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APPLICATIC�1 FOR CONSTRUCT�I�i PERMIT � <br /> TO 9E COMPLET�D IN BLACK INK—PLEASE PRINT <br /> BUILDING DEPARTMENT f HEATING SYSTEM: U GAS �ELECTRIC J __ � <br /> 259-8810 <br /> DEMOLITION �Ci COMBINATION I 1 BUILDING i ' MECHANICAL i pLUMBING i SIGN <br /> OtVNGB MN1400R[55 CIiV 21P PMONE <br /> K«� C1=i..,�1 ��3���. i,a� �'I_ NE .S-Lal�l�- ���s'S �06- 3�/- lYi�' <br /> TEN4NT MAILAUDRE55 CITV 21P PNONE <br /> ARctIMECt nq pESIGNER MML AD�RE55 CITY IIP PIIONE <br /> __�eh l,L;lJnit� Sqn-2 <br /> GENERALCON�{iR�ACTOP p h14ILADOFiE55 CITV 21P PHONE STAT[LICENSE• <br /> kF1� IAL�.A:.lr1 s�+�-e.. �p <br /> IdEC11�NIC�L WNiB�CTOR ^IdNL AI�ORE55 �C ax j�o /CITV n IIP PNONE ST�TE UCENS'El• U? <br /> QVII' ����,� C�iSt.qtY�-Eli�:I�C L-�il�hlNO,�A �� S�U�G %�/Z•'7U�JU C�J�YS'G N�� <br /> PLUTA�INGCONT f,�CTOfl,. 9 RINL�DDRESS qiY IIP P/IONE ST�TEUCENSEn <br /> e rrv 5<e�(-���'r <br /> T i Hn�lY6lecv.� � i..), .y�G �'scr �(,3S F`t�-t,� '11"7.i,' J S-'. <br /> �_�9�1— �I � 1 `II}� �iul�t> >�� i�i7_ �,� . <br /> CONTR�' PRICEOF\Y RK .y� � 1 �¢ � <br /> + ,�ti-n� o*T-1 CO)'r/Y 1;)GG 8 <br /> DES IBE YlORRry+D$OU RE FODT�GE INVOLVED � CONTACT PERSQN AND P O E NO. <br /> Add n..x bt.� �^rmm �n.+�. s4ii.n s�-.d�a ��et�st. 1n.c . e�. us�.,�• � c� • r .3/°/ y�7�_ <br /> � <br /> ; 4,�� �� +�. � -:�r, tlt,�+�,�..,e �h�� x�„�_ al�,.. �c�-1 ��1' <br /> —�. <br /> �Ip�n�i., nS���Uu� r q�.il Pc, � Sn _ i HEREBY CERTIFV THAT I HAVE READ AND EXAMINED THIS <br /> noaoseo Se oF euaoirvc G� APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT.ALl <br /> S"^j�" Fr.'�+�� r�W'^-���Y`'� �CI� � Ia � F-� PROVISIONS OF LAWS AND ORDINANCES GOVERNING THiS TVPE OF <br /> LEGALDESCRIPiIONOfPROA RTV�SNOWNBE WORATfAC11TWOCOPIES� WORK WILI BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br /> ior�— u�ocK�— oF J6 k�"'� '�`�'�`�����"�� NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br /> AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br /> fJ��:i Sly� /Ii'o./ �'Ccv,t.Z�� „-, �����, /��/��ir f u � OTHER STATE OR LOCAL LAW flEGULATING CONSTRUCTION OR THE <br /> 1 PERFORAIANCE OF CONSTRUCTION.THAT I AM AUTHORIZED BY THE <br /> "''���s � J1\G��7t1'Sh C�; OWNER OF THIS PROPERTV TO PERFORM THE WORK FOR WHICH <br /> r�nqr,e�tnnio.��uti+ew � APPUCATION IS MADE AND I COMPLY WITH THE STATE <br /> �Y JZ- O�l%"�v�` OU:7 S ��i.� 2�q_ CONTRACTORS LAW 1827 RCW AND 296200 WAC. <br /> CONSTRUCTIONLO�NLENOER.4DDRfSS.TEIEPHONEIJLB[B(�,/ ( � J <br /> '��� �r(G X ��. ��✓' !� � �� <br /> PROJECT ADDRESS 1 sm ro���k U�c��� i c9�D ti o�rc <br /> � , �� �� ,=,1. � , L-i��t ��,.��;��ss���E�«<:� — <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM FEE N0. TYPE OF EOUIPMENT FEE <br /> WATER CLOSET(TOILET) !VC-A'HNDLG UNITS-H.P. <br /> BATHTUB FORCED AIR SYSTEMS-B.T.U. M E.A. <br /> LAVATORY(WASH BASIN) � UNIT NEATERS-B.2U. M <br /> SHOWER CLOTHES DR�ERS T <br /> KITCHEN SINK& DISP VENTILATION FAN <br /> DISH WASHER RANGE Ii00D <br /> LAUNORY TRAY ' WATER HEATER <br /> CLOTHES WASHER � WOOD STOVE <br /> URINAL METAL FIREPLACE(WOOD BURNING) � <br /> DRINKING FOUNTAIN FIREPLACE INSERT ; <br /> FLOOR DRAIN HEAT PUMP <br /> BACKFLOW PREVENTERS ; GAS PIPING ' <br /> ROOF DRAINS-RAINLEADERS � EXHAUST FAN � <br /> SINK(SEFVICE-BAR,ETC.) ; <br /> � ; <br /> � , <br /> SUB TOTAL S SUB TOTAL S <br /> PERMIT S PERMIT S <br /> TOTAL fEE 5 TOTAL FEE S <br /> FOR OFFICE USE ONLY: ,�1g�, <br /> FRONTSETB�CKI REAR$_ ETHqCN/ SIOESET�� / PLANCIIEG UM FFE D �`, RGCE�t'ipq.�/� <br /> GC� �� � �iu <br /> / <br /> use zor+e ior nAen VACANT SITE FEES VALUATION FEE <br /> - : � VES ❑ NO BUILDING '� �Yj � � <br /> IVPE Oi LOtlSt NO.OF STORIES ¢�ur.cw qn or pwnuxcuxrts <br /> c��0°� PLUMBING <br /> - ti.r I - 3 I <br /> SIZEOFBLOG FIFESFRICKLEOSRECD BFSEhtGNi � � � <br /> 2 �F A� �� <br /> . VES '(/Np MECHANICAL f� � <br /> OCCUPANCVLOnD FIREAInRhInEOu IIEIGMTL161IinTION, ADOITIONALPLANCHECK <br /> 1,� / '_ <br /> A J`�'� OTHER � <br /> aensou <br /> STA7E BUILOING SURCHARGE _; �j� <br /> u/-V <br /> iNtAKE�Y PLANSAPP{�0 EDBV CITYOFEUERETT PUBLICWORKS ' <br /> �J�' LOCALSALES ' <br /> o�Te � c� TAX COOE IS 3105 TOTAL 3 �Q <br /> � <br />