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APPLICATIC �7 FOR CONSTRU�T. )N PERMIT � <br /> TO BE GOMPLETED IN BLACK INK—PLEASE PRINT <br /> BUILDING DEFARTMENT HEl,TING SYS7EM: f►�GAS J ELECTRiC J .______ —__.—_ <br /> 259-8810 � <br /> DEMOLITION COMBiNATION BUILDING /MECHANICAL PI.UMBING SIGN <br /> OW R MMLRDURE55 CiTV l�P PNONE <br /> 'Y .� �R�Q�lN_/�bRc�lN aYa7 8�4(CEe �,�*9� ��a-7Yci <br /> LLNANt MML�ODFE55 CILV Zi' PNONE <br /> /FCNItF.GTORpE51GNEN MAIL�ODPE55 CIiV ZiC PHOhE <br /> G(NtR�LCONTRACTOR M�IL�ODRE55 OIV IP PHONE ST�TELICENSE• <br /> M/EC'N���N�iG�AI�GONiq11ClOR MaiI'�D�D/PE5`5 CCi'V ZiP VNONE St�tEIICENSE/ <br /> 1'1t11Ar/IL�(11�NG�� ��IlADO'�REj��N/1CT�e�� .c•/I�����.�£ldG�_�P '�����i �i "T !Nfs 6�fS��1lKI <br /> � <br /> CON'FRCT PRICE OF WORN � � <br /> 3, sty <br /> DESCNIBE WONH�NO SOU�RE FOOTAGE INVOIVE� LONI�LT PERSON AND PNONE NO/�,�„ _ �� �5.�' / <br /> (�fiJ//lr/M1 <br /> �l/��P�o�9a �u�lcc hEJT <br /> i HEREBV CERTIFY THAi I HAVE RFAD AND EXAMINED THIS <br /> PROi'�ED USE OF BUiLDING APFLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT.AlL <br /> /(/�j���C! PFIOVISIONS OP LAWS AND ORDINANCES GOVEFNING THIS 7YPE OF <br /> LEWLDESCRIPTIONOLPROPERiY�SNOWN9ElOWOR�TTACNiWOCOVIE51 WORK WILI. BF COidPLETED WITH WH.THER SPFCIFIED HEREIN OR <br /> NOT. 1'HE C,RANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br /> tot-- e�or:K c:� AUTHORITV TO VIOLATE OR CANCEL THE PROVISIONS OF ANV <br /> GTHER STATE OF LOCAL LAW REGULATING CONSTRUCTION OF THE <br /> - --— PERFOFMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED bV THE <br /> ON'�JER OF THIS PROPERTY TO PERFORM THE WORK FOR WHlCH <br /> — APPLICATION IS MADE AND I COMPLV WITH THE STATE <br /> PARCEL U%I D NUMPEN CONTRACTOPS lAW 1827 RCW AND 296200 WAC. <br /> CONSiRUCTION LO�N LE�•DER.ADDRESS.TEIEPHONE NUM�EN <br /> s_��•9y' <br /> PRWECTADDRE --- • ���nt �n.rt ---- <br /> —��a� 3a.�P� _ ���.P��=�,s:,,�E��,��, <br /> PLUMBINCi MECHANICAL <br /> N0. TYPE OF FIXTURE OR ITEM fEE NO. TVPE OF E�UIPMENT FEE <br /> WATER CLOSET ITOILET) A�C—A/NNDLG UNITS—H.P. <br /> BATHTUB FORCED AIR SYSTEIJS—B.T.U9 tA E.A. _�_ <br /> LAVATORV(WASH BAS'N) � UNIT HEATERFi--B.T.U. M _ I� <br /> SHOWEFI CLOTHES DRVERS ' <br /> KIiCHEN SINK d DISP VENTILATION FAN <br /> DISHWASHEF ANGE HOOD _ <br /> LAL'NDRV TRAY WATER HEATER � <br /> CLOTHES WASHER WOODSTOVE <br /> URINAL METAL FIREPLACE(WOOD BUiiNING) ' <br /> DHINNING FOUNTAIN � FIFEPLACE INSERT _ _T_ <br /> FLOOR bFAIN HEAT PUMP _ ' <br /> BACKFLOW PREVENTERS GAS PIPING _ � <br /> HOOF DRAINS—RAINLEADERS EXHAUST FAN _ <br /> SINK�SERVICE—BAR,ETC.) _ -- - - <br /> T- <br /> SUO TOTAL S _ SUB TOTAL S _____ <br /> PERMIT E PERMIT E _ __ <br /> TOTALKEE S TOTALFEE S ' <br /> FOR OFFICE U^E ONLY: <br /> FRONiSETBACN (1EARSET011CN SIOESETB�CN PUHCHE.K UM�ER fEF �ECEIPINO — <br /> S <br /> u«1oNe LO7AHEA V�G4NfSIiE FEES VAIUATION FEE_r_ <br /> ����. VES � �. NO yUILDING ' <br /> —�—__ <br /> 1VPF(f[�I!$1 NO Of SiOCICS CCNo4NCv N4 W pW1�CNi.i.A!5 -- <br /> L9°�''e pWMBING <br /> SIZFOFBLW FIRESVRIlIF�ERSPEO'� B�SEMENT MECHANICAL <br /> � � VES � � NO —'—" --��— <br /> hODIT10NAL PIAN CHECK <br /> OGLUP�NCYLOAp FIPkAURNREOD NEiCiHTIIMITRTION — <br /> OTHER <br /> —__ ----r-- <br /> RE�SON " — <br /> STATE dUILDING SURCHARGE <br /> ItITqxE BV PUNS�PPAOVEUAV CITY OP EVEREIT PUBLIC WORNS <br /> LOCAL SALES <br /> UA'E TAX CODE IS 3105 TaTp� ' <br />