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��E �,�Klc2 <br /> APPLICATId' FOR CONSTRUCT�N PERMIT � <br /> TO BE COMPLETED IN BLACK INK—PLEASE PRINT <br /> BUI�DING DEPARTMENT HEATING uYSTEM: U GAS U ELECT9IC �j"���I�Zi \n-��LCI <br /> 259-8810 <br /> DEMOLITION COMBINATION BUILDING MECHANICAL PLUMBING SIGN <br /> OWNER� JC RI�II�ODRE55 CITV ZIP PHONE ��ti -�-SS'S'S <br /> '�A� ?A�T�'�S 6s9 f'lusK�F SFiCoT' GieuE LA Co�..a.�cy2,w�l 9B2s�7 <br /> TENANT M�ILA�DRE55 CITY 21P PHpNE <br /> �LY�Gi�.�E A�S ^ Z4 N�rT IIS wEST CAS�..�O �P� EVE17e�w� `T S�oZ <br /> 1�IS1111!'�WDESiGNEil�y�y„;MRILADDRE55 CITY ZIP PHONE �Z���483' �Ey7 <br /> IQD✓A�.JC.Ft7 �P� l��oT�crrc��,.2�.x. t�0 C 5 WooD�,�vILLE.WA `IRO72 <br /> OENER�I CONiR�CTOR MNl�DDNESS GTY 21P PHONE ST�TE LICENSE� <br /> �aa�n,.�F,>,�9 s[� <br /> MECNANICQCONTR�GTOR MMIRDDNE55 CITv IIP PHONE STATELICENSE� <br /> PLUMBINGCONTR�CTOR M�IUDDRESS CIiV 21P PNONE STATEIICENSE� <br /> CUSS OF WORK . <br /> NEW I ' ADDITION � � ALTERATION REPAIR DEMOlITION WOODSTOVE/FRPL INSERT �. ' BUILDIIJO RELOCATION <br /> CONUCT PEFSON�ND PHONE NO. �.y <br /> CONTP�GT PRICE M WORN 1 - � - Sbs" 1 <br /> DESCHIBE W0111(�ND 6IX1ARE FOOT��E INVOIVED <br /> �Q.�� F�TCE �ZDTE �nJ C <br /> PROPOSEOUSEOFB�IRDMG I HEREBV CEHTIFV THAT I HAVE READ AND E%AMINED THIS <br /> Z q U�Z��r a f�A Q S APPLICATION ANO KNOW THE SAME TO BE THUE AND CORRECT.ALL <br /> LE�AL DESCflIPTION Cf 1'RO?ERTY�SHOVR!BELOW ON ATTACH FWR COPIES� PROVISIONS OF IAWS AND ORDINANCES GOVERNING THIS TYPE OF <br /> WORK WILI BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br /> �o* ei.ocK ___ oF NOT. THE 6RANTING OF A PERMIT DOES NOT PRESUME TO OIVE <br /> AUTHORITV TO VIOLATE OH CANCEL THE PROVISIONS Of ANV <br /> OTHER STATE OR LOCAL LAW REGULATINd CONSTRUCTION OR THE <br /> — — PERFORMANCE OF CONSTRUI:TION.THAT I AM AUTHORIZED BY THE <br /> OWNER OF TH�S PROPERTV TO PERFORM THE WORK FOR WHICH <br /> — — APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> CONTRACTORS LAW 1827 RCW AND 296200 WAC. <br /> x � �aue 'S-19-94 <br /> PR0.IECP��]DDPESS 6iaHnURE w�E <br /> IC7� �� �G7 � � CItYBU9MIfB4lICEN5EN0 <br /> PLUMBINO MECHANICAL <br /> Np, TYCE OF fll(TURE OR ITEM FEE NO. TYPE OF EOUIPMENT FEE <br /> WATER CLOSET(TOILET) � NC—A/HNDLG UNITS—H.P. <br /> BATHTUB ; FORCED AIR SYSTEMS—B.T.U. M E.A. ' <br /> LAVATORV(WASH BASIN) � UNIT HEATERS—B.T.U. M � <br /> SHOWER ' CLOTHES DRYERS <br /> KITCHEN SINK 6 D'SP � VENTILATION FAN � <br /> DISHWASHER � RANOEHOOD _ � <br /> LAUNDRVTRAV ; WATERHEATER <br /> CLOTHC-5 WASHER � WOOD STOVE � <br /> URINAI. METAL FIREPLACE 6 CHIMNEV ' <br /> DRINKIN6 FOUNTAIN � FIREPLACE INSERT � <br /> FLOOR ORAIN � HEAT PUMP ' <br /> BACKFLOW PREVENTERS ; GAS PIPING ' <br /> ROOF DRAINS—RAINLEADEPS E%HAUST FAN � <br /> SINK(SERVICE—BAR,ETC.) ; � <br /> � . � <br /> �Ar <br /> � <br /> � <br /> i <br /> � SUB TOTAL S ; SUB TOTAL S ' <br /> PERMIT S PERMIT S � <br /> TOTAL FEE E TOTAL FEE S <br /> —•— <br /> FOR OFFICE USE ONLY: <br /> FNONTSETB�CIt REARSfTBACN SIDESF.TBACK PUNCHEG NUMBER fEE REGEIPTNO <br /> ��c�v 91��s os�3 <br /> use ra+e LOT AflE� V�C�NT SITE FEES VALUATION FEE <br /> BUILDING � <br /> ttK Of GON'S�IIOWABIE ��PE Of LaN51�CiWil Ottuwxc� Mo a oxnuMa Wns i <br /> �"W° PLUMBING <br /> SREOFBLIX3 NOOF6TORIES BASEMENT MECHANICAL ' <br /> OCCUP�NCV LOI10 FIPE SPRNNLERS REO'D NEqHi IIMIT�TION ADDITIONAL PLAN CHECN i <br /> SPRINNIER �� � �Z� <br /> PE�SON FOR SPNINItIERS i <br /> STA1E BUILOING SURCHARf,E � <br /> IN1�ICE Bv PLAN �VPROVEO BY CITY OF EYERE7T PUBLIC WORNS i <br /> � Rr LOCIIL SALEB <br /> � . �� �.� TAX CODE IS 3105 ror�� I �—� ;ST� <br /> - � 9 <br />