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APPLICATIC� FOR CONSTRUC'T!�"►N PERMIT <br /> TO BE COMPLETED IN BLACK INK—PLEASE PRINT aj–`T <br /> BUILDING DEPARTMENT HEATING SYSTEM: U GAS ELECTRIC J ____—_ _� <br /> 259-8810 <br /> C I DEMOLITION � COMBINATIQN �.�� <. 1 �;9L1�LDING�9?:, r '� ( I MECHANICA4 . ;,�I PLUMSIMG __ SIGN <br /> OWNER MAIL�DDRESS Gr� 21P PHONE <br /> Ca�L � �c,,-:f �c<<% a16�i �.z/,�ti (t s'� ���d�.,: /i �s� _�_Y��� I:� <br /> TENFN7 MAIL AOORE55 CITY 21P 'HO'•. <br /> ARCHITECT OR OESIGNER MNl�OORESS CITY ZIP '��CNf , , <br /> LZRALCONTN4C�RI �r�I�DDRESS �A �-- �'-- _ . . . -- <br /> �— CRV ZIP PHOh': � � ST�TELICENSE7 � � <br /> L����o.�.r,fi��:'fr.,, L�,,� �/�'�'7 S/'7� ��.5�.'�" 8'odC�li l,�sA 9fl1�� ySts'-y.Jyy �:Cacuc �/Ss�' <br /> MECHANICALGONTRACTOR M ILACUPE55 CITY 21P PMONF STAi[LICENSEe <br /> • �����Q'��I <br /> PWh�BING CON7P^CiOR MAIL A��RESS GTY ZiP P110NE STATE LIqfiNSE a '. <br /> ��.��-� /��c�Cai� i�L,••<.�.� — <br /> CONT ACT PRICE Of WOFK <br /> /.32�� � -- <br /> DESCRIBEWORKANDSOOAREFOOTAGEINVOWED CONiACTPER50N(ydDp MQIJENO. - <br /> �"/ec C ///S ���6 - ' ����� <br /> / / C , <br /> C U��.S�l�C1c� /��I-t✓ J.n q �f. – cr s•.,.L; --- <br /> /� . <br /> I'�J/oCd�C.C- �� / O � i HEREBY CERTIFY THAI' I HAVE READ AND EXAMINED TFIIS <br /> PROPOSED USE OF�UILD� APPLICATION AllD KNOW THE SAME TO BE TRUE AND COFREGT.ALL <br /> _Si�y L( tl-c<<"�%� �-✓��t-c-c.. PROVISIONS O� LAW�i AND ORDINANCES GOVERNiNG THIS TYPG OF <br /> LEGFLDE RIPTIONJFPROPERTV�SH6WNBELOWORATTACHTWOCOPIES) WORY. WILL 8E COMPLETED WITH WHETHER SPECIFIED HEF�IPf OR <br /> "7 ;> f.'1 .� ._� NOT. THF 6RhNTING OF.A PERMIT DOES�NOT PRESUME TO GIVE <br /> �oT—L�— BLocN - oF J.GL(L qUTHORITY TO VIULAI E OR C.4NCEL THE PROVISIONS OF AN'/ <br /> �7G����1 r�� �/ ��.�� ������ • � OTHER STATE OR LOCAL lAW REGULATI�G CONSTRUCTION�OP THE <br /> PERFORMANCE OF CONSTRUC� )N.THAT I AM AUl�iORIZED BY THE <br /> UWPiFR OF THIS PROPERTY TO PERFOFM�THE WORK'FO4, VJIiICH <br /> . APPLiCATION IS MADE AN0.�1 COMPLY WITH .,THE STATE <br /> rnace�rnx i.o.NUMeea ,, CONTRACT�RS LAW 78.2?RCW AND 290200 WAC. � '- ' <br /> CO([��^TRUCTIONLOANLENDER.A�DRESS,TELEPNONE NUM�ER ���'I ^ 'n <br /> �J E�G d % � ?4.:l _ �_ /f' �'�_iC/��'N e�� nar[� �x 7� <br /> PROJECT ADDflESS � ,[',,q/ � , ��. , ' ?'c"^''.!E . .. ,' � <br /> SSO� J //t�-p !iC/ snvn�:.s�.nr:;i�::r�s[r:o. <br /> PLUMBING �dECMAN�i;l.L <br /> NO. TYPE OF FIXTURE OR ITEM FEE NO.; ��'� 7YPE OF EOUIPMENT FEE <br /> 3 WATER CLOSET(TOILET) � NC—AiHNDLG UNITS—H.P. ' � <br /> y'� BATHTUB '� � �FORCED AIR SYSTEMS—B.T.U. M E.A. �_ <br /> 3 LAVATORY(WASH BASIN) � UNIT HEATERS—B.T.U. M � <br /> / SHOWER ' I CLOTHESDRYERS <br /> / KITCHEN SINK&DISP -- � �' ' � ' ' I � 'V�NTILATION FAN �_ <br /> j DISHWASHER � RP.NGE HOO'J <br /> j LAUNDRY TRAY ; / WATER HEATER __y_ <br /> J CLOTHES WASHER �WOOD STOVE � <br /> URINAL �. �:� �i .•, / � : i METAI FIREPLACE(WOOD BURNING) ,�jD 'OD <br /> DRINKING FOUNTAIN • FIREPLACE INSERT � <br /> T <br /> FLOOR DRAIN ' HEAT PUMP . ; <br /> BACKFLOW PREVENTERS � ,I, GAS PIPINa � <br /> ROOF DRAINS-RAINLEAD'cRS � �EkHAUST FAN � <br /> SINK(SERVICE-BAR,ETC.) <br /> U �do <br /> — - � <br /> -- � --� <br /> SUB TOTAL $ SUB TOTAL //D ; �O <br /> PERMIT S PERMIT G _ <br /> TOTALFEE $ TOTALFEE 5 _ <br /> FOR OFFICE USE QNLY: �I9 �� <br /> J <br /> FRONTSETBAC� / REAflSETB�CK / SIDESETBAC�t •�i/rP'.�NCMEC(�� N FEE � 7� RECEIPT��� ` <br /> `u- � � p -- !J <br /> uSezoNe � LOTAFEA v:.^.nNr e FEES VALUATION PEE <br /> j� l! YES ' ' NO 0U:_D��dfi ��/n _ �� ' OC� <br /> TV OFCC Si NOAFSTORIE OCcuvautv rmovo+iE��u:r,�,r.nc �'F <br /> _ � 40� � PLU ABING - � � O�-� <br /> —_. <br /> � F9LD5� � FlRESPPINKLERSREO'D BASEM- T . MECiiAi!ICAL � <br /> ves ! No llD , OD <br /> ��� t ��� Nv ADDITIONAI.PI AN CHECK �p� i//� <br /> CGCUPANCYLOAD FIREALARMREOD MEIGMT�Ih9�ATI0NJ _ _. / <br /> ��_ /�/(� � OTHER �:� ' t�C�' <br /> PEASON <br /> STATE BUILDIIJG SURCHAF7GE <� <br /> _--- i <br /> INTFKE BY P�ANS�P°�n�E��� CITY OF EUERETT PUBLIC WORY.S '� i -, � <br /> �'j� LOCAL SALES —�— <br /> �. � 'c� TAX CODE IS 3105 TOTAL �> ; � � <br /> � <br />