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APPLICATIO�� FUR COPI�TRUCT► .�N PERMIT °``'"'" <br /> r,,,,�.,. ;., . <br /> TO BE COMPLETED IN INK—PLEASE PRINT � <br /> rnvo� {.} <br /> eve i e l l HEATING SVSTEM1I: J GAS_ J ELECTRIC J _– __ _� <br /> BUILDING DEPAFiTMENT <br /> 259-8870 <br /> GEMOLITION COMBINATION `, BUILDING MECHANICAL �`PLUMBING 31GN <br /> �.,�:.�i7� I.IMLAUL`RCSS � � CITY LP PMONE _ ( <br /> �1/I�ItIO �� �/if 'Yi�/ % - / I ''/'Uc=< , _ (r��i .,�. , , - / ":;. _> <br /> �EbnNi MAiLPOLlE55 LiTv 2iP ���ONE <br /> AqL111tELTORDE5IGNER MRiLAD��E55 CITY lIP PHONE <br /> cP1EPnLCONi11 lUR fl4a�D�RE55 CItY ZIP PHGNE LICENSE� <br /> ��,�����1,S1/ �W i1 C r <br /> l�COUNiCALt NiRACi01 A�ILA on S CILV 2�P PHONE UCENSEI <br /> ytC]"� ` — <br /> � C� PLUMOINGCONiRnCIDn M1milA00PE55 CIiV 2iF FIIONE IILENSE/ <br /> A �x <br /> ~'�' y y ClAS50F WOqK ' — <br /> C' � NEW X�DDITION ALTERATION F7EPAIR DEMOLITION WOODSTOVE'FRPL INSERT BUILDING RELOCATION <br /> 1 I. / �yct. 6bn n� .1�N[�+kiv i �: - , c. <br /> ~ N I�Q�St ��C�N C/1(CC, �"� <br /> � CaTtF U�;,,,� f' sss-y� �o /-�„u. <br /> � y � CONIRACTVRIC[OFWOfiN _ <br /> � r�i � OCSCRI E\V,p ANy SOUAREfOOiRGEINVOIVE� [�• � r��"�'U< <� . Z Z�S7 C��nr <br /> � v~i H ��K�f l��o✓� Q�i�,a.�fu�.�c��. G.rl�d-�rs zsR-GG su Wcr� <br /> 5 awroseouscor�w�o�r�c �4�j flJ ��k( I HEREBV CERTIFV THAT I HAVE READ AND E%AMINED THIS <br /> �—'E� K p0��` t�� E � �ti?�'!;L APPLICATION AND KNOW 7HE SAME TO BE TRUE AND CORRECT.ALL <br /> H <br /> � pQj. �y � -- PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br /> �ccai oescairnor+ovrnorir,rvis�owNo O\VORATiACHFOURLOPIE51 y�ORK WILL BE COMPLETED WITH WHETHER SPECIFIE� HfREIN OR <br /> H � g ic; / oi�H�d8 �F � �G�' ;JO7.THE GRANTING OF A PEFiMIT DOES NOT PRESUME 70 GIVE <br /> �„ n AUTHORITY 70 VIOLATE OR CANCEL THE PROVISIONS OF ANV <br /> H y� ,)! � f fl,� �L L T� /(�0 S� ��� OTHER STATE OR LOCAL LAW REGULAT;I IG CONSTRUCTION OR THE <br /> �r" �� PEFiFORMANCE OF CONSTRUCTION.i HN I AM AUTHORZEO BY THE <br /> C, 2; / OWNEfi OF THIS PROPERTY TO PEqFORM THE WORK FOR WHICH <br /> NH ( �•J APFLICATION IS MADE AND I COMPLV WITH THE STATE <br /> H ��CONTRACTORS LAW 1827 RCW AND 296.200 WAC. <br /> ��(n ��f F.r--���y �\� J� � SIG�NiURE Of CONTl1ACiOROBAUTN0IUZEDAGENT OAIE <br /> �� y .�� _�� x ;c,�) �•��.��+; :,.,..,(.,( __- <br /> H O p1 �..on c�nonni.:;. ]� " � 5J� )�JL� _— <br /> � � ./�/ :✓ nFFlif.PNISCi pLI5iNE55LICFNSf b0 RN�BUSINESSNPI.IE t <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FI%TURE OR ITEM FEE N0. TYPE OF EOUIPMENT FEE <br /> WATER CLOSET�TOILET) A'C—AMNDLG UNITS—H.P. _ <br /> � FORCED AIR S`.'STEMS—B.T.U. M E.A. <br /> I __ _1 6ATHTUB - -- <br /> / LAWT.ORY IWASH BASIN) UNIT HEATERS—D.T.U. M <br /> �' J SHOWER r CLOTNESORYERS <br /> KITCHEN SINK 8 DISP VENTILATION FAN <br /> DISHVl.4SHER RANGE HOOD <br /> � LAUNDRY7RAY WATERHEATER <br /> I �� CIOTHES WASHER _ WOOD STOVE <br /> —�— METALFIREPLACEB CHIMNEV <br /> URIN�L <br /> DRINKING FOUNTAIN FIREPLACEINSERT � <br /> —� <br /> � FLOOR DPAIN ' HEAT PUMP <br /> � '�I 1 BhCKFLOW PREVENTERS GAS PIPING _ . <br /> � ROOF DRAINS—RAINLEADERS E%HAUST FAN <br /> SINK�SERVICE—BAR,ETG) <br /> '�=1 _ <br /> �1�' _ SUB TOTAL 5 V _ SUB TOTAL 5 — <br /> PERMIT S PERMIT S <br /> TOTAL FEE S Zo TOTAL FEE 5 <br /> FOR OFFICE USE ONLY: <br /> ff101lTSE1��Ch R[ARS[TAACM SR]LS[LOAG( CLANCMELK UMBEfI FL[ RECEiPiNJ —7 <br /> ^^( �/�1 S � l�/'o-�i3(t;-�G' 1�f��Z3- C/,SLQU / <br /> d•�/ OW <br /> u.;rtors iornne,n1 vncnHrsrt[ FEES VALUATION FEE T <br /> _��_ �O U� n DUILDING ��j?(-� � i D v <br /> I��i��CONi$AlLOY:��IL 11YIO�G04514LipAl rcmnpa HOOIPNflavcc'.Js <br /> 0P01° PLLIMBING <br /> -- �- - -3 __ 3v � a'•- <br /> ..P[OI'pIOG NO.OFSTORIES BASEMENf MECHANICAL / '00 _ <br /> 7_�% $� (1 / �J <br /> e;.cui'nqeYtOAO FRiESPPNrcLER5nE0'D NEiG�rtuMrtAiioN ADDITIONALPLANCHEGK <br /> 1 <br /> /� /v� .Z� otr�Ea '� <br /> —�-- <br /> HLASON FOR SPRINKI.ERS <br /> STATE oUIL�ING SUqCHARGE �j ' _S v <br /> WiA✓.[ OY PLA115APPROVEO�V CITY Of EVEflE7T PUBLICLNOFK$ <br /> /I� LOCALSALES �� <br /> �3 TAX CODE IS 3105 rorn� j � <br />