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APPLICATIC J FOR CONSTRUCT'lN PERMIT <br /> TO BE COMPLETED IN BLACK INK—PLEASE PRINT � <br /> BUILDING DEPARTMENT � ^GATINu SYSTEM: U GAS ❑ELECTAIC U <br /> 259-8810 <br /> f 1 DEMOLITION !i� COMBINATION i I BUILDING I 1 MECMANICAL ❑ PLUMBING ❑ SIGN <br /> OWNEP A1�IlA0DRE55 CITV IIP PNONE <br /> W1�l�AN CAMP/�F�c 23z5 h+ `vov��c. �vE�Ear 252- �yq� <br /> TENANT MAIL�DORE55 GTV 21P PIqNE <br /> ARCHITECTORDESIGNEF M�IL�ODPE55 CITV 21P PNONE <br /> NA�Q9�N (.aNST <br /> GENERAL CONTRACTOR M�I��ODFE55 CiTY ZIP PNONE STAT:LICENSE� <br /> /✓At./�.A� coN.S'�. 1/ 32 {I��NL?Na 9t.� E���c'61T Gvl�, tiS�i 2St-�YSo N9VS�7�'X L3acy <br /> MECNANIGIL GONTR�CTOR M�IL�DORE55 GTV ZIP PNONE ST�Tf IIGENSE I <br /> PLUMBINGCONTR�CTOP M�ILAODRESS CITY 21P PHONE SfATEIIGEN5E1 <br /> OAvE .9nf_ BYII on(ic fv T W ui �S�- 0 O�v SSP1la��ISVc _ <br /> CONTMCi FRICE OF WORK <br /> 3p Ooo - <br /> UESCRIBE YNi1N AND SCMIARE FOOUOE INVOIVED CONTRCT PERSON AN�PHONE NO <br /> �f1/1RY 9�/Sa4r iSi-7 s:� <br /> R� 9� fRE OAhAL_ - � r SI!n r _ <br /> i HEREBY CERTIFV THAT I HAVE READ AND EXAMINED THIS <br /> PROPOSEO USE OF B111101N0 APPLICATION AND KNOW THE SAME TO BE THI,E AND CORRECT.ALL <br /> R� slA��l t PROVISIONS OF LAWS AND OPOINANCES GOVERNIN6 THIS TYPE OF <br /> LEOALDESCHIPiIONOFPROPERNISNOWNOEIOWORATTACNTN'OCOPIES� WORK WILL BE COMPLETED WITH WHETHEF SPECIFIED HEqEIN OR <br /> NOT. THE GHANTING OF A PEFMIT DOES NOT PRESUME f0 GIVE <br /> tor i'� BLOCK �� or AUTHORITY TO VIOLATE OR CANCEL THE PFlOVISIONS OF ANY <br /> C��TUL N�LC AOO/ T/or� OTHER STATt OR LOCAL LAW REGULATING C�NSTRUC710N OR THE . <br /> PERFORMANCE OF CONSTRUCTION.THAT I AM AUTHORIZED BV THE <br /> OWNER OF THIS PqOPERTY TO PERFORM TNE WORK FOR WHICH _ ti <br /> APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> PARGEL TA%I D.NUMBEN CONTRACTORS LAW 1827 RCW AND 296200 WAC. <br /> � �QD <br /> CONSTNUCTIONLOANIEN�ER ADDRESS,TELEPMONENUMBEP � �v`// �JA ^ ' .� <br /> 4w�asl.� S-N-yy <br /> PR0.IECT ADDRES s��c "r"^E � � °uF � � ���:�:� <br /> 2ti zB g9 NER CitYflU5ME55liCENSENO <br /> PLUMBIN MECHANICAL � <br /> NO. ITEM FEE N0. TYPE OF EOUIPMENT FEE <br /> WATER CLO (TOILET) N�NHNDLG UNITS—H.P. � <br /> BATHTUB ; fORCEDAIRSYSTEMS—B.T.U. M E.A. � <br /> LAVATORY(WASH BASIN) i UNIT HEATERS--BS.U. M � <br /> --� <br /> SHOWER ' � CLOTHESDRYERS � <br /> KITCHEN SINK 8 DISP � VENTILATION FAN ; <br /> DISHWASHER � RANGE HOOD � <br /> � LAUNDflYTRAY ; WATER HEATEfl ` <br /> CLOTHES WASHER � WOOD STOVE � <br /> URINAL METAL FIREPLACE(WOOD BURNING) � _ <br /> DRINKING FOUNTAIN FIREPIACE INSEflT i <br /> FLOOF DRAIN HEAT PUMP � <br /> BACKFLOW PREVEN7ERS ; GAS PIPING � <br /> ROOF DRAINS—RAINLEADERS � EXHAUST FAN � <br /> SINK(SEHVICE—BAR,ETC.) ; ' <br /> � ; <br /> � <br /> � � <br /> SUB TOTAL S SUB TOTAL S <br /> PERMIT S PERMiT S � <br /> TOTAL FEE $ TOTAL FEE S ' <br /> FOR�1FFICE USE ONLY: <br /> FRqITSETBALK REAPfiETBACN SIOESETBACK PIANCHECKNIIM9ER FEC RECEIPTNO. <br /> USE 20NE LOT 11RE� VAC�NT SITE F ES VALUATION FEE <br /> ❑ YES ❑ NO BUILDiNG � � <br /> nr�acoNsr NOOFSTOf11E5 ac�a�c. xoarMw��x�rs <br /> cnouv pLUM81NG � � <br /> i <br /> SIZEOFBl00. FIRESPRINNLERSREO'0 BAS{MENT MECHANICAL � <br /> n ves r� No , <br /> OCCUP�NCVLOAD FIREAURMREO'D HEIONTLIMIi�TION AD�ITIONAIPLANCHECK j <br /> OTHER � <br /> i <br /> NEAuON �— <br /> Sir1TE BUILDING SURCHARGE _ � <br /> INTANEBY PIANSAPPROVE09v CITY OF EYEREIT PUBLIC WORKS � <br /> LOCAL SALES � <br /> OAiE TAX COUE IS 3105 TOTAL � I _ <br />