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APPLICATIC& FOR CONSTRUCT4pN PERMIT ;,, <br />TO BE COMPLETED IN BLACK INK -PLEASE PRINT <br />BUILDING DEPARTMENT I HEATING SYSTEM: AS J I I ECTRIC Ll ] <br />259-8810 <br />11 DEMOLITION fCOMBINATION i%B�U.IL�IADIING_ MECHANICAL 110 <br />/ 4 �(�/PLUM(///�'BIN/NG (VVf 1I/I S!GN <br />4A4 1'N'�8l d ^�� �� WE\TI•�1 try 11 /f1hV�[E�^`J� =L fY�T <br />S5 A L L. .AAA (6x C IE.�liv\[ (L 1-. -1 X ). V" L L I 1 �O <br />M <br />4fc14NK.1t CMIFWNIR 4ALAawESS clir m M1[lNf STATE mew <br />RUIwBC°NiRACIaI MA4 A8a1f88 cRr tP PIa1E 57ATf LCEMfr <br />I \K �1�i11Ytxw_ <br />°EecN A�.w.aLvfP <br />ccwTUTrtRs°N.N°wnNE Tq <br />(�u <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br />APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. Al L <br />PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br />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 OR CANCEL THE PROVISIONS OF ANY <br />OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br />PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br />OWNER OF THI PR PERTY TO PERFORM THE WORK FOR WHICH <br />APPLICATI O 1 AOE AND 1 COMPLY WITH THE STATE <br />CONT T B.27 RCW AND 2DS200 WAC <br />T•TorosEP uEE a euA w° <br />LEMI WWTMM r Rtr ISTowN KIM ATT" <br />yq[ : <br />tm "� BIfCK fV <br />E�, 1� <br />a I�D - 000 -�z l7DD <br />rATnfuAAm HlwwfR <br />C4N5IRLICtM Ld LEA()ER. ABft% tfttw MAAKR <br />PRE JECT ADDRESS <br />CIdqF9 <br />C- <br />.RwncL..v .a <br />PLUMBING <br />MECHANICAL <br />NO. <br />TYPE OF FIXTURE OR ITEM <br />FEE <br />NO. <br />TYPE OFMEQUIPMENIT77E�E�WATER <br />CLOSETITOILEF) <br />ATrMINDLO UNIBATHTUB <br />FORCED AIR SYSTLAVATORY(WASH <br />BASIN) <br />UNIT HEATERS-B.SHOWER <br />CLOTHES DRYERS <br />KITCHEN SINK 6 DISPVENTILATION <br />FAN <br />DISHWASHERRANGE <br />HOOD <br />LAUNDRY TRAY <br />WATER HEATER <br />CLOTHESWASHER <br />WOOD STOVE <br />URINAL <br />METAL FIREPLACE <br />DRINKING FOUNTAIN <br />FIREPLACE INSERT <br />FLOOR DRAIN <br />HEAT PUMP <br />BACKFLOW PREVENTERS <br />GAS PIPING <br />ROOF DRAINS-RAINLEADERS <br />EXHAUST FAN <br />I <br />SINK (SERVICE -BAR, ETC) <br />SUBTOTAL f <br />SUBTOTAL $ <br />PERMIT f <br />PERMIT f <br />TOTAL FEE f <br />TOTAL FEE f <br />FDA OFFICE USE ONLY: A.. ELn n 11-14-dil to wl. �.2) <br />ERCwt 9E018KJ1 <br />REM)go <br />6f[SFt <br />RwIG1F 4 N <br />3 <br />f[F.�� <br />(/ice <br />REUP d <br />usEr <br />tOTMEA <br />Vu TSITE <br />-' YES - NO <br />FEES <br />VALUATION <br />FEE <br />PLUM1q l~ •� <br />nuA BIND <br />!A//J 7�.r <br />II11af.YNft <br />�JIJ <br />FAD msm4s <br />2 <br />m: . tlR[nK�IAEYrn <br />3 <br />t <br />fwf SmMLfRE PEOD <br />NO <br />MENT <br />C YES %C NO <br />MECHANICAL <br />— <br />AUgTIONAL PUN CHECK <br />�= <br />x 0A0 <br />ENf AIATW PF°0 <br />E5 <br />NF18NI lENi <br />OINER <br />R1A50 .'Aw1 <br />STATE BUILdNO SURCHARGE'co <br />winter HANs�erwvf°m <br />VrA <br />CITY OF FVERETT <br />LOCAL SALES <br />TAX COCE IS 3105 <br />PusLK:w Ks <br />TOTAL <br />