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..,.�:_�_.._._ --_-- - __.�_. ..� <br /> APPLICATIOi_ FOR CONSTRUCTI+`N PERMIT <br /> TO BE COMPLETED IN BLACK INK—PLEASE PRINT �rr <br /> BUILDING DEPARTMENT HEATING SYSTEM: ❑GAS ❑ ELECTRIC ❑ <br /> 259-8810 <br /> ❑ DEMOLITION ❑ COMBINATION ❑ BUILDING �'INECHANICAL ❑PLUMBING ❑ SIGN <br /> OWNEj MAILADDRESS / CITV ZIP PHONE <br /> —L�J1iLa�c a.x.� cs 3a o /���`.� .� �be// g�vo� �s3 - �a� - <br /> TEIIANT MAILAODRE55 CITY ZIP PHONE <br /> O/S (n'\ 3 <br /> AflCNITECTOR0E51GNER MAILADDRE55 CIN ZIP PHONE <br /> GEVERALCONTRACTOR MAILADDPESS CITV ZIP ��JI'IOI�I/�.I STATELICENSE:1 <br /> � � � d ��J' .�.7 <br /> EC ICALCONTRACTOR MAILADDRESS CITY ZIP PHONE STATEUCENSEp <br /> PLUMBING CONTRACTOR MAIL A�DRE55 CIN ZIP PHONE S TE LICENSE N <br /> NTRACT PRICE CF WORK <br /> 0 <br /> DESCRIBE WORK NO SOUARE FOOTAGE INVOLVED pB/1i(��P RSON AtJj]PNO,N� . <br /> _(l (!°�I�cl. <br /> � HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br /> PPOPOSED USE OF BUILDING APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT.ALL <br /> PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br /> LEGALDESCRIPTIONOFPROPERTY�SHOWNBELOWORATTACHTNOCOPIES) WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br /> NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br /> �or BLOGK oF AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS Or ANY <br /> OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br /> PERFORMANCE OF CONSTRUCTION.THAT I P.M AUTHORIZED BY THE <br /> OWNE OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br /> PARCELTAXI.D.NUMBER APPL C TION � MADE AND I COMPLY WITH THE STATE <br /> CON R TORS W 18.27 RCW AN�296.200 WAC. <br /> GONSTPUCTION LOAN LENDER,ADDRESS,TELEPHONE NUMBER � � (� �/ — <br /> YLIJ��\ � ' <br /> PROJECT ADD E S E o�TE <br /> CItt6U51NE55UL NSENO. <br /> PLUMBING MECHANIC L <br /> N0. TYPE OF FIXTURE OR ITEM FEE N0. TYPE OF E�UIPMENT FEE <br /> WATER CLOSET(TOILET) � A/C—FVHNDLG UNITS—H.P. � <br /> BATHTUB ; FORCED AIR SYSTEMS—B.T.U. M E.A. � <br /> LAVATORY(WASH BASIN) � UNIT HEATERS—B.T.U. M ; <br /> SHOWER ' CLOTHES DRYERS � <br /> KITCHEN SINK 8 DISP � VENTILATION FAN � <br /> DISHWASHER � RANGE HOOD � <br /> LAUNDRYTRAY ; WATER HEATER <br /> CLOTHES WASHEFi � WOOD STOVE � <br /> URINAL ; METAL FIREPLACE(WOOD BURNING) � <br /> DRINKING FOUNTAIN � FIREPLACE INSERT ; <br /> � FLOOR DRAIN � HEAT PUMP � <br /> BACKFLOW PREVENTERS i GAS PIPING i <br /> ROOF DRAINS—RAINLEADERS � EXHAUST FAN i <br /> SINK(SERVICE—BAR,ETC.) • ; ' <br /> � � <br /> � ' <br /> SUBTOTAL S ; SUBTOTAL 5 � <br /> � PERMIT $ � PERMIT $ � <br /> TOTAL FEE $ ' TOTAL FEE $ <br /> FOR OFFICE USE ONLY: <br /> FRONTSE�BACK flEAR5ET6ACK SI�ESETBACK PLANCHECK UMBEB ^ FEE FECEIPTNC. <br /> r� <br /> c1- <br /> USEZOYE LOTAREA VACANTSITE FEES VALUw710N FEE <br /> �T <br /> ❑ YES ❑ NO BUILDING � <br /> TYPEOFCONSL NO.OFSTORIES OCCUPANtY NuovmYEluxGUxnS i <br /> cAour PWMBING i <br /> SREOFBLDG. FIRESPRMNlER5FE0'D BASEIdENT MECFIANICAL � <br /> C.� YES ❑ NO , <br /> OCCUPANCVLOAD FIREALAFMREO'0 HEIGHTLIlAITATION ADDITIONALPLANCHECK i <br /> i <br /> OTHER � <br /> FEASON <br /> STATE BUILOING SURCHARGE i <br /> INTAKEBY PLANSAPPflOVEDOY CITYOFEYEflETT PUBLICWORKS � <br /> �M LOCAL SALES <br /> DATE 10 C 6� � TAX CODE IS 3105 Tora� � <br />