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APPLICATIOr' FOR CONSTRUCTt'�N PERMIT � <br /> TO BE CO�IPLETED IN BLACK INK—PLEASE PRINT <br /> BUILDING DEPARTMENT HEATING SVSTEM:. GAS O EIECTRIC ❑ <br /> 259•8810 <br /> i I DEMOLITION ! I COMBINATION i BUILDING �MECMANICAL �.I PLUMBING 1� 910N <br /> pYME MAIADCNESS CI\Y �l�a oWNf <br /> .���,��n '8ra�en 10�4 Oa�e� r��c, E�� 98ao3 a59-a�i ► <br /> lEN4lT WlM0�E64 LifY Z�F MOME <br /> AfIC��NEN WI�OGNE55 CIiY ZIP VMONE <br /> � <br /> p[H[�q1iMLT011 Wi�00PE53 trtv IiY YMNE Si.1iE4CEN5E� <br /> 1 � <br /> YEdMNCKCWt Tdl WIMDPE55 C�tV ZiP FIqNE Si�1ElICEMS[� <br /> '�,�>- '� <br /> py�y�p�{p,K}pq yu��ppp[gg Gn tia v�tlNE sr�rEtKFNSE• <br /> � n <br /> PACTMC OF .�O <br /> OESCRlE HpiM�NO SOV�wf f0011GE M'OlVEO CONI�Ci VER59N ANO VwONE x0 <br /> i HEREBY CERTIFV TMAT I M�VE READ �ND EX�MINED TXIS <br /> enpvpsc c� mc pPPIICATION AND NNOW THE SAME TO BE TRUE AND LORRECT.ALl <br /> PROVISIONS OF LR1YS AND OfiDINANCES GOVERNING TNIS NPE OF <br /> iceuocscn�oiqrvaoarocarv�vwvmo¢iaron�n.c«mocoo�esi WORNWILLBEC0IAPLE7EDWITMWNETHERSPECIFIEDHEREINOR <br /> NOT. iHE GAANTING OF A PERMIT OOES NOT PRESUME TO GIVE <br /> iot eixK � AUTMORITV TO VIOLATE OR CANCEL THE PROVISIONS OF ANV <br /> OTMER STATE OR LOCAL LAW REGUUITING CONSTRUCTION OR THE <br /> PEAFORMANCE OF CONSTRUCTION.THAT I AM AUTHORIZED BY TME <br /> OWNER OF THIS PqOPERTV TO PERFORM TME WORK FOR WMICN <br /> APPLICATION IS MADE AND I COMPLV WITM THE STATE <br /> vM�EI i�1Y�D NUV8E11 CONTR�CTORS LAW t B 2%RCW AND 296.Y00 WAC. A <br /> COMSIMICTqML0.WlENOER.ADW1E55.TElEVHONENU4BEN Y,( ,/ A ` ;� /, . 1' //�� � <br /> LVI�/(/ii_i /��.�.��it��HCt .�� <br /> �p'1O s� mi <br /> �aO �e `�V V C�Te'.RFlff\CIYYNJ <br /> y��yp��p MECX�NIC�L <br /> NO. TYPE OF FIXTURE Ofl ITEM FEE NO. TYPE OF EOUIPMENT FEE <br /> WATER CIOSET�TOILETI A C—A�MNDLG UNRS—H P <br /> BATMTUB FOFGEDAIRSVSTEM$—BTU. IA EA. <br /> UWTORY�WASHB�SIN� UNITNLATERS—B.TU. M <br /> SMOWER CLOTNESDRVERS <br /> KITCHEN$INK 6 UISP �'ENTIIATION FPN <br /> DISXWASNER RANGE MOOD <br /> LAUNDRVTPAY ' WATEHMEATER <br /> LLOTHES WASHER wOOD STpVE <br /> URINAL METAL FIREPIACE�W00�BURNINGI <br /> ORINNING FOUNTAIN FIREPLACE INSEHT <br /> FLOOR DMIN NEAT PUMP <br /> &1CKFlOW PREVENTERS GAS PIPING <br /> HOOF DRAINS—RAINLE�DERS E%HAUST FAN <br /> SWK�SERVICE-6�R.ETC.) <br /> SUBTOTAL S SUBTOTA� S <br /> PERMIT f PEFMIT S <br /> TOTALFEE E ' TOTpLFEE S <br /> FOR OFFICE USE ONLY: <br /> {IILWi$EIy.CK PE�PSCIB.�CR SW[SEfB/.CR VIANCNECJ�N 4Bf? fFE RECEIiiMO <br /> �/ 3'/ <br /> us¢xw[ IOiI.PE� v�uwtvte FEES VALU11T10N FEE <br /> ❑ VE$ G NO BUILOING <br /> M1I[qCOMS� MOOFSLIXUES ott�.ti`n WnTN��wta�ry <br /> V� PIUMBiNG <br /> SCEOF&06 finESPPUMlEP5PE0D MSE4ENi MEGMRNICAL <br /> u YES -: NO <br /> OLCUvu�LvtWD fWEAUwnE00 NEqMiLi4rt�TqH �DUIiIONAIPIANGHEtN <br /> pTNER • <br /> NEASON <br /> ST�TE BWl01NG SURCHIRGE <br /> wru�cer ttANS�POPDVEDBv CITYOFEYEflETT PUBIICWORNS <br /> LOCAL SIILES <br /> o.re LO(COUE IS 9105 rou� <br />