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APPLICATIC�'1 FOR COI�ISTRUCT'lN PERMIT � <br />TO BE COMPLETED IN BIACK INK—PLEASE PRINT <br />1�\�� HEATING SYSTEM: GAS O ELECTRIC ❑ <br />BUILDING DEPARTMENT <br />259-8810 <br />❑ DEMOLITION ❑ COMBINATION � BUILDING 1�MECHANICAL [�PLUMBIN(3 ❑ SK3N <br />OWNEN 1MILIWUIIE`u5 GITY <br />�lrN��%�iac6�tv L�'e,ctt%��/� 7�l�ST <br />iEWWT WILI100RES5 CITY <br />' t ' 0 5�a � <br />CONIMCTOq MAIL ADD/R�ESS CIiV <br />� �,��d /�iwCLl�ia' C"/Ns'T 8i/� !%� <br />� ►�c�wxcKconm�crqi MAILADDRESS cm <br />i �L�L�T�Q�,'� �dcr.�/iGc -SiY/� <br />! PLU�lMI�CONTMCIOR ILI1DDqESS � . � <br />I 7Ai� PLr/n� '�►r � S�✓i / <br />CONTRACT P111LE OF WORK <br />i DEBCRIBE WqIK NID Sd1�RE FOOTM3E MNOLVED <br />i�,�,� � r,� �r �vE,� s, �,�.� z <br />: �__ _ .,.. �--:.•_..__ . <br />ilim—�y.�--e[ouc —Z oF <br />� �-�� 05 2nA�R\1e�. <br />i <br />4 <br />f <br />i <br />PMfB TAII 1.�. MlllER <br />KfTCHEN SIM( 8 DISP i <br />DISHWIIBMER � <br />�.�..�b..te.v _ <br />c�or►�es <br />[a'�•:� '. I7:ilI:. <br />FOR OFFICE U3E ONLY: <br />FnoNrena�cu n�wsEre�cK <br />., _ . .. . <br />K- ► <br />rwe a misr. <br />�t . � <br />-�3c'.:: <br />..I.,r� ::i:t <br />TOTALFEE S <br />NO.OF STOfiIES <br />2 <br />FIRE SVRINKLE115 REO'D <br />/� O <br />FlRE NARM 1iE0'D <br />wre <br />ur rnune <br />� k%� $2 fG <br />ZIP PIIONE <br />ZIP PNONE <br />� ,Pal Srv��t 9i <br />ZIP PHONE <br />ZIP <br />ZIP <br />CONT�CT PERSON AND PHONE NO. <br />� /O� <br />PFIONE <br />� 3 �`r.6 <br />STATE LIGEp9E I <br />sr�ie�1�0� <br />STATE LICENSE I <br />i HEREBY C n EXAMINED THIS � <br />APPLICATION _ n //,�,}. WD CORRECL ALL � <br />PROVISIONS f 7`,�,�ir (_O�w" IINCi THIS TYPE OF � <br />WORK WILL B CIFIED HEREIN OR <br />NOT. THE GR ZI�' RESUME TO OIVE � <br />AUTHORITY' )VISIONS OF ANV <br />OTHER STATE p J�rd �ue1�P � TAUCTION OR THE <br />PERFORMANC Y� b� � �TFiORIZED BY THE <br />OWNER OF TI � y1� VORK FOR WHICH � <br />APPLICATI01 �� ITH THE STATE � <br />CONTRACTO . . WAC. � <br />Y r:l...r,Y�,�� a-��1-95� <br />SprMiwE " DI�IE <br />FORCFD AIR SYSTEMS—B.T.U. M E.A. � <br />UNIT HEATER�B.T.U. M ; <br />CLOiHES DRVERS — � <br />VENTIUTION FAN ; <br />RANOEHOOD i � <br />WATER HEATER � ! <br />METAL FIREPLACE <br />OAS PIPINO <br />S� � � <br />�r s�re FEE8 <br />j] VES ❑ � g�ILDING <br />Y}IPINCr Ip 0{OWEIIiMGIiNrtS <br />FR01P 1 a�uMa�rrc <br />15EMEM �� MECHANICAL <br />❑ VES ElNO <br />EIOMT LIMIT`�TION ADDITIONAL PUN CHECK <br />ZU, OTHER <br />EYERETT PUBLIC WORKS <br />8ALES <br />f IS 5106 �� <br />TOTAL S I /�7 — <br />i <br />r <br />� <br />