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APPLICATI� �1 FOR CONSTRUCT�N PERMIT � <br /> TO BE COMPLETED IN BLACK INK—PLEASE PRINT <br /> BUILDING DEPARTMENT �HEATING SYSTEM: U GAS U ELECTAIC IJ � <br /> 259•8810 <br /> I DEMOUTION I COMBINATION I BUILDING I I MECHANICAL i I PLUMBING I I SIGN <br /> OWNER AI�IIADDRE55 CIIV ZIP PNONE <br /> 7�c �6i✓� co.� Ratsrc 27e'/ K/s dF-�S , .t6a91'aa', w�► �tL'j ��Is-�339 <br /> TENAN' MRILADOFE55 CITV 2iP PNONF <br /> �1Q'�N6 <br /> ARCHRECTOR�ESIGNER M�IL�JORESS Gliv 21P PHONE <br /> �.a�iNs. <br /> GF.NERAL CONTRRCTOR MRIL ApDRESS CIiV 21P PNONE STATE LICENSE� <br /> �Fs' r3Row6d, C,or. <br /> MEGHANICRLCONTRRCTOR MRIL��DRESS CIiY 21P PHONE STATELY.ENSE� <br /> PLUMBING CONTR�CTON M�IL ADDNE55 CITV ZIP PHONE ST�iE IICENSE/ <br /> GONTRACi PRIGE OF WORN <br /> 'f�70• <br /> DESCPIBE WORK ANO SIXIARE i007�GE INVIX.VCU GONT�GT PERSON�NO VHONE NO <br /> _�� t.asr✓aao �f�ssa�Qo�csa� '2��-3s� 3 <br /> I HEREBV CERTIFV THAT I HAVE flEAD AND ExAMINED THIS <br /> PROPOSED USE O�BUROIN6 APPLICATION AND KNOW THE SAME TO BE TRUE AND COFRECT.ALL <br /> PROVISIONS OF LAWS AND ORDINANCES 60VERNINQ THIS TVPE OF <br /> LEOALDESCRIPiIONOFPROPERTV�SHOWN9ElOWORATTACHTYOGOP1E51 WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEFEIN OR <br /> NOT. THE GRANTING OF A PERMIT UOES NOT PRESUME TO GIVE <br /> �ot BIOLN or AUTHORITV TO VIOLATE OH CANCEL THE PHOVISIONS OF ANY <br /> OTHEF STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br /> PERFORAIANCE OF CONSiRUCTION.THAT I AM AUTHORIZED BY THE <br /> OWNER OF THIS PROPERTV TO PERFORM THE WORK FOR WHICH <br /> APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> P�RCEI TA%I D.NUMBEN CONTRACTORS LAW 1827 RCW AND 296200 WAC. <br /> CONSiRUCTIONIO�NLEN�EP.MDflESS.TELEPNd1ENUMBEH ���� � <br /> PROJECT ADDREBS/� .t san+�— cuE 9 <br /> ',�� (A/. y�f//YL� I� T� ���� I GrvRuswtssiK•Nscxo <br /> � � PLUMBINfi MECHANICAL <br /> � NO, TYPE OF flIITURE OR ITEM FEE N0. TYPE OF EOUIPMENT FEE <br /> WATER CLOSET(TOI�ET) � A/C—A/HNDLG UNITS—H.P. � <br /> � BATHTUB ' FORCEDAIRSVSTEMS—B.T.U. M E.A. ' <br /> IAVATORY(WASH BASIN) � UNIT HEATEHS—B.T.U. M � <br /> T <br /> SHOWER CLOTHES DRVERS ' <br /> KITCHEN SINK d DISP � VENTILATION FAN � <br /> DISHWASHER RANOE HOOD � <br /> LAUNDRY TRAV WATER HEA?ER ' <br /> CLOTIiES WASHER WOOD STOVE � <br /> URINAL ' METAL FIHEPLACE(WOOD BURNING) ' <br /> DRINKING FOUNTAIN FIHEPLACE INSERT � <br /> FLOOR DRAIN � HEAT PUMP <br /> BACKFLOW PREVENTERS ; GAS PIPING � <br /> ROOF DRAINS—RAINLEADERS EXHAUST FAN � <br /> SINK(SERVICE—BAR,ETC.) <br /> � <br /> � <br /> � <br /> � � <br /> SUB TOTAL S ' SUB TOTAL E <br /> PERMIT $ � PERMIT $ � <br /> TOTALFEE S TOTALFEE $ ' <br /> FOR OFFICE USE ONLY: <br /> � FPONT SETB�C1( PEAR SET&1CK SIDE SETBACK PLAN CNEGN NIIMBER FEE RECEIPT NO. <br /> 67 <br /> USE 20NE l0T�REA VACNIT SITE FEES VALUATION FEE <br /> ❑ YES 1 i NO BUILOING � �]JU � _ <br /> IYMOftONSI NO.OiSTORIES accW'�N[r MaIXowuuMcuxrti <br /> F R N � �"2 PLUM6ING i <br /> i <br /> SIZEOFOLOG FIqESPRIN1tlEN5RE0'0 B�SEMENT MECNANICAL <br /> N�I �E S i—: VES ;l� NO � <br /> OCCUPANCY LOAD FIRE�URM RE00 HEIGNT LIMITRTION ADDITIONAL PLAN CHECK <br /> i <br /> � N� Y� S OTHER i <br /> NEASON � <br /> . �F St h STATE BUILOING SUFCHARGE <br /> INTAN[BY PUNSAPP VfOBY CITY OF EVEREIT PUBLIC WORNS ; <br /> %j� LOCAL SALES <br /> o"TE , I f •S TAI(CODE IS 3105 TOTAL ' <br />