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APPLICATIO.� FOR CONSTRUCT_ JN PERMIT � <br /> TQ BE COMPLETED IN BLACK INK-PLEASE PRINT <br /> HEATING SYSTEM: � GAS i,]ELECTRiC J <br /> �UII_DING DEPARTMENT <br /> 259-8810 <br /> DEMOLITION COMBINATION BUILDING MECHANICAL �' PLUMBING SIGN <br /> OWNEq �1 M ADORESS CITV ZIP �1��°j PHONE <br /> c f!41 1 '��`'���%. -�/J�J S o 4 C� I! 1����J'-�`'37G� � __ <br /> TENANT � MAiLA'JDRE55 LITV ZIP HONE <br /> ARGHRECTOFDESIGNER MAILAODRESS CITY ZiP PHONE <br /> GENERAL GONTRACTOR MAIL ADORE55 CITV ZIP PHONE STATE UCENSE e <br /> MECHqNIGALCONTqACTOR MAiLADDR[SS GTY ZiP PHONE ST�TEL�CENSE• <br /> ��.� i��-��a��.,����-� 1�9���,� 5k��-�,��,G:r e,r�t Rs�_�-�'� <br /> PLUTABII CON1RFf.T MI.iLADDR[55 � GTV 2iP PNONE STATEtICLNSEr <br /> CLASS OF WORK <br /> � NEW . ADDITION ALTERATION REPAIR DEMOLITION WOOOSTOVEiFRPL INSERT BUILDING RELOCATION <br /> � N/�J C �t C . CT PERSON ID PNON NO ^ �-q{ [/./� / / / <br /> CONTqf.GT PRICE OF WORK�l�� � a��� ✓1� / '�lOV/((L� <br /> DESCR'6E WORK AND SOUARE F AG[INVOLVED <br /> .���.��,� � `^ � <br /> aaorosEouseoFeuao i HEFEEY CERTIFY THAT I H.4VE READ AND EXAMWED THIS <br /> �� �V1 � � APP�_ICAI"ION AND KNOW THE SAME TO BE TRUE AND CORRECT ALL <br /> �e�"nioesc tioNOF ocEarvisNowNeetowoanitncnFou�coPiesl PRO�'!SIONS OF LAWS AND ORDINANCES GOVERNING THIS TVPE OF <br /> WORK Wli_L BE COMPLETED WITH WHETHER SPECIFIED HEREIN OF <br /> �oi_ e�ocK UF NOT. TIiE GRANTING OF A PERIdIT DOES NOi PRES�IM[ TO GIVE <br /> AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br /> OTHER STATE OR LOCAL LAW FEGULATING CONSTFUC110N OR THE <br /> PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHOr71ZED BY THE <br /> OWNER OF THIS PROPERTV TO PERFORM THE WORK FOF WHICH <br /> — APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> TRACTORS L 1 . 7 W AND 296200 WAC. <br /> „ ,� L � ` 2L� � �I =' <br /> PROJECT nDDRESS � - `"�-"E –� �'-v`-- <br /> r.mnun•.rv:unRc1 No <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM FEE NO. TYPE OF EOUIPMENT FEE <br /> WATER CLOSET(TOILET) A'C-4'HNDL^u UNITS—H.P _ <br /> BATHTUB FORCED AIR SYSTEMS—B.T.U. M E.A. <br /> LAVATORY(WASH BASIN) i UNIT HE4Tf_RS—B.T.LL M _ <br /> SfiOWER CLOTHES DRYERS <br /> KITCHEN SINK 8 DISP VENTILATION FAN <br /> DISHWASHER RAfJGE HOOD <br /> LAUNDRV TRAV WATER HEATER <br /> CLOTHES WASHER i WOOD STOVE <br /> URINAL METAL FIREPLACE 8 CHIMNEY _ <br /> DRINKING FOUNTAIN FIREPLACE INSERT <br /> FLOOR�RAIN HEAT PUMP <br /> BACkFLOW PREVENTERS � GAS PIPING <br /> ROOF DRAINS—RAINLEADERS � EXHAUST FAN <br /> SINK(SERVICE—BAR,ETC.) _ <br /> —T <br /> SUB TOTAI 5 SUB TOTAL S Q ; <br /> PERMIT 5 PERMIT S __�� <br /> TOTALFEE u TOTALPEE $ � <br /> FOR OFFICE USE ONLY: <br /> FRONTSETBACN REARSETP/CK SID[5[i�ACK PLPNCII� KNUfAp[P FE' HECEiPTNO <br /> /L –�, ' <br /> usezoNe LOTAP.EA VAGANTSITE FEES VAL'JATICN FEE <br /> BUIL�ING <br /> TVPEO�LONiS.Al10WABLE iYFE01CON5iAGitlFL aC[ucexcv HOO�PMwrisWi�S <br /> cnaur � pLUM81NG <br /> SREOFBLDG. NOOFSTOBICS BASEMFiNT MECHANICAL <br /> OCCUPANCVLOAD FIRESPRNKlERSRW'0 NEIGHTUMITATION A�DITIONALPLAIlCHECK <br /> SPRINKLER <br /> REASON PON SPRINKlERS �T— <br /> STAT[�UILDING SURCNAAGE <br /> INTANEBV PtFNSAPi'ROVE�AY CITYOFEVERETf PUBLICWOPN$ <br /> LOCAL SALES <br /> �TAX CGDEIS 3105 TOTAL <br />