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TO BE COMPLETED IN BLACK INK—PLEASE PRINT ��� <br /> � HEATING SYSTEM:�;J GAS J ELECTRIC J I <br /> BUILDING DEPARTMENT � <br /> 259-8810 <br /> DEMOLITION COMBINATION BUILDING �MECHANICAL �PLUMBING SIGN <br /> w , � <br /> r.aiino,eess ar. . o.o,e <br /> `��� (�o������ �7ua l,�l��-r���.-�_��U c f�� 4 ;h.��� � .�:;'1 -�Cr71 <br /> li':ANT MnLLADDRE55 Cliv Z�v i•��O'I_ <br /> 11 �1'� <br /> �..CH1I^tECTOR^DESiGNER MARADDRESS C.iTv Z�0 PHDNE <br /> 1 1 I 1 \ <br /> ��E�iERPlL C TR�CIOR MAR ApDRE55 ❑I� ZiP PMONE STATE LiGENSE• <br /> ��� 1 1�� _ — <br /> I.ICCIIPNICALCCViRACTOR�\�AII,ADDliNI `I �V� ��/* I��"I� ��I �wEI �C��Y�WEr \EIV �I�- c�- <br /> p�x Il li� � � <br /> Q h'� pWM91NGCO�iiRnCTOR IAniLApDRE55 I C�Tv ZiP PHONE STRTEUCENSE• <br /> >y�' �� 111-�rl��i�,cc <br /> y �� Sc� �•,� <br /> Ct SSOFWORR <br /> �! y� �NEW FDDITION ALTERATION REPAIR DEfdOLITION WOODSTOVE:PFPLINSERT BUILDINGFEIOCATION <br /> LONTAp PERSONANpFMON[NO <br /> � yH CONif1PCiFRIGEOFIVOHK 1 � ..� •�O <br /> F3 GLSCRIpC WORK A4�$OVARE fOOTAGE MVONED <br /> � �� ��� ��, c�r� ��� ,� �I c�. N . -- <br /> cnon Eouse w�oMc I HEREBV CERTIFV THA7 I HAVE READ AND ExAMINEC 7HIS <br /> H — ' <br /> �y qpPLICATION AND KNOV!THE SAME TO BE TRUE AND CORREC?ALL <br /> M C�C O PROVISIONS OF LAWS AND ORDINANCES GOVERNING'HIS TVPE OF <br /> �� n LEGALDESCNIPTiONOFPROPERtt15HONNBEIOWORATTALHFOUPCOPIES� <br /> ❑ WORK WILL BE COIdPLETED WITH WHETHER SPEGFIED HEREIN OR <br /> z y 3 ior etocK ov NOT. THE GRANTING OF A PERIdIT �OES N0T PFESUME TO GIVE <br /> � LZ AUTHOIiITV TO VIOLA7E OR CANCEL 7HE PROVISIONS OF ANY <br /> �y y OTHER STATE Oq LOCAL LAW REGl1LATWG CONSTRUCTION OR TNE <br /> Cy fA PERFORIdANCE OF CONSTRUCTION.THAT I AM AU7HORIZED BV THE <br /> nd y OWNER OF THIS PFiOPERTV TO PERPORIA THE \VORK POR WHICH <br /> �+ �+ APPLICATION IS 1dADE AND I COMPLY W�TH THE STA7E <br /> 1' L''1� CONTRACTORS LAW 1827 RCW AND 296.200 WAC. <br /> Ly C/� <br /> H O p� • � <br /> x �����L- � _ t�(�r.�.�/ :7 I �� <br /> vaoiect�.00r+ess '"""+..,�� +•c <br /> � � V� �.r io�.rs��...��.,i��o <br /> PLUM�ING MECHANICAL _ <br /> N0. TYPE OF FI%TURE OR ITEM FEE NO. TVPE OF EOUIPMENT FEE <br /> WATERCLOSET(TOILET) AC—A�HNDLG UNITf—H.P. <br /> +� BATHiUB FORCEDAIRSYSTEMS—B.T.U. M E.A . _ <br /> ! 1 LAVATORV IWASH BASIN) UNIT HEATEPS—B.TU. M _ <br /> SHOWER CLOTHESDRVERS <br /> KITCHEN SINK&DISP VcNTILAT10N FAN _ <br /> I� � DISHWASHER RANGE HOOD ' _ _ <br /> LAUNDRVTRAV WATERHEATER �_�__ <br /> —�— <br /> . CLOTHES WASH[R VJOOC STOVE ___ <br /> URRJAL tdETAL FIREPLACE 8 CHIMNEV _ <br /> �+ ..� DRINKING FOUNTAW PIREPLACE INSERT __ <br /> FLOOR DRAIN HEAT PUMP _ _ <br /> BACKfLOW PPEVENTERS GAS PIPING __._ <br /> I�� � ROOF DI7AINS—RAINLEADERS EXHAUST FAN _ <br /> � SINK ISERVICE—BAR.ETG) - - <br /> � a � —_ — —_ <br /> SUB 70TAL S SUB TOTAL 5 �J� <br /> � (� PERMIT b PERMIT S �'� � � <br /> �' TOTAL FEE $ TO7AL FEE 5 <br /> FOR OFF�CE USE ONLY: <br /> ' �� IPOl1T$E1B�C✓ nEnliSCiPerx SIOES[TBACK n�ANCN@GKNUMBER PEE AECCi�;NO <br /> 7� '�/ <br /> use zone ior aeen vncnHt site FEES �ALUATION FEE <br /> �UILDING <br /> i�i'L Of COqfS AILDWABIE �VC[P WN9 K1UAl ur.cw�r¢r m n�:,n!.i x:iro.�c — - - <br /> caarv p�.UfdBWG <br /> �'' <br /> SQEOFBIDG NOOFSIOfli[S OASEM[NT MEGHANICAI �� <br /> oCCUPNNCVLOA� FlRESPRNnlER5PE00 ��EiGHrliMrtnuON AUDIIiONFIPLANCHEGK . <br /> SPf71NNLER <br /> nrasonro�sPAirveifns -- — � <br /> STAIL DUILDING SURCHARGf � <br /> —_ — <br /> _ " _-_-__"" __ ' " _ _ ' <br /> �unc..ii�+ i ��ir,�s,nrrnovrnnr CITYQFEVERETT PWUGwoRKS ' <br /> LOCALSALES ' <br /> TAK CODE IS 3105 Torn� <br />