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FFOr,:EUERETT BUILDING DEPT T0� 20E;4334'TS �RN 17. <br />� ,"'�, <br />APPLICAT`JN FOR GONSTRtJC'��ION <br />TO BE COMPLETED IN BLACY. INK—PLEASE PRINT <br />1992 2:13PM p412 P.02 <br />� <br />BUILDI�JG DEPARTMENT CcATING SYSTEM: GAS �J ELECTRIC IJ _ ,-1 <br />259•BB!0 <br />I I DEMG�lTION I I COMBINATION I'I BUILDIIJQ 11MECHANICAL I IPLUMBING I I SIGN <br />OWNEN ` MIIILAOORCi'w5 CRV iIV PHONE <br />/ ���i�v �� nr.�1^= ,. ,� , <br />c, l ��y[t- ��- i �� , , <br />rFN�NT ' � �/- r'p l i � :. CC. %c' C:Lt at�c' y�CC ]�7. ,� c/� �. ,2-'-� <br />rn�a�oncss cim� zm � , /� / =--ti�_ <br />ij' VUM7E <br />AR(MITpCI UH UC910NCI1 MAI� �UNl55 CIl Y il �� PIIONF <br />� . <br />;�i'ci�f (L,i L7�v�"L�' f' <br />OGNEIVLLCONTRA�TOp MAILADDPC&6 CITY 21V PHONC `� STATF.I.ICCNSC• <br />S>, , Y�.c.. c=� Z� ��:_c r �'��O�L�N <br />MFGMN:IVIILCONTI1ACTnP MAILAUUH[5Y CIIY ZIP <br />PMONG 67�TE LIC[NSF � <br />PLUMBMqCONTMCT(Si MAILAUDIIE99 _—J— CIIY ZIP YNON[ — <br />STA[ LIC[N9F � <br />f.I�fjSQWOi1K ��' . <br />I�NEN I 1 ApDITION I 1 ALTERATION I I REPAiq I i bEMOL <br />CONTqAGT PNIC! UF WOON (// �L- [:(�.� t <br />OCSf.PpIF WpqK ANU SOUIIIIG FOOT�GC INV(N Vp(1 '' <br />� � <br />✓�L J f�)rv'/i["!l��,nh f`I7�)�f /� ���� <br />YNUYW'ED USEOf OIIIl01N(1 ��' � <br />.�j'/4 ' f' 172m��1c .�c -lL£�i[G[ <br />LEGALU S�pPpPFRTV. HOWNBELUWUfiATTACHiWRfAPIES) <br />l(fT�L_� BLOCK__OF ��G/.-�7�7-:C.�'�i.�..VG� <br />/"%/ce,� ... . ' ' � <br />_...._� —. . �. � --` — <br />� <br />/?lt r� G -�G <br />Pkb�tc�nooncss� <br />.1; �l� � D� �� <br />8 <br />FOR OFFICE U:tE ONLY: <br />� <br />. S�_ <br />rrtalcOxib.�IIOWABIE <br />�.L�_' <br />'� Z�s�FY <br />sez sf c;�w .c;�, <br />Zp' S6TM <br />LUTAst� <br />��_ <br />imC �f CfINST. �CTU4L <br />�� �/ <br />NO, fIf STON�FS <br />1. <br />fIPC SVRNNI Fq6 REO'1) <br />/1!,9 <br />O�MISAPP ryF[IBY <br />, <br />.. !d. <br />/�/,Z `r�9� <br />FEE <br />ma <br />c,.� <br />ITION I I WOOD5T9VE/FRPL INSERT I I BUILDING REIOCATION <br />]NTACT PER60N AN ' PI IONF N0. <br />.r�r.�.��v_Ce I� G-�;ire ".. l•' �/-,a: �.� 3— <br />?I_h���=�.r,;_ �k E✓2��-f�c�''�" F��c,� <br />—�. � .." <br />I HEREBY CERTIf'Y THA I HAVE FEAb AND EI(AMINED THIS <br />APPLICATIDN A11� KNOW THE SAMB 70 BE TRUE AND COHRECT. ALL <br />PAOVISIONS OF LAwS AND ORDINANCES GOVERNINQ 7HIS TYPE Of <br />WORN: WILL BE COMPLE7ED WITH WHETHER SPECIFIED HEREIN OR <br />NQT. 'i HE GHANTINp OF A PERMIT DOES NGT pRESUMC- TO GIVE <br />AUTh'ORITY TO VIOLqTE OR CAIJCEL THE PROVISIONS OF ANV <br />OTHEFI STATE OR LOCAL LAW flEGULATING CONSTqUCTION OR THE <br />PERFO�iMhNCE OF �ON5TRUCTION. THA�i I qM AUTHORIZED BY THE <br />OWNER OF THIS PROPERTY TO PERFOPM THE WORK FOR WHICH <br />APPLICATION IS MApE AND I COMPLY WITH 1HE STATE <br />CONTRACTORS LAW 1827 RCVv AND 296200 WAC. <br />�� <br />D:1ILDING <br />RANGE <br />PLUMBING _ <br />MF,CHANICAL <br />ADDITIONAI, PLAN CIi[CK <br />9PHINKLER <br />STATE BUI:DINO SURCMAF <br />runucwonKs <br />TOTAL <br />S—B.T.U. M E.A. i� <br />= M . _ . <br />�.� <br />_. . <br />- —T <br />__ _ � <br />� <br />_ .... . � <br />�HIMNEY U � <br />• �...T <br />� <br />-T <br />__" � <br />1 <br />— ' .. <br />1 <br />=�... . . O 1 U� <br />.. ' <br />— -• i—� <br />, . <br />SLIBTOY..! g �/p �Gl?j <br />PERMIT S ' � <br />� <br />70TAL FEF $ —i—� � <br />� RFC Irt rq. <br />. j�; � <br />VALUATION FE <br />og � _ . � ; Sa <br />_ � 'VU <br />� <br />—.. ��� ! (%U <br />i <br />� � <br />�� ' <br />� /� <br />i <br />_ � UL <br />��h � C5u <br />