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APPLICATICII FOR CONSTRUCT�l�1 PERMIT <br /> TO BE COMPLETED IN BLACK INK—I'LEASE P(iINT ��7—"► <br /> BUILDING DEPARTMENT HEATING SYSTEM: ❑GAS ❑ELECTRIC ❑_ <br /> 259-8810 �/ <br /> ❑ DEMOLITION I I COMBINATION I I BUIIDING f I MECHANICAL I�'PLUMBING (1 SI(3N <br /> OWNER MAIL ADDRESS QTY 21P PHONE . <br /> $D�InIC-����u 3707 ._�A�-773�.�L�-34�- Sfi78 <br /> TEN�NT AInKADDREtiS LITV I�P VIM`� <br /> _Ir.! � /�n. FD� Lo� 37bL��-rn.� �IZ4 �42-5a7R <br /> ARCHI ECTORDESIONER M1IlA��RE55 71TV 21P PIqNE <br /> OEkFR�Tq����M�I�ORESS �OI � ��ITYG"�ZIP�82o3 ��-Z��► Si�TELICENSE/ _—" <br /> LX <br /> MEGH�NIC�L CONTR�CTOR M�X.�DORESS CITY ZIP PHpNE SMTE LICENSE� <br /> ..�(�JUr.1s-ttZu Co, Po� enx z.4��'7 `�i� �z-33r1 /N�Kl�l37znlo <br /> PLUMBINOCONTR�CTOR AllA0DRE5S UTV IIP PHUNE fiTREIICEN5F.1 <br /> CONTPACT RKEOiV/ORK <br /> �13 .40� - - <br /> DESCRIBEV/ORNA �REFOOTAOEINYOLVEU C04TAGTPEHSCNNIDPNq1EN0 '/��,� /� uL�� <br /> n c� <br /> _ 7(?_•3'SII v �3 <br /> I HEREBV CERTIFV THAT I fiAVE READ AND EXAMINED THIS <br /> PROPOSED USE OF BUI rta � APPLICATION AND KNOW THE SAME TO BE TRUE AND COHRECT.ALI. <br /> ��'��,pt' �YZ f L' I C�'1Y_/A PpOVI510NS OF LAWS AND ORbINANCES OOVERNINO THIS TYPE OF <br /> LEO�LDESCPIPTIONOFPROPERTY�SIqN'NBELOWOR�TTACHTWOCOPIES� WOHK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREINOR <br /> �or e�ocK ov NOT. THE 6fiANTINO OF A PERMIT DOF_5 NOT PRESUME TO QIVE <br /> AUTHORITV TO VIOLATE OR CANCEL THE PROVISIONS OF ANV <br /> OTHER STATE OR LOCAL LAW HEOULATIN6 CONSTRUCTION OR THE <br /> PE�7FORMANCE OF CONSTFUCTION.THAT I AM AUTHORIZED BY THE <br /> OWNEF OF THIS PROPERTV TO PERFORM THE WORK FOH WHICH <br /> PARCELT�%IA.NUMBER APPLICATION IS MADE AND I COMPLV WITH THE STATE <br /> CONTFACTORS LAW 18 27 pC AND 200 WAC. <br /> CON9TRUCTION LMN LENDER.ADDNCBS.TELEPHONE NUMBFR /—�, <br /> �T� <br /> PIIOJECT ADDRE88 sr tc <br /> �m� �� G-s� No e� ��..w�,.�n��E,�E,� <br /> pLUMlIIKi MECHANICAL <br /> N0. TYPE OF flIITURE OR ITEM FEE N0. TYPE OF EOUIPMENT FEE <br /> WATER CIOSET(TOILET) A/�NHNDLQ UNITS—H.P. _� <br /> BATHTUB FORCED Alq SVSTEMS—B.T.U. M E.A. � <br /> LAVATORV(WASH BASIN) UNIT HEATERS—B.T.U. M � <br /> SHOWER CLOTHES DHVERS � <br /> KITCHEN SINK 8 DISP ; VENTILATION FAN ; <br /> DISHWASHER RANGE HOOU � <br /> LAUNORY TRAY ; WATER HEATER ` <br /> CLOTHES WASHEH WOOD STOVE � <br /> URINAL ' METAL FIqEPLACE(WOOD BUHNINO) ; <br /> DRINKING FOUNTAIN � FIREPLACE INSERT � <br /> FLOOR DflAIN HEAT PUMP � <br /> BACKFLOW PREVENTEFS ; GAS PIPINO <br /> ROOF DRAINS—HAINLEADERS � EXHAUST FAN � <br /> SINK(SERVICE—BAH,ETC.) ; <br /> CA � <br /> i <br /> i <br /> i <br /> SUB TOTAL S SUB TOTAL S ' <br /> PERMIT S � PERMIT S � <br /> TOTALFEE S ' TOTALFEE S ' <br /> FOR OFflCE USE ONLY: <br /> FPONT9ETB�CN PEAR6ETB�CN SIDESEttiACR PUNCNEC lIMBER FEE AECEIPiIq <br /> h��3c' <br /> USE Z(k!E LOT�PEA V�CANT SITE FEE8 VALUATION FEE <br /> �l YES Q NO BUILDIM3 � <br /> IYPEOfCONSi. MO.OF6TORIEb ocuMwcr xanuHlt�xGUMns i <br /> ��v pLUMBIN� i <br /> BIZEOFBI.DO. FIflE6PPINNLERSREO'D BASEMENT MEC�I�'dG�L � � � <br /> ❑ VES f' NO � � — — � <br /> OCCUPANCYLOAD FIRE�URAIPEOD HEqNTLIMIi�T10N �UUi110NALPUNCHECN i <br /> OTHER ' <br /> REASON � <br /> STATE BUILDINC SURCHARGE � <br /> i <br /> INiAME PY PUN P �Y CITY OF EYEREIT PUBUC WORNS <br /> LOCALSALES <br /> o�r y_ �3_�t TAX COOE IS 3105 To1�� <br />