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APPLICATIO:: FOR CONSTRUCTl�N PERMIT <br /> TO BE COMPLETED IN BLACK INK—PLEASE PpINT � <br /> BUILDING DEPARTMENT HEATWG SYSTEM: ❑GAS p ElEC7RIC ❑ <br /> 259•8810 <br /> IJ DEMOLITION f7 COMBINATION I i BUILDIN(i CIMECHANICAL �WMBIN(i ❑ SIpN <br /> ��Ep MAIL�DDRE55 <br /> GTY 21P PMONE <br /> �InY �n <br /> TENANT M�IL�DDRE55 <br /> CITY zIP P1qNE <br /> APCNIiECTOPDE5IGNER MAIL�DDRE55 CITY ZIP PIIONE <br /> OENER�LCONTPACiOR M�ILADDRESS CITV 21P PNONE STATELICENSE/ <br /> • <br /> MECNANIOA�LONTq�CTOR MAIL A6DRESS qTY ZIP PNONE Si�TE LICENSE I <br /> w a. �,-.-�� Po. Enx �3a� ��rT� Qei3� 36�-0�0 <br /> PLUI.IBINOCONTMCTOH MAILADDRE55 q{y z�p PIqNE 8T�{���Ng�� <br /> CONTqAGi PRICE OF WOPN <br /> DE5CPIBE WOHK AND SOUARE FOOT�OE INVOLVED LONTAGT PERSON ANO V1qNE NO <br /> 5 G C BS QO- - 3 <br /> l�/ l�+�Z3 AIU� A��3� lb� i HEREBY CERTIFV THAT I HAVE READ AND EXAMINED THIS <br /> PqOPO�SE�D U,r�SE�O�F�BIIILDINO pppLICATION AND NNOW THE SAME TO BE TRUE AND CORqECL ALL <br /> -�IB++d`+f�L �-� PROVISIONS OF UWS AND ORDINANCES 60VERNINO TNIS TVPE OF <br /> L OALDESCRIPTqhJFPRpPERTY�SNOWNBEL OR�TUCNTWOCOPIES� WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br /> �or e�aK oF NOT. THE ORANTINO OF A PERMIT DOES NOT PRESUME TO QIVE <br /> AUTHORITV TO VIOLATE OR CANCEL TME PROVISIONS OF ANY <br /> OTHER STATE OR LOCAL LAW REQULATIN(3 CONSTRUCTION OR THE <br /> PERFORMANCE OF CONSTRUCTION.THAT I AM AUTHORIZED BV THE <br /> OWNER OF THIS PROPEqTV TO PEHfORM THE WORK FOR WHICH <br /> P�RCELTA%ID.NUMBER APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> CONTRACTORS LAW 18.27 RCW AND 298200 WAC. <br /> CONSiRUCTqN IOAN LENOER.ADq1E55.TELEP/qNE NUMBER ,(� /� <br /> , �l�L�.�1LJ�1�. �io�19�94 <br /> � CItY BUSNE6$IICFHSE Iq <br /> �� MECNAINCAL <br /> N0. TY/E 01�fl7ITU11E OR ITEM fEE N0. TY/E OF EOUIPYENT fEE <br /> WATER CLOSET(TOILET) � /VC—NHND�O UNITS—H.P. , <br /> BATHTUB ; FORCED AIR SYSTEMS--B.T.U. M E.A. � <br /> LAVATORV(WASH BASIN) � UNIT HEATER�B.T.U. M ; <br /> SHOWER � CLOTHES DRVERS � <br /> KITCHEN SINK 8 DISP ; VENTILATION FAN � <br /> DISHWASHER � RANQE HOOD , <br /> LAUNDRVTRAV ; WATER HEATER � <br /> CLOTHES WASMER � WOODSTOVE ' <br /> URINAL ' METAL FIREPUCE(WOOD BURNING) � <br /> DfiINKINO FOUNTAIN � FIREPUCE INSERT ; <br /> FLOOR ORAIN � HEAT PUMP , <br /> BACKFLOW PFEVENTERS ; GAS PIPING � i <br /> ROOF DRAINS—HAINLEADERS � EXHAUST FAN , <br /> SINK(SERVICE—BAR,ETC.) � , <br /> � � <br /> � <br /> � � <br /> SUB TOTAL S ; SUB TOTAL S ' <br /> PERMIT $ '7 � PERMIT S � <br /> TOTALFEE S ' TOTALFEE S ! <br /> FOR oF�ce use oN�r: <br /> FRONTSEi&1CN REARSkTBACN SIDESETB�CK VLANCMECNNUMBER fEE REGEIPiNO. <br /> USE20NE LOTAREA VALANTSITE FEE8 YALUATION FEE <br /> ❑ YES ❑ NO BUILDINO ' <br /> i <br /> TYPEOffANST �dO.OFSTORIES acuwNtr rqpp,ytuqcuxns <br /> Gp�P PLUMBING � <br /> I <br /> 612EOFBlDO. FIRESPRINRLEHSREO'0 O�SEMENT MECHANICAL i <br /> ❑ YES ❑ NO <br /> OCCUPANCYIOAD FIREAURMREOD NEIGNTLIMIiAT10N ADDITIONALPUNCHECN � <br /> pEA� _ OTHER � <br /> SiATE BUII�ING SURCHARGE � <br /> INTANE BY RANS APPROVED BY CITY OF EVEflE1T PUBLIC WORKS � <br /> LOCAL SALE8 ' <br /> DATE TAX CODE IS 3105 Ta*�� I <br />