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� APPLICATIO. . FOR CO��STRI�ICT["^'N �EPIMIT <br /> TO BE COMPLETED IN BLACK INK—PLEASE PRINT � <br /> BUILDING DEPARTMENT HEATING SYSTEM: I�((GAS i]ELECTRIC ❑ —� <br /> 259-8810 , <br /> f 1 DEMOUTION I I COMBINATIO�I �Q BUICDING I I MECHANICAL I I PLUMBING . I J SIGN <br /> OWNER Mr1ILAUUPE55 dIY 21P PIIONE <br /> TENANT l.tAIIADDf1E55 ' <br /> CIlY ZIP PHONE � <br /> AqCH17ECiORDE514NER MAII.AUDRESS (;IIY ZIP PIIONE ' � <br /> 6ENERALCONT�TOR MAIIADURF.SS CIIY ZIP PHONE S7ATEUCENSE/ <br /> L�L I/e�vr'v�s /o7i/ �✓���c/wa✓ �r 4frzoy ZsoiBiB [.1.✓��c2-�lc�D��l�c <br /> MECNMlICALCONiPACTOR MAIIA�DAESS CITY ZIP PHONE STATELICENSE/ <br /> PLU4BINOCON7MCT09 M�IL�OORE55 ClIY ZIP P{IONE STAiEUCENSE• <br /> CU15S OF WORK _ <br /> I� NEW I I ADOITION I I ALTERATION I I REPAIR I ! DEMOLITION I I WOODSTOVE/FRPL INSERT I 1 BUIl01NG RELGCATION � <br />� �/ 7�J --- Co�^L�rQ�yorM��/�� � . <br /> CONTRACT PAICE OF WOI1N . <br /> DESCPIBE WONN ANO SOUARE FOO7qGE INVOIVEU � <br /> �..,�.,�� aeE� iss3'���a�a�� yyo� �r <br />� � PflOPO5E0U5EOF8UILDING r "� �/ 1 HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br /> I SN�eGe� �(�N/(�7� �(Q�LJ� APPLICATION AND KNOW THE SpME TO BE TRUE AN� COFRECT.ALL <br /> LEORLDESCRIPTIONOF PROPERiY�511ON'N BELOW O(1�itnCH FOUflCO`PIES� PROVISIONS OF LAWS AND ORDINANCES GOVERNINIi THIS TYPE OF <br /> �ot� BI.00K oF SHD� c7US . WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR . � <br /> NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br /> AUTHORITY TO VIOLATE Oq CANCEL THE PROVISIONS OF ANY <br /> I � � OTHER STATE OR LOCAL LAW REGULATING CONSTpUCTION OR THE <br /> I PERFORMANCE OF CONSTRUCTION.THAT I AM AUTHORIZED BY THE <br /> . OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHI� H ' <br /> 4 /� APPLICATION IS MADE C.YD I COMPLY WITH THE STATE <br />, /�J�f y CONTRACTORS LAW 1827 RCW AND 296.200 WAC. <br /> G Ci 0 A <br /> X // �J2 <br /> � PRQIECTADDRE55 ^ 5¢iNnnmE / p�� / I <br /> � , 2��y, `. <br />` • �� `J CIfYB�51NE55lkEH5EN0. <br /> i ; PLUMBIN(3 MECHANICAL <br /> I t ' NO. T%PE OF FIXTURE OR ITEM FEE*' NO. TVPE OF EOUIPMEN7 FEE <br />(, � ; _� WATER CLOSET(TOIIE'i) __ � _ FVC—q/HNULG UNITS--H.P. T— <br /> i 2 BATHTU2 ____ ; _ FORCED AIR SYSTEMS—B.T.U. M E.A. �—�— <br /> Z LAVATORY(WASH BASIN) � �-- UNIT HEATERS—B.T.U. M ; <br />� � � �} SHOWEP / CLOTHES DRYERS -�— <br /> KITCHEN SINK&DISP ' VENTILATION FAN � <br /> � <br /> • DISHWASHER • RANGEHOOD �— <br /> � �B- LAUNDRY TRAY � � <br /> � , / WATEN HEATER -� <br /> � / CLOTHES WASHER � WOODSTOVE ; <br /> I � URINAL � / METALFIREPLlCEBCHIMNEY G�S �-- <br />� DRINKING FOUNTAIN � -�• FIREPLACE INS°RT f7NL �— <br />' � FLOOR URAW � HEATPUMP , <br />� BACKFLOW PREVENTERS ; GAS PIPING � <br /> ROOF DRAINS—RAINIEADERS —� � EXHAUST FAN / <br /> � <br /> � �— <br /> SINK(SERVICE—BAR,ETC.) � � <br />'� -r— i— <br /> —+ � � <br />� . I — _..__ _. �_ <br /> i_ ' <br /> i <br /> i <br /> � �—_ <br /> '_ ' i <br /> _ _ SUB TOTAL $ ; SUB TOTAL $ <br /> _ PERMIT $ PERMIF $ � <br />� � TOTAL FEE $ " ; TOTAL FEE $ � • <br /> FOR OFFICE USE ONLY: <br /> FRONTSETBA� / fiEARSEIAACK � SIOESEI94CN � PL4NCIIEC<NUMOEfl FEE REf�IPTNO. <br /> Z� � ,_ _Z ,�372, <br /> USE20NE LOTAREA VAC�NTSIIE FEES VALUATION y_�EE <br /> �r� " T <br /> � ou�;oiNr, ` � ; <br /> i TYPEOFCONIS.RLIOWABLE iVPEO�CONSL�CIU��. acun�vcr HOWNYOliN3uxn5 <br /> .. � f� PLUMBING ' /„3 i <br /> ��=�— <br /> SIZEO BLUG. NO.OFSTOf11E5 BA.: MEHT MECHANICAL O i <br /> l$53 +D S F D - , <br /> OCGUPAlCYLWO FIRESPRNHLEOSf1E0'D HEIGH�LIIAITAIION A�DITIONALPLANCHECK � <br /> �{�7� � <br /> I �! SPPINK(.ER i <br />, REASONFORSPIIINKLERS � <br /> S7A7E BUILDING SURCHARGE ' 6 <br /> iNunEer n�nusnrrnov�oev CITYOFEVERETi PUBLICWORKS /Zai — <br /> LOCAL SALES ' <br /> Q7 TAX COUE IS 3105 rora� � � ,O� <br /> � <br />