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APPLICATIO" � FOR CONSTRUCT("N PERMIT <br />TO BE COMPLETED IN BLACK INK —PLEASE PRINT <br />BUILDING DEPARTMENT EATING SYSTEM: ❑ GAS U ELECTRIC U <br />259-3810 <br />F1 DEMOLITION G COMBINATION BUILDING U MECHANICAL ❑ PLUMBING LI SIGN <br />OWNER MAtI ADDRESS CITY ZIP PHONE <br />�F_1?e` : 54f x GIST `i'7� C�x eVFR5iT 48203 33q-q2z6 <br />TENANT MAIL ADDRESS CITY ZIP PHONE <br />M ► DOLE SagmL —It- <br />ARCHITECT OR CESIGNER MAIL ADDRESS CITY ZIP PHONE w L <br />A __III �_...N. - ia9"AI •.#L Qgo9jiml =lt7o I[T-?' 7cza-io <br />GENERAL CEO TOR <br />: <br />MAIL ADDRESS <br />27 <br />CITY <br />ZIP <br />x ��CcMn <br />PHONE <br />STATE LICENSE. <br />4 <br />d <br />/ - <br />l m <br />a- <br />MECHANICALCONTRACTOR <br />--%%%DV <br />MAIL AODRESS -� <br />CITY <br />YIP <br />HONE <br />STATE LICENSE. <br />PLUMBING CONTRACTOR <br />MAIL ADDRESS <br />CITY <br />ZIP <br />PHONE <br />STATE LICENSE <br />CONTRACT PRICE OF WOR gcoD� <br />DESCRIBE WORK AND SQUARE FOOTAGE NVOLVED <br />I <br />CONTACT PERSON AND PHONE NO, L L d9&x;p4XA <br />l or✓ATiaN P(.tiG�M a t <br />g <br />— Z 5 - <br />PDk 2401,E `-'A35�i�_J�F' <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br />PROPOSED USE OF BUILDING <br />APPLICATION AND KNOW THE SAME TC BE TRUE AND CORRECT. ALL <br />5c4twL C-tAS59M <br />PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br />WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br />LEGAL DESCRIPTION OF PROPERTY(SHOWN BELOW OR ATTACH TWO COPIES) <br />NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br />LOt BLOCK OF <br />AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br />OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br />- <br />PERFORMANCE OF CONSTRUCTION. THAT I AM AU HORIZED BY THE <br />---- <br />OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br />— <br />APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />CONTRACTORS LA .27 CW AND 296.200 WAC. <br />PARCEL TAX LID NUMBER 7� <br />CONSTRUCTION LOAN LENDEDEFL ADDRESS, TELEPHONE NUMBER <br />PROJECTADDRESS <br />SIGNATURE DATE <br />BUSINESS LICENSE NO <br />ZCITY <br />PLUMBING <br />MECHANICAL <br />NO. <br />TYPE OF FIXTURE OR ITEM <br />FEE <br />NO. <br />TYPE OF EQUIPMENT <br />FEE <br />WATER CLOSET (TOILET) <br />I <br />AIC—A/HNDLG UNITS—H.P. <br />_ <br />BATHTUB <br />FORCED AIR SYSTEMS—B.T.U. M E.A. <br />LAVATORY (WASH BASIN) <br />I <br />UNIT HEATERS—B.T.U. M <br />SHOWER <br />CLOTHES DRYERS <br />' <br />KITCHEN SINK & DISP <br />VENTILATION FAN <br />T_ <br />DISHWASHER <br />RANGE HOOD <br />' <br />_ <br />LAUNDRY TRAY <br />IWATER HEATER <br />_ <br />_ <br />CLOTHES WASHER <br />I <br />WOOD STOVE <br />URINAL <br />' <br />METAL FIREPLACE (WOOD BURNING) <br />' <br />DRINKING FOUNTAIN <br />FIREPLACE INSERT <br />_ <br />FLOOR DRAIN <br />HEAT PUMP <br />' <br />BACKFLOW PREVENTERF. <br />GAS PIPING <br />_ <br />ROOF DRAINS—RAINLEADERS <br />EXHAUST FAN <br />_ <br />SINK (SERVICE —BAR. ETC.) <br />I <br />' <br />SUB TOTAL $ <br />; <br />SUB TOTAL $ <br />PERMIT $ <br />I <br />PERMIT $ <br />TOTALFEE $ <br />' <br />TOTALFEE $ <br />FOR OFFICE USE ONLY: <br />FRONT SETBACK REAR SETBACK SIDE SETBACK <br />OT <br />PAN CHECK NUMBER FEE <br />VALUATION <br />RECEIPT NO. <br />FEE <br />USE zaNE <br />LOT AREA <br />VACANT SITE <br />I j YES �NO <br />FEES <br />BUILDING <br />' <br />TYPE OF CONST <br />L <br />�f <br />NO. OF STORIES <br />OCCUPANCY <br />GRav <br />NOMMLLINGUNGS <br />PLUMBING <br />MECHANICAL <br />I <br />_ <br />SIZE OF BLDG. <br />W <br />FIRE SPRINKLERS REO'D <br />Ilk <br />BASEMENT <br />F-, YES �T C NO <br />ADDITIONAL PLAN CHECK <br />; <br />' <br />OCCUPANCY LOAD FIRE ALARM REDD HEIGHT LIMITATION <br />3 NO <br />REASON <br />OTHER <br />� <br />STATE BUILDING SURCHARGE <br />' <br />PUBLIC WORKS <br />' <br />INTAKE BY <br />TDATE/���q¢ <br />PLANS APPROVED BY <br />��IiI <br />CITY OF EVERFTT <br />LOCAL SALES <br />TAX CODE IS 3105 <br />TOTAL <br />i <br />