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+ • ' {:.•.i (' �� <br />; ,APPLI�..�►TION FOR COMSTR�CTION <br />� PERNfIT <br />j IM Eve�p�cer, everell <br />? CiTY OF <br />� e���rett � <br />BUILDING DEPARTMGNT <br />i <br />259•8810 TO 6E COMPLETED IN INK— PLEASE PRINT <br />i <br />ABLHItEGtOR0E51GNEf1 MAILA�DRE55 CITY ZIP PNONE <br />1 <br />� GENERALCONTflACTOB MAIL�OORESS CI1Y 21P PHONE 4CENSGr <br />r.4.ti1 G �_� /� b O v�� . <br />MECH�NiC�IGONiqPCtOR MAIL��ORESS CIiY ZIP PNONE LIG[NSE• <br />i <br />� PLUMBINOCONiRRCiOR MFILADOPESS GiiV ZiP PNONE UCENSE� <br />p,i NEW ❑ ADDITION ❑ AITERAiION ❑ REPAIR ❑ DEAfOLITION ❑ WOODSTOVE/FRPL.INSEFT ❑ BUILDINGRELOCATION <br />iENFNTIMPl�OVEMENiORINiERIOHfiEMO�ELONLY CONIACTPERSON�NOPHONEIIO. <br />CONiRALTPFICEOFWORIt �(.i � d0 � �QN /�/N � 3..7 � ����-1 � <br />. �or � o�ocK oF <br />. i^ . / J' T .. <br />PLUMBIN6 <br />TYPE OF FIXTURE OR ITEM <br />CLOSET ITOILETI <br />SHOWER <br />KITCHEN SINK 8 DISP. <br />DISHWASHER <br />LAl1NORY TRAV <br />" NKING �OUNTAIN <br />� - UOR DRAIN <br />BACKFLOW PREVENTERS <br />ROOF DRAIh'S — RAI NLF.ADERS <br />ciuK recv�nnv _ aea rrrn <br />. SUB TOTAL <br />PERMIT <br />TOTAL FEE <br />� FFONTSETB�ICK REARSETpRCK <br />�° �� -- <br />USE20�Nj" LOTRPEN <br />-. I`' I �OG�Jc� <br />. TYPEOFCON9T. O CUPANCY�FOII( <br />ALLOWABLE/AG OAL _ �/ �� _ � <br />°2EOFBLD�. NO.OFSTOR!ES BSM <br />/3�y � ,QN <br />� FIREBPRINItLER9RE0UIRED ❑YES y�NO <br />i <br />$ <br />i �'�r 6 � <br />VACRNT SIiE <br />�I YES ❑ NO <br />I H EREBY GERTIFY THAT I HAVE READ AND EXAMIN ED THIS APPLICATION AND <br />KNO W TH E SAME TO BE TRU E AND CORRECT. ALL PROVISIONS OF LAWS AN D <br />ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLETE� WITH <br />WHETHERSPECIFIEO HEREIN OR NOT.THEGRANTINGOFA PERMITDOES NOT <br />PRESUME TO CaIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS Of <br />ANY OTHER S?ATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE PER- <br />FORMANCE OF CONSTRUCTION. TH,1T I AM AUiHORIZED BY THE 06VNER OF <br />THIS PROPERTV TO PERFOF.M THE WORK FOR WHICH APPLICATION IS Ml�OE <br />AND I CO�APLV WITH TIiE STATE CONTRACTORS LAW 1827 RCW AND <br />2�J6200 WAC. <br />SIGNRiUREOFCONiRAGIOHOR�UiMORIZEDNGENi �AiE 3 -�a- �ry <br />X �.- � /��� �' <br />APPI C� i5 CITY pUSME55 LI[ENSE NO. AHD B�/SWESS NAME <br />/ <br />MECHANICAL <br />NO. TYPEOFEQUIPMENT <br />A/C— A/HNDLG UNITS— H.P. <br />FORCED AIR SYSTEMS— B.T.U. M <br />UNITHEATERS—B.T.U. M,2�0 <br />/ CLOTHESDRYERS <br />T VENTILATION FAN <br />METAL FIREPLACE 8 <br />FIREPLACEINSERT <br />HEAT PUMP <br />GAS PIPING <br />� FEES <br />BUILDING <br />PLUMBING <br />MECHANICFL <br />OTHER <br />STAT[ BUILDING SUFiCHAflGE <br />STATE ENERCiY SURCHARGE <br />PUBLIC WORKS <br />TOTAL <br />SUB TOTAL <br />� 9 y� <br />C <br />FEE <br />_.....� -..._.._ ... . . ... .. . _ _ .. _ .. .. . . . . _. ... ....._... <br />Tn�•:.� . . . ��_ .: - . � � '-� . . . � . . . . .. <br />