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APPLICATIt"`1 FOR CONSTRUCT""`�N PERMIT � <br /> TO BE COMPLETED IN BLACK INK—PLEASE PRINT <br /> BUILDING DEPARTMENT HEATING SYSTEM: []GAS JaELECTRIC ❑ <br /> 259•8810 <br /> ❑ DEMOLITION ❑ COMBINATION ❑ BUILDING �3MECHANICAL ❑PLUMBING ❑ SIGN <br /> ONTIER M�ILADDRE55 CITV ZIP PHCINE <br /> �i1.9�?c� ��'vU: P.o. A'o�'sYf Cv �zoG 2s�-9Ai <br /> TENANT ^ � � MAILIIOUR 55 CITY ZIP PNONE <br /> ` ,j Q�i�� �/�00� �-c,�(� x.r� �'ir� �8'�C'/_3 2 5�'Zlo.�3 <br /> RRCNR[�-i � �.'.�LSIGN R MAILADDR S �F.ITV ZIP PHONE <br /> v <br /> GENERALCONTNACTOR MAILADDRESS CITY ZIP PHONE STATELICENSEI <br /> ,�r�m o.t-r): t�.��� <br /> MEGMANIGLLCONTRACTOq MAILADDRE55 CITV 21P PNONE STATELILENSEII <br /> 8�c��s:s�.���� 3y���rFs EL, 9'�4Lo/ z5'2-?iiri �u�nGSs'izi�s-7 <br /> PLUMHM(3CONTR�CTOR M�ILAUDRE55 CITV ZIP PMONE STATEIICENSE� <br /> CONTR�CT PflICE OF WORK <br /> J � <br /> SCRiBE WORK AND SOUARE FOOTAOE INVO�VEO CONTACT PERSON ANO PNONE NO. <br /> u �o o " .7vc LSz-3�� 5' <br /> 4 /!�r Oru�„o s ^ /.��i wAa k <br /> ��S� �I 1 HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br /> rnovoseo use oF ew�oir�e APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT.ALL <br /> (,Z�/�,�/j/ff(r PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br /> LE(3ALOESCRIPTIONOFPRq+ERTY(SNOWNBELOWOHAiTACHM'OCOPIES� WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br /> NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br /> �oT �aK oF AUTHORITY TO VIOLATE OR CANCEL THE PIlOVISIONS OF ANY <br /> OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br /> PERFORMANCE OF CONSTRUCTION.THAT I AM AUTHORIZED BY THE <br /> OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICii <br /> , PARCELTA%I.D.NUMBER APPUCATION IS MADE AND I COMPLV WITH THE STATE <br /> CONTRACTORS LAW 1827 RCW AND 296200 WAC. <br /> ' CONSTRUCTIONLOANLENDER.ADDRESS.?ELEPHONENUMBER <br /> �� SI-/L• ��_ <br /> PflOJECT ADpRES9 s�cr��rune � o�r <br /> /9 GiVB115ME55lKfN$ �q <br /> PLUMBINO MECHANICAL <br /> '� Np, TYPE OF FlXTURE OR ITEM FEE N0. TYPE OF ECUIPMENT FEE <br /> �. WATER CLOSET(TOILET) � A/C—NHNDLG UNITS—H.P. � <br /> - BATHTUB ; FORCED AIR SYSTEM�B.T.U. M E.A. <br /> LAVATORY(WASH BASIN) � UNIT HEATERS—B.T.U. M � <br /> SHOWER ' CLOTHES DRYERS � <br /> i KITCHEN SINK&DISP � � VENTILATION FAN ; <br /> � � DISHWASHER � RANGE HOOD � <br /> LAUNDRY TRAY ; WATER HEATER ' <br /> CLOTHES WASHER � WOOD STOVE � '� <br /> ' � URINAL ' METAL FIREPLACE(WOOD DURNING) �, <br /> � DPoNKING FOUNTAIN � FIREPLACE INSERT � <br /> � FLOOR DRAIN � �j HEAT PUMP � ' <br /> BACKFLOW PREVENTEflS ; GAS PIPING � <br /> FOOF DRAINS—RAINLEADERS EXHAUST FAN � <br /> SINK(SERVICE—BAR,ETC.) ; � <br /> � �' <br /> , i ,. <br /> ,'� <br /> SUBTOTAL $ ; SUBTOTAL $ ' � . �..�:tr��� <br /> PERMIT $ PEflMIT $ / � � � <br /> TOTAL FEE $ ' TOTAL FEE $ ' � <br /> FOR OFFlCE USE ONLY: _ <br /> FRONTSETBACK REARSETII4CK SIDESETBACK PUNGHECNNl1MBEfl FEE RECEIPTNO. <br /> USEZIXJE LO?AREA VACRNTSITE FEES VALUATION FEE <br /> ❑ YES ❑ NO BUILDING � <br /> TYPFOFCONST. NO.OFS70RiE5 accuwnr xnaow[uixcuxirs � <br /> cnouo PLUMBING i <br /> 5¢EOFBLDG. FIRESPqINKlER5RE0'D BASEMENT MECHANICAL ' <br /> ❑ YES ❑ NO � <br /> OCCUPANCYLOAD FIREAURMREO'D HEIGHTLIMI*RTION ADDITIONALPLANCHECK i <br /> OTHER � <br /> REASON i <br /> STATE BUILDING SURCHARGE <br /> INTAKE9Y PLANSAPP VEDBV CITYOFEYERETT PUBLICWORKS i <br /> I�F� LOCALSALES � <br /> oAre ,11 TAX CODE IS 3105 TOTAL <br />