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�►PPLIC/�T6t��d FOR C�W�TRUCY�OW Pl,RNiiT � <br /> TO BE COMPLETED IN BLACK INK—PLEASE PRINT <br /> HEATING SYSTEM: XI GAS ❑ELECTRIC O <br /> +UILDING DEPARTMENT <br /> 59-881U . <br /> DEMOLITION CUMBINATION I I BUILDING X MECHANICAL i PL'JMBING i SIGN <br /> ',;:Gq MAILAOOFE55 Litt 21P PMONE <br /> �:ve�rr Eiouszr�c Avn�oiuTsr iatn a ror�x ��'r�'. w+- 9e2oi zse-92zz <br /> ;:.ui MRiLA0DRE55 CIiV ZiP PHJHE <br /> �,uniCLTOF10E51GNEN MAILAUGF[Lc CITV ZiP PHONE <br /> f-]QH .nERALCONTRACIOfl MAILA��RE55 CIiY ZIP � PNONE $tATELIL[NSEJ � <br /> �c�jtrr,'� ,tUp6[TIDAAL — [IONCOOP 7969 [IAM�ID(',t�N Im- rJ'CIDIIJ� �1• 98264 354-5561 <br /> 9H ...CNANiCALCONiflRCTOR MAIL�ODF[55 CIiY 21P PHONE STAIELICENfE1 <br /> c�H X�RBY, INC i471 127th PL [� R�r.rr•.v�m., WA. 98005 646-3471 CORBY�;2620.5 <br /> 9 F?W � C:IY 2iP PHONE STAiE L�C[NSL• <br /> W/9'NGCONTBACiOfl MAi:ADORE55 <br /> H �� <br /> y zH <br /> y� y� ,:SSOf WOFlN <br /> t�EIV I '� qODITION IX ALTERATION ��. REPAIR i �. DEMOLITION I I WOODSTOVE/FFPLINSERT � � BUILDINGRELOCATION <br /> � H�—�.J GONiAGT PEPSON AND PMONE NO <br /> �~' ftqS]�R BIImS(k1G 646-3471 <br /> H r ul(�ACTPFICEOGWORH 57876.00 <br /> t'1 y� �cnIBEWORNANO50UAREPOOiAGEINVOLVEO '.��iF1U� <br /> C] <br /> � H tLPI1�CE L�IIRNACE. FII�TC[t FIFJ1'lER.ItANC�,' IIOOD. FAN <br /> � nCy ��.;r•oseouseoFeua�mc � i HEREBY CERTIFY THAT I HAVE READ AND E%AWINED THIS <br /> H Ci]O pq]LTI FAMILY APPLICATION AND KNO�V THE SAM�TO BE TRUE AND CORRECT.ALL <br /> �y �C, �.ni oescFlianor+oF aaover+rv is�w�.vm oe�on cHFn�,cr�vouF ccr��_si PROVIS10�S OP LAN15 AND OflDINANCES GOVERNING THIS TYPE OF <br /> z H 3 WORK WILL �E COMPLETED WITH WHETHER SPECIFIED HERFIN OR <br /> � �7 z � B�ocK oF NOT. THE GRANTING OF A PENMIT DOES NOT PRESUME TO GIVE <br /> H y AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br /> ty V] OTHER STATE OR LGCAL LAW RE3ULATING CONSTR JGTION OR THE <br /> � d y - PERFORMANCE OF CONSTAUCTIJN.THAT I AM AUTH�RIZED BV THE <br /> p ❑ OWNER OF THIS PROPERTY TO PERFORM THE WJRK FOfl WHICH <br /> 3, L=1� _ APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> z <br /> z y y CONTRACTORS LAW 10.27 RC\V AND 296200 WAC. <br /> H O fn <br /> - �, 3-/7�� ^ <br /> - -...,�.,� - �.,� <br /> ��icrnooness <br /> 1218-20-24-2G-28-30 IJ�PIII w���°���� — <br /> PLUMBING MECHANICAL <br /> �IO. TYPE OF FIXTURE OR I7EM FEE NO. TVPE OF EOUIPMENT PEE <br /> 'r'+ � WATEF CLOSET ITO�LET) A,C-0.�HNDLG UNITS—H.P. <br /> (.m, � BATHTUB ' FORCEDAIRSYSTEMS—B.T.U.(pM E.A. <br /> —T— UNIT HEATERS—B.T.U. M <br /> LAVATORY(WASH BASIN) —�— <br /> SHnWER CLOTHESDRYEHS <br /> �� �'+ FITCH[N SINK 8 DiSP VENTiLATION FAN <br /> "" DISHWASHER � RANGE HOOD <br /> LAUNDRV TPAV WATER HEATER i_ <br /> (�� � .s CLOTHES WASHER WOOD STOVE <br /> �. � URINAL MEIAL FIflEPLACE 8 GHIMNEY <br /> �we � ' � <br /> ORINKING FOUNTAIN _r__ FIRFPLACE iNSERT �_ <br /> FLOOR DRAIN H[AT PUMP <br /> � ' a BACKFLOW PREVENTERS ; GAS PIPING _ <br /> ��`�' pOOFDRAWS—fiAWLEADERS --r— EXHAUSTFAN <br /> SINK(SERVICE—�AR,ETQ) � — <br /> --i— <br /> � � <br /> _ T— <br /> .'. v gUB TOTAL S ' � <br /> ' SUB TOTAL $ <br /> �� ! PERIdiT 5 PEFPdIT 5 <br /> TOL1L fEE $ TOTAL FEE ff <br /> �' • • )R OFFICE USE ONLY: <br /> ulbllp/.Lrc NE�NSETtl�GN SIDlSLiB�GN VLRNC11hCkNllMptfi FlL hCCLIYINO <br /> ,O ' .� <br /> �-ror�e �oraaen wcartsrte FEES� VALUATION FEE _� <br /> BUILDING <br /> w�01115�ALLOWA�Lk IYPEOfWN51AGIWt n:cuvr.nv xouur�uur�'�ux��s <br /> cxav - PLUMDIN(; <br /> , OFBLDG. NO.OFSTONES DASEMENT MECHANICAL —'— <br /> �_ <br /> u1ntICYLOR� FIRESPPNNLERSREOD MEiGMLIM1iPTI0N ADDITIONALPLANCNECK <br /> SPRINKLER <br /> _ _�— <br /> ,sON FOR SPRINnlGPS <br /> STATE BUILDING SURCHAHG[ <br /> i <br /> _— <br /> ,,, i,r PlANSAPPROVEOBY CITYOFEVERETf PUBLICYJORnS ' <br /> LOCAL SALES , ` <br /> TAX CODE I�3105 TOTp� ; <br /> c <br />