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� t�^ � <br />C� <br />�y <br />>HC~/� <br />1 !� <br />r <br />H�� <br />�H� <br />� H 'il <br />y [/� H <br />t2] O � <br />H C7 <br />� n b <br />NLTJO <br />G] � C] <br />>H� <br />t-� H H <br />pNH <br />n�V <br />� r <br />ZHt�n <br />H O f/� <br />�PPdICAT�C!► _ FOR CONS"TRl1CT1 �ilf PER�1li �� <br />TO 8E CO�APLETED IN BI_ACK INK—PLEASE PRINT �� <br />- -�-- � - � <br />HEATING SYSTEM: J GAS Y1 ELE :TRIC 'J _ __ _,�' <br />BUILC'WG DEPAR�i�I.�fENT �- -- <br />259-8810 ; <br />DEMOLITION `�OMBINATION BUILDING MECHANICAL PLUMBING SIGN <br />o:•.ae.r� rna�nooaess a1v nv miom[ <br />' -fLt� i=w..-�L ;q,1C's f2�TnAvr. �r" �i�ir�•.�. r"�_. ��_G_''!u %/) _. <br />�ICI:nN! M�ILAO�B[55 CI1V _i� PNOM1E <br />, .�nRCTOR0E5iGNER �APiL�DOR[55 CITY ZIP PHONE <br />�_•..� f< F � �-5�2. f L��" a � Fv=PFr�� %�'7oi .�,5.7-_/I// <br />t��nCr�nLCONiHRCTOP MAILAODRE55 CITY ZIP FHONE STATELICENSE <br />YfrM f_ /S-� � I��'✓ - �F Iv FL }/[�/ K:t" . <br />�:'fJUNICALLONTlIACTOR MAILA�DRES's LIiV ZIP FHONE SiAT[L�CENSEtl <br />%I <br />`,./}MI' /i'S �T'VE <br />i�,I!�9iNGCONieACiOR ldRILA�ORE55 CITV ZiP PNONE STATEIiCENS[u <br />I/ <br />- ,)M - S /Rl3-.e�c= — <br />C�n_5 O� WORN <br />�-'FEW �DDITION ALTERATION REFAIR CEMOLITION WOODSTOVE/FRPLINSERT BUILDWGRELOCATIO"J <br />oF�voarc �_2C�,Cou <br />rN <br />r��oroseo use oF owiowa <br />.. - F! e� r`' r n <br />1 CG�L DESGRIPTION OF PROPEFTV �SHOWN BEW W OF <br />i or >' � 4 e�xK � oF 1 <br />� 'vl`�. <br />( <br />NO. TYPE OF <br />� WATER CLOSET <br />j BATHTUB <br />/ <br />DISHWASIiER <br />CLOTHES WASHER <br />URINAL <br />DRINKING FOUNTAIN <br />FLUOfl DRAIN <br />BACKFLOW PREVEN' <br />�%� � l :1''�� ll.L^./Jr;i�i — <br />SUBTOTAL S <br />PERMIT S <br />TOTAL FEE 5 <br />FOR OFFICE USE ONLY: <br />� ilurvi SETlinf.k � [;LnR tiEtOn[K <br />�n �A <br />LSCZONE LOLqR[A <br />�'�'Z �.� <br />;r;�QiCONISRLLONM1PIC 1vPCOttOtl5iAQ0AL <br />.P�OFOIC-: � NOOFSTORIES <br />CCCIIPANGYLOAU <br />m <br />� � r, <br />= ICOYTACT PEii50N ANO PHONE NO <br />i ri�� <br />=?37Gc1 M>prJ �; � _� � .-7,' �: , <br />IO uoo ..-�'tit. � -. <br />�37�u � � HEFEBV CERTIFY THAT I HAVE READ AND EXAMINED THIS <br />APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT ALl <br />iEs e36 CcP�QVISIONS OF LAWS AND ORDINANGES GOVERIJING THIS TYPF OF <br />S� 6 OHK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br />NOT THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVG <br />AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OP ANV <br />� Fvr-�c rT OTHER STATE OR LOCAL LAW REGUL�TING CONSTRUCTION OR TH� <br />PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED 8� T��E- <br />OWNER OF THIS PROPERTV TO PEPFORM THE WORK FOR WHICFI <br />APPLICATION IS h1ADE AND I COfdPLY WITH THE STATF <br />CONTRACiORS LAW 1827 PCW AND 296200 WAC. <br />— <br />u�i: 7( ��� _��._ .c�C 3�=>"�7-�.-- <br />. :.m,�„ onre <br />, .. :�vsnia <br />NO. I TYPE OF EOUIPMENT � FEE <br />A C--A HNDLG UNITS—H.P <br />FORCED AIF SVSTEMS—B.T.U. Pd E.A. <br />UNIT HEATERS—B.T.U. M <br />/ CLOTHES DHYERS <br />VENTILATION FAN <br />j R�NGEHOOD <br />� WATERHEATER <br />WOOD STOVE <br />METAL FIREPLACE 8 CHIMNEY <br />FIREPLACE INSERT <br />HEAT PUMP <br />GAS PIPING <br />.,Z E%HAUST FAN <br />suororn� s <br />PEPMIT S <br />. TOTALFEE 5 <br />SIGES[I�ACN PIANCHECNliN.rz:�-n rc�. <br />3 3 � ��, �7� <br />VACANTSIiE FEES �-(� VALUATIO <br />� BUILDING / ) I 3�!(� ( <br />ncmr�x�v ou�.i..�:�.�.�..�� <br />cP�O� r'� r PLUTABING - -- <br />• <br />BAS[MENt WfCHANICAL <br />PEoO MEiGH'i'')u�mm�'ion AODITIONALPLANCNECK <br />L L� SPFINKLER <br />S7nTE �UILOING SURC�{nRG[ <br />auHsnavaoveoo�v �CITYOFEUERETT vunict•�oras <br />� I LOCALSALES <br />TAX CO�E IS 3105 TOTAL <br />�� <br />t <br />