE Sl�IEIICENS[• <br /> Cli� ' 'c��^��y� az�t� P�cx�f �&s�� ,���-����c� �e�,r��€'�- <br /> �,._ ,�A� <br /> x NEW � '� ADDIiION ALTERATION REPAIR DEMOUTION WOODSTOVE�FRPL MSERT BUILDING RELOC�TION <br /> ACiP[P OPIIy! NO / / / <br /> CIXIiPACIPflCEOFWJIIY. � _ �� ��'(��(/'(/��� <br /> OESCF��E YABK AND SOUARElOOIAGE�NVQI'EO <br /> r orououseoreucowe i HEfiEBY CERTIFV THAT I HAVE READ AND E%AMMED TNIS <br /> �, 4. / APPLICAiION AND KNOW THE SAME TO BE TRUE AND COFRECT qLL <br /> iCcuoE �vr rnwenrvi owrvaciowa+�ruCH� eawe,� PROVISIONS OF LAWS AND ORDINANCES GOVERNING TMIS TYPE OF <br /> WORK WILL BE WMPLETED WITM WMETHER SPELIFIED HEREIN OR <br /> io* eiocx a NOT THE GRAN7ING OF A PERhIIT DOES NOT PRES�i6�E TO GIVE <br /> AUTNORITY TO VIOLATE OR CANCEL THE PROVISIUNS OF ANY <br /> OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION ON THE <br /> PEflFORMANCE OF CONSTRUCTION.iHAT I AM AUTHORRED BY TME <br /> OWNER OF THIS PROPERTV TO PERFORh1 THE WORK FOR\'JHICH <br /> APPLICATION IS MAOE AND I COIAPLV 1YITH THE STATE <br /> ACTORS LAW CW AND 296200 WAC. <br /> ('� `r �s���. <br /> eAw[er neon[ss (— q we un <br /> 1 ` F J <br /> PLUMBING MECMRNICPL � <br /> NO. TVPE OF FI%TUflE OR ITEM FEE NO. TYPE OF E�UIPMENT FEE <br /> WATER CLOSET�TOILET) A'C—A HNDLG UNITS-4 P <br /> BATHTUB FORCEOAIRSVSTEM$--B.T.U. M E.A. <br /> LAVATORY�WASHBASIN) UNITMEATEFS—B.TLL M <br /> SHOWER CLOTHESDRVERS <br /> KITCHEN SINK 8 DISP VENTILATION FAN <br /> DISMWFSHER RANGE MOOD <br /> LAUN�RV TRAV \YATER HEATER <br /> CLOTHES WASMER WOOD STOVE <br /> URINAL METAL FIREPLACE&CHIMNEY <br /> DflINKING FOl1NTAIN FlPEPLACE INSERT <br /> FLOOfl�RNN MEAT PUMP <br /> BACKFLOWPREVENTERS GASPIPING '-� ' <br /> ROOF OflAIN$—RAINLEADER$ E%MAUST FA � <br /> SINK�SERVICE—BAR.ETC.� <br /> SUBTOTAL 5 Sl1BTOTAL 5 �D ; — <br /> PERId1T 5 PERMIT 5 /..+ 1 ' <br /> TOTALFEE S TOTALFEE 5 �— <br /> FOR OFFICE USE ONLY: <br /> 1l10Ni5[1BACM PE�RSEIp/,C6 SIpC5Ei6�CK PIANCNELNNUNB IEE PELEIPiNp <br /> �/07� p <br /> uurw+c IOiAPEA vK.Wi51TE FEES VALUArION FEE <br /> OUIl01NG <br /> f1flf�CONISµlqV4BLI IYMC3COXSfACIWI ¢N4K� tlOp�11lM.N'�S <br /> °� � PlUM9iNG <br /> SV[0�9�Dp NpOFSlOFRS BASEMENt IAEGNrWICNL �� <br /> IXWP.WCYl0.10 fIflESPflNtllFflSPEOp NEqN14MilAtIPY AD�ITIONALPIANCNECN <br /> SPRINNIEN <br /> nLe[OufOqSPflWMlEAS —��— <br /> SiATE BUiIDING SIIFGX�RGE <br /> lau,cor vw�s�ornoveoov CITYOFEVEflETT PUBUCIVORNS <br /> LOCALSRLES <br /> TAX CODE IS 3105 *oT�� <br />