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APPLICATIO� FOR CONSTRUCTt 'N PERMIT � <br /> TO BE COMPLETED IN BLACK INK—PLEASE PRINT <br /> HEATING BYSTEM: �GAS CI ELECTRIC ❑ <br /> BUiLDING DEPARTMENT <br /> 259-8810 <br /> ❑ DEMOLITION I1 COMBINAIION I I BUILDING vCMECHANICAI '7PLUMBING ❑ SIGN <br /> ONNEN ��0.�DDPE55 Clry ZIP PMONE <br /> -''/-��0�1� �Ci�✓Ja i✓ic�o�.q,r %C32 Glf.d«000 �R/� Evr wa, 9Bza� <br /> ICNM't �/W�4AOONE55 GTY Ii0 PNCNE <br /> � <br /> /�PCNiIfCI'1HOES�GNfN M�4MJPE55 GIIY ��P ���E <br /> N�,� <br /> GENER.4Cp1iMCIq1 M.1RMDflE55 CI1T ZIP PIqNE SiA�ElKENSE� <br /> '�%A <br /> MEOUNIGtLfMiP�LipP M�M1AOONRS CIiV IIP YNOHE S���EIKfNSE� <br /> �o,�,oc£—L �<+� -�`,C'//!�& 2928 /sa�P[c S:, f✓Llr�A O COML'GCaSOBoLD <br /> MUMBMfiLpliP�CiOR ��M1aDq1E55 LIiY ZIP PIqNF SU�EIICENSE� <br /> CONiflACiCflICEOiWOFN n <br /> ��,sOU`_ <br /> ocxnm[wonK�rro sou+n[roo*r.c[nrvavEo coHucr vEnsorv tivo nrorve ra <br /> O/C — .oA — <br /> �E/J?c':l� �Cn0.2 �U.G�./�U, /dJ:.OL4 _ I <br /> �7n,S /I-'.✓AC�� C/LT L�lon n'j i.�.'�Tt2 <br /> �� <br /> Hf��� 1 HERE9V CEFTIFV THAT I HAVE REAG AND EXAMINED TNIS <br /> vr+oroseous[oraunort+e APPLICATION AND NNOW iME SAME 70 BE TRUE ANO CORRECT.ALL <br /> PflOV1510N5 OF LAWS AND ORDINAI�CES GOVERNINCa TMIS TYPE OF <br /> tEouoEsceiaipNocrroaEenisrqx+�eEirnvonnneC��rv.ocorrt5� WORKWILLBECOMPLET[DWITNWHETHEflSPEGFIEDNERERGCR � <br /> NOT.iHE GRANTING OF A PERMIi DOES NOT PRF.SUME TO GIV'_ <br /> �oi B�acK � �yTMORITY TO VIOLPTE OR CANCcL TME PROVISIONS OF ANV <br /> OTHER STATE OR LOCAL LAW HE�iULATING CONS7 RUCTiDN OR TME <br /> — PEflFORMANCE OF CONSTRUCTION.THAT I AM PUiHORRED DV IHE <br /> (IWNER OF?I115 PROPERTY i0 PEHFORM TME WORK fOR WHICH <br /> APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> vencei ux i D NuuO¢n CON�i RACTORS LAW 1 P27 RCW AND 296200 WAC. <br /> CGISINI1CiICNLMNLENMR.�O�F[SS.IELEPNCNENOMO[fl �`�n�'unt V a•__ <br /> �£A' �Va�✓ fi�—O[J=9:I <br /> VBOJECT1100PESS / CnZfo70� ���� <br /> �llo� n,ao-�v�— �.,,�,;�„s.,K��•.,.,, _ _ <br /> PLUMBING MECMANICAL <br /> NO. TYPEOFFI%NNEONITEM FEE NO. TYPEOFEOUIPMENT FEE <br /> WATER CLOSET(TOIIET� A C—A NNDLG U1!ITS—H.P. <br /> BATHTUD FORCED AIR SYSTEMS—B.T.USD M F.A. <br /> LAVAiORV�WASHOASIN) UNITHEATERS—BTU. M <br /> SHOWER CLOTH[SDRVERS <br /> KITCMEN SINK 8 DISP VENTILATION FAN <br /> DISHWFSHLR RANGE HOOD <br /> LAUNDRV TRAV V1ATEf1 NEATER <br /> CLOTHES WASHER WOOD S10VE <br /> URINAL METAL FIREPLACE(WDOO BURNING) <br /> �RINNING FOUNTAIN FIREPLACE INSERT <br /> FLOOR DRAIN HE�T PUMP <br /> BALKFLOW PFEVENTERS J GrtS PIPING <br /> ROOF ORAINS—RAINLEADERS E%HAUS7 FAN <br /> SINK�SERVICE—BAR,ETG� <br /> SUBTOTAL S SU910TAL S <br /> PERMIT S PERMIT $ <br /> TOTALFEE b TCTALFEE S <br /> FOR OFFICE USE ONLY: ((q11 <br /> iPCNi5E1BACN RGPSRB.KM SIDESEIBACN MNCNECKfJ� OC� fEC AECEIViNO <br /> / <br /> i� y / <br /> uSExor�E iorenEn ceGu�isuE FEES VRLU�iION FEE <br /> G YES ❑ NO pUItD�NG <br /> �p�,.y� noasroarts omwa+ +onowiu�mu�n <br /> W°� PLUMBING <br /> ��prg�pp GiqE5M1MMLEP5FE09 O�SEYENT IAECHANICRI <br /> 7 YES C i NO <br /> OLCUPANLVIOW FlN[MARMPEOD IIE�OHiUMIIAipN A�OIiIONAtPUNCNECK <br /> OiNEP <br /> PEASp1 - --T <br /> STATE UWLOMG SURCHRRGE <br /> INiAKEBY PlAN5AMP0VE0BY CITYOFEVEHETT PU6LICWORNS <br /> LOCIIL S11LES <br /> o„�E TIIX CODE IS 3105 roret <br />