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APPLICATIO: . FOR CONSTRUCTI �N PERMIT ���� <br /> TO BE COMPLETED IN BLACK INK—PLEASE PRINT � , . <br /> fHEATING SYSTEM J GAS iJ ELECTRIC J _—__ -- -- - - I I <br /> BUILDING DEPARTMENT <br /> 259-8810 <br /> DEMOLITION COMBINATION BUILDING MECHANICAL PLUM8ING SIGN <br /> o�vrven - �aa�nooniss cnv z��, w�or�e <br /> � /�..1.- r ��'c-'J'F"/( %'i'�Z<-�/ •�- <br /> Ff ,��. I ��<<�-�'�:�.��z - <br /> lC1lpNi MFILADDR[ 5 CI Y 21P �'��OM[ i <br /> Pi+C��rt[CiORDESiGNER MNLAO�RE55 CITY ZIP P�ONE � <br /> ��� — <br /> al-3 Gt�lFnnLLOHiRACiOR MAILAD�RE55 CITY ZIP P110NE STAiELICENSE� II <br /> A�H C'... - � �zrFc�n rn5/' �nc � yi0! �'!�"S!✓�7tK���Pn� l�27_,� �r.SY7Y3 GLi�'�r-cilG�it�;y <br /> a y N 1.11 r��qryi�qLCONTRPCTO�SS LITY 21P PH NE SiA E UC[NSE I <br /> H �3. <br /> H ZH �•IUlAA1NGCONTRACTOR MRILAODRESS CIiV IiP I410NE SIAtCUCCtlSL• <br /> K n <br /> H� <br /> Ox0 <br /> � �H �inssow�onK . <br /> NEW X ADDITION ALTERATION REPAIR DEMOLITION WOODSTOVEFRPL INSERT BUILDING RELOCATION <br /> � "j� . � �-yL� CONiACi PERSON N:C PHONE NO <br /> � �i <br /> C7 cournnctvnceoFwo�K '��� Fal� EC1 /L> ��2.!'Gvt �YSC{vl ��"''����l7 `�� <br /> 0[Sf,RipEWORNAND50UAPELOOTA INVOLVEO <br /> ��gC, G'�,.� � �P-' �� -- �� <br /> zH3, r�oros[o Eovouaoinc i HEREBV CERTIFY THAT I HAVE READ AND ExAIdINED THIS I � <br /> � �� C i1 f c , E !�� APPLICATION AND KNOW THE SAIdE TO BE TRU6 AND CORRECT.ALL <br /> ICf.AL�ESCFIP NOFPAU�tR1Y�5HONMBElOW0l�nitncHFouacoaiesl PROVISIONSOFLAWSANDORDINANCESGOVERNINGTHISTVPEOF ! <br /> H y �L WORK WILL �E COMPLETED WITH WHETHER SPFCIFIED HEREIN OR � <br /> g y H �or�9'�� e�ocK �Q'3 0� Et/c4 J�4 1 1 _ NOT. THE GRANTING OF A PERh11T DOES NOT PRES'Ih1E TO GIVE <br /> n d� J /J AUTHORIiY TO VIOLATE OR CANCEL THE FROVISIONS OF ANV <br /> � �� / I� i Ii�1 :S �i(�� � � �� OTHER STATE OR LOC�L L�VJ REGULATING CONSTRUCTION OR THE <br /> PERFORMANCE OP CONSTRUC11bN.THAT I AM AUTHORIZED BV THE � <br /> z y y OWNER OF THIS PROP[RTV r0 PERFORM THE WORK FOR WHICH � <br /> H O� APPLICATICN IS MADE AND I COM1IPLV WITH THE STATE � . <br /> CONTRACTORS LAW 1827 RCW AND 296200 WAC. ' � <br /> _— ���/'�1��� �l� /C��'-�x,,J — // j <br /> .�.... � onn . <br /> - PRu�CCTAD�R[55 <br /> I/c� I �<C� C �C� �<�-tf Y1,1��Y[t��. � <br /> PLUMBING ' MECHANICAL � � <br /> � s N0. TYPE OF FIXTURE OR ITEM FEE NO. TYPE OF EOUIPMENT FEE ; <br /> !� WA7ERCLOSET�TOILET) � _ hC—A.HNDLGUNITS-4i.P ! <br /> BATHTUB FORCED AIR SVSTEIdS—B.T.U. M E.A . <br /> LAVATORV(WASH BASIN) UNIT HEATERS--B.T.U. M ; <br /> �`� —,— <br /> SHOWER CLOTHESORVFRS <br /> � ! ;�FNTILA710N FAN � <br /> KITCHEN SINK R DISP --- <br /> DISHWASHER RANGE HOUD _ � <br /> '� +. LAUNDRV TRAY WATER I1EA";ER <br /> i ..� ClO7HES WASHER _ WOOD STOVE _ _ <br /> URMAL METAL FIREPLACE 8 CHIMNEY <br /> — FIRcPLACE MSERT <br /> DRINNING POUNTAIN --i— <br /> � ��� FLOO(i DRAIN _ HEAT PUMP <br /> BACKFLOW PREVENTERS GAS PIPING <br /> ROOFDRNNS—RNNLEA�ERS EXHAUSTFAN _ <br /> f •+' SINK(SERVICE—BAR.ETC.) _ <br /> _ "� SllB TOTAL 5 SUB TOT�L S __ <br /> PERMIT 5 �— PERMIT 5 ___ <br /> TOTALFEE 5 iOTALFEE 5 <br /> FOR OFFICE USE ONLY: <br /> tRONi5ET0ACK REARSC�ip�Cn 5!�[FLiOPGK PIAHCNF KNIIMOCfi �L! FEGEIPiHO <br /> Zo' p' ` ; /o'-�fi� ��oa� ��,. .�n ,���a� <br /> usc zor¢ �or anen vncnrvl site FEES tVALUATION FEE I <br /> —Z � BUII.DING _ ___ __ P4'U_'�(� _ _ � �� ��� , <br /> IYfI.OiLOdiSRLLOWAPIE 1TPEOICOf15i�G{�PL OCCUNV^r INuntcirtuvi5 — <br /> - �'9aD PWh101NG <br /> � '�"_ —' <br /> SVfpFHIOG NO.UFStORi[5 BASEMLNL MECHANICAL <br /> 3oi St `� ; <br /> of.cUPANcvIGRD FlRESPnNKlF.RSR[o0 NLiG1rtLiMlinllt� ADOITION�IPLANCHECK ' <br /> � �O _I S __ SPRINKLER � <br /> — � <br /> �e[n50N FOR SPFINNLERS i <br /> STATEBUILOINGtiUHGHANGL � 'SZ' I <br /> nankeer rur+sn�rnwmur CITYOFEUERETT punuCwGr�hs ----f--- � <br /> LOCAL SALES J` i � <br /> • )J9�'� � i��j� TAX CODE IS 3105 �otai <br />