Laserfiche WebLink
OH <br />L Iv <br />JD P H <br />4 <br />HH <br />ca <br />0 t7 cn <br />E C=1 <br />HUK <br />(ho Ecolornvn <br />CITY OF <br />eve-rett <br />BUILDING DEPARTMENT <br />259.8810 <br />APPLIGATI®N FOR CONSTRJC TION <br />PERMIT <br />E <br />� <br />TO BE COMPLETED IN INK-- PLEASE PRINT _ <br />TENANT MAILADDRESS r� CITY ZIP <br />1 O "tom SF LC�T6D <br />GENEMLCONTRACTOR MAIL ADDRESS CITY 21P PHONF LICENSE <br />MECHANICAL CONTRACTOR IL ADDRESS CITY ZIT PHONE LICENSE• <br />PLUMBING CONTRACTOR MAILADDRESS CRY ZIP PHONE LICENSE <br />r-I .. 1-1 n mnu rI WnnMQTnvF/PRPI INSFRT ❑ BUILDING RELOCATION <br />TENANT IMPROVEMENT OR I.Iff+�ERIOR REMODEL ONLY <br />CONTRACT PRICE OF WORK" <br />CONTACT PERSON ANDPHONENO n <br />DESCRIBE WORK AND SQUARE POOTr UE IN LVED <br />ADD(T L <br />PROPOSED USE-%uc U DING <br />'p>u(1.011-DG <br />I HEREBY KNOW THE NSOFATIONAWS AND <br />SAME THAT IHAVE READ CORK CT.ALEXAMIN D THISPROVISIONS AND <br />ANDCOR FWOR L ILLBEICOMPLE COMPLETED <br />KNOWGOVE GOVERE TRU NING <br />ORDINANCES GOVERNING THIS TYPE H WRANTIN OF PERMIT DOES <br />WHETHERSPEC] FIEDHEREIN OR NOLTHEGRANTING OFAPERMITDOES NOT <br />PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF <br />ANYOTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE rER- <br />FORMANCE OF CONSTRUCTION, THAT I AM AUTHORIZED BY THE OWNER OF <br />THIS PROPERTY TO PERFORM THE WORK FOR WHICH APPLICATION IS MADE <br />AND 1 COMPLY WITH THE STATE CONTRACTORS LAW 18.27 RCW AND <br />288.200 WAC. <br />SIGNATURE OFGON RORAUTHORIZED E DATE <br />Ff-/G •E9 <br />LEGAL DESCRIPTION OF PROPEfl1YISHOWN BELOW OR ATTACH FOUR COPIES) <br />1IEL.un�e�! <br />rL'1 ILri211/ HT1Yy\l+ <br />LOT BLOCK OF - - <br />2 <br />-75 o�- CvG�L�Ps WA <br />PR OJEC!M1DORESS <br />t_'Q C�� v I o <br />Ap CANS USSI ENSE NO AND BU N NAME <br />PLUMBING <br />MECHANICAL <br />NO. <br />TYPE OF FIXTURE OR ITEM <br />FEE <br />NO. TYPE OFEOUIPMENT <br />FEE <br />WATER CLOSET (TOILET) <br />A/C — A/HNDLG UNITS — H.P. <br />BATHTUB <br />FORCED AIR SYSTEMS— B.T.U. M EA <br />LAVATORY (WASH BASIN) <br />_ _ <br />UNIT HEATERS—B.T.U. M <br />SHOWER <br />CLOTHES DRYERS <br />KITCHEN SINK & DISP. <br />VENTILATION FAN <br />DISHWASHER <br />RANGE HOOD <br />LAUNDRYTRAY <br />WATER HEATER <br />CLOTHES WASHER <br />WOOD STOVE <br />URINAL <br />METAL FIREPLACE& CHIMNEY <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 />SINK (SERVICE — BAR, ETC.) <br />SUBTOTAL <br />$ <br />SUBTOTAL $ <br />PERMIT <br />S <br />PERMIT S <br />TOTAL FEE <br />$ <br />TOTAL FEE S <br />FRONT SETBACK <br />REAR SETBACK <br />SIDE 9ETBAGK <br />PLAN CN CK NUMBE$,� <br />/O'YL <br />FfEO�� � <br />BECE�ND. <br />M,J'�YFE/�E/E <br />USEZONE <br />— <br />LOTAREA <br />VACWTSITE <br />O YES h O <br />6' <br />FpFEE_ESiJ <br />VALUATION <br />BUILDING <br />TYPE OfCONST. <br />ALLOWABLEJACTIIAv-"I_ 1 <br />� <br />OCCUPANCYOROUP <br />o - 2 <br />NO.Of DWELLING UNITE <br />-6- <br />PLUMBING <br />SIZEOFBLOO <br />6 F'4vv <br />Na CFSTORIES <br />' <br />BSML <br />Y <br />OCO LOAD <br />C/O <br />MECHANICAL <br />OTHER <br />FIRE SPRINKLERS REQUIRED DYE& NO <br />HEIGHTLIMITATION <br />STATE BUILDING SURCHARGE <br />T <br />C^) <br />APPLICATION ACC BY PUNS APPR BY <br />aPUBLIC <br />STATE ENERGY SURCHARGE <br />WORKS <br />TOTAL <br />''II <br />