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APPLICATIC� �OR C�N�iTRUCT.'�N PERMIT � <br /> TO BE COMPL'ETED IN BLACK INk:—PLEASE PRINT <br /> HEA"i ING SYSTEM: �GA;i J ELECTRIC J <br /> BUILDING DEPARTMENT - <br /> 259-6810 <br /> DEMOLITION IC COMBINATIO�{ x BUILDING ' MECHANICAL XPLUMBING SIGN <br /> OLVNEq tAAILAD�RE55 CIiV ZIP PHONE <br /> Ror3e2T M�CoYY f923 Nr,r� Av6 F=�rx�'�i�1:��� (Zi�G)339-85(c7 _ <br /> TENANT 11AiLq9DFE55 � CITY ZiP PHONE <br /> S�1� <br /> ARCMITEGTCF�E9GNER MARAOOFESS CITY Z�P PMONE <br /> GENERALWNTR�CTOR IdAIIA��RE55 GITY ZIP PMONE STATEUCENSE� <br /> SAM� <br /> IIEGHANICA�WNiRACTOR MAILAp�RE55 CITY ZIP PHONE StATELILENSE+ <br /> PLU1dBING CONTRACTOR IMit ADORESS CITY ZIP PHONE STATE LIGENSE t <br /> CONTRACT PRiCE OF WORK <br /> �� ��C� <br /> DESCRIBE WORN AND SOLARE FOOTAG[INVOLVE� CONiACi PEPSON ANO PNONE NO <br /> U.1�Q-X.Y�"L�3�� 1° <br /> �1JSTAU_ NEv1 5E�_ Sc�.� 13�NRLt7 N aw�� R- m��s�, til�m� �39-k,sv7 _ <br /> aao���o eoOus��uaoi� �� ��R�m �`(� APPL CATION AND'KNOW THE S MEETO BE�TRUE�FND CORR CT.ALL <br /> ?ROVISICNS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br /> iEcn�oescaiv7ioNOFvnoaeatt-��sNopwuo«ov+oTafnracr�rwo�co/Pies� 1VORK WILL BE COMPLETEO WITH WHETHER SPECIFIED HEREIN OR <br /> �or�' � 12 e�ocK --��'-- o� `�A� �� "�'�• NOT. THE GRANTING OF A PERMIT DOES NOT PRFSUME TO CIVE <br /> AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br /> ��.1 T� OTNER STATE OR LOCAL LAW REGULATING CONSTRU.TION OR THE <br /> — � �� PERFORMANCE OF CONSTRUCTION.THAT I AM AUTHORIZED BY THE <br /> OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br /> APPLICA?ION IS MADE AND I COMPLY INITH ?HE STATE <br /> PAP.CEL TP%I D NUIdBER CONTRACTORS LAW 1827 FCW AND 296200 WAC <br /> �(30-3�8-n� �-oc�l <br /> CONSTRUGTIONLOANLEN�ER AD�RESS.TELEPHONENUMBER � ` � � <br /> j-��. , _ 2- �-9�1 <br /> PflOJECT ADDRESS 19 3 �' �(E s��'�^'u�r o��� <br /> 2 � � zirvnusrt+cssucrns�uu <br /> FLUMBING � MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM FEE NO. TYPE OF E�UIPMENT FEE <br /> WATER CIOSET(TOILET) A�'C—A'HNDLG UNITS—H.P. _ <br /> BATHTUB FORCED AIR SYSTEMS--B.T.U. M E.A. <br /> Q, LAVATORY(WASH EASIN) UNIT HEATEflS—B.T.LL �A <br /> SHOWER CLOTHES DRYERS <br /> KITCHEN SINK 8 DISP VENTILATION FAN_ <br /> DISHWASHER RANGE HOOD <br /> LAUNDRY TRAV WATE9 HEATER _ <br /> CLOTHES WASHER WOODSTOVE _ <br /> URINAL ' METAL FIREPLACE(WOOD BURNING) <br /> DRINKING FOUNTAIN i FIREPLACE INSERT _ <br /> FLOCR DRAIN HEAT PUMP <br /> B�CKFLOW PREVENTERS GAS PIPING <br /> ROOF DRAINS—RAINLEADERS EXHAUST FAN <br /> SINK(SERVICE—BAR,ETC.) <br /> � <br /> --� <br /> SUB TOTAL 5 SUB TOTAL S _�� <br /> PERMIT 5 PERMIT $ _ _ <br /> TOTALFEE S TOTALFEE S <br /> FOR OFFICE USE ONLY: <br /> pRON15ETdACN REARSET9�CN 510[SE?�ACH PI.ANCHECKIdUldOEF FEf. RCCEi�'TNO <br /> usezor+e �ornaen VACANTSIT[ FEES VALUAfiON FEET_ <br /> : � YES � � NO pUIL01NG V(� I I _'�� <br /> 1�FEOLLONSi. NOOFSiORIES Mr�,;=uvr Nao�ov.[n'su':u5 -- � <br /> °�° PLUMBING �_ <br /> � 2. �3 <br /> SiZEOfBLOG FIRESPFINKLEFSREO'D BhSEM11Ey T MECHANICAL /�� <br /> , J .4'YES �. NO <br /> OCClIP4NCY 04D FIREALARMREO� HEIGMTL�IMITATION ADDITIONALPLANCHECK <br /> �I l� (.t�� OTHER �` �� <br /> i�FnSON' <br /> STATE BUILDING SUflCHAFGE � <br /> ir�rnKeov Fv,usnPraovEoov CITYOFEVERETT auaucwoaHs <br /> �r} LOCALSALES <br /> � u,,rE •��� �� TAX CODE IS 3105 TOTAL /7 ;,S� <br />