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APf��.ICAT10 : FOR CONSTRUCT; )N PERMIT <br /> TO BE COMPLETED IN BLACK INK-PLEASE PRINT ������ <br /> BUILDING DEPARTMENT HEATING SYSTEM: � GAS U ELECTRIC ❑ <br /> 259-8810 <br /> DEMOLITION COP.781NATION BUILDING MECHANICAL PLUMBING SIGN <br /> OWNER MFILADDRE55 CITY ZIP PHONE <br /> �'rui��e �SrtQ � t /ol �{ - �U�'J S.� �� . ��iS-!53 <br /> TENA 7 MAILAODRESS CITV ZIP PHONE <br /> ARCHITECTORDESIGNER MAILA�DRESS CITV ZIP PHONE <br /> GENERFLCONTRACTOR �,1NLqODRE55 CITY ZIP PMONE STATELICENSEY <br /> idECHANICAL CO/NI Rq�CTOR MFIL AODRESS � " ,� IiV IP PMONE STATE UCENSE a <br /> �?�� ��Su,tl•�Noc/lGG�/a�iur�i�lJa� �/l�irurl�/�/a fdv7L �s " 7Ho�r,�1/,�ao&'4,tt� <br /> P�Uld91NG CONTRFCTOF ✓� IAAIL qDDRE55 CITV ZIP PHONE STFiE LICENSE n <br /> - CLA55OFWOFK - <br /> � NEW . ' ADDITION / A�_TERATION . : REPAIR � DEMOLITION WOODSTOVE/FRPL INSERT � - BUILDING RELOCATION <br /> CONTACT PENSO AND PNONE NO. <br /> CONTRACT PRICE OF WORK /�� �U/ . ./��� <br /> DESCBIBEWOFHANDSOUAREF TAGEINVGLVED a�� E <br /> O � � � l(r!i <br /> aaoaosEouseoFeuaoinc i HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br /> APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT.qLL <br /> LEGALDESCRIPTIONpFPqOPERN�SHOWNBELOWORATir1CHPOURCOPIES� PROVISIONSOFLAWSANDORDINANCESGOVERNINGTHISTYPEOF <br /> WORK WILL 8E COMPLETED WITH WHETIiER SPECIFIED HEREIN GR <br /> �or e�ocK oF NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br /> � AUTHORITY TO VIOLATE OR �ANCEL THE PROVISIONS OF ANY <br /> OTHER STATE OR LOCAL LAW qEGULATING CONSTRUCTION OR THE <br /> PERFORMANCE OF COIJSTRUCTION.THAT I AM AUTHORIZED BY THE <br /> OWNER OF THIS PROPERTY TO PERFORM THE WORN FOR WHICH <br /> APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> CONTRACTORS LAW 18.27 RCW AND 296200 WAC. <br /> - S: �' - . �;�r�' f]/ <br /> PflOJECTA00PESS Smrvnru�E r qj��� <br /> cirv ou—girv�ss ucEHSE rvo <br /> PLUMBING MECHANICAL <br /> N0. TVPE OF FiXTURE OR ITEM FEE NO. TYPE OF EOUIPMENT FEE <br /> WATER CLOSET(TOILET) AIC—NHNDLG UNITS—H.P. ; <br />�� � AATHTUB _ ' � FORCED AIR SYSTEMS—B.T.U. M E.A. � <br /> � LAVP,TORY(WASH BASIN) I UNIT HEATERS—B.T.U. M ; <br />�. SH9WER � CLOTHES DRYERS <br /> KITCFIEN SINK 8 DISP I VENTILATION FAN � <br /> CISHWASHER RANGE HOOD <br /> LAUNDRYTRAY ; WATER HEATER � <br /> CLOTHES WASHER � WOOD STOVE ' <br /> URINAL ' METAL FIREPLACE&CHIMNEY � <br /> JRINKING FOUNTAIN I FIREPLAC[ INSERT � <br /> . FLOOR DRAIN HEAT PUMP , <br /> BACKFLOW PREVENTCRS GAS PIPING � <br /> flOOF DRAINS—RAINLEADERS EXHAUST FAN � ; <br /> ' SINK(SERVICE-3AR,ETC.) � , <br /> � <br /> ' � <br /> � <br /> SUB TOTAL S ; SUB TOTAL $ 1 <br /> PERMIT $ � PERMIT $ <br /> TOTALFEE S TOTALFEE � � <br /> FOR OFFICE USE ONLY: <br /> FRONTSETBALK REFPSETBACH SI�ESETBACK PLANCHECKNU1dBER FEE{� /' RECEIPTNO. <br /> / v <br /> usezoNe LOTAREA VACANTSITE FEES VALUA ON FEE <br /> BUILDING � <br /> i <br /> TVPEOFC01li5.ALl0VlABLE iYP[UFWNSi.Af,iUAL actuPnxCY anCrpwEw9Gm;rt5 <br /> cwouo PLUMBING � � <br /> SREOP9LDG. NO.OFS70FIE5 BASEIACNT MECHANICAL i <br /> OCCUPANCVLOAD FIRESPPNKLERSREOD HEIGNTLRdITqT10N AODITiONALPLANCHECK � <br /> SPRINKLER � <br /> REASONFORSPqINKLERS _ —�_ <br /> STATE B W W ING SURCHAqGE � <br /> INTAKEBY PLA�ISAFPqOVEDOY CITYDFEVERETT PUBLICWORKS � <br /> LOCAL SALES ' <br /> TAX COUE IS 3105 TOTAL ; <br />