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�S� APPLICATIG_J FOR CONSTRUCT�N PERMIT <br /> TO BE COMPLETED IN BLACK INK—PLEASE PRINT � <br /> V <br /> BUILDING DEPARTMENT HEATING SVSTEM: U GAS 0 ELEGTRIC O <br /> 259-8810 <br /> DEMOLITION COMBINATION Q�BUILDING MECHANICAL PLUMBINQ i g�pN <br /> OWNEH M�R��DRE55 �iry Z�p p110NE <br /> J'E1�6 i''�a��N� co. , � U� lSox37f7 ,W��SoF-�� , ��-rr[.E.G.�n •y�i2y 3;2-s'l'�� <br /> TENANi MAILADD SS ITY :� p E <br /> 5�++E f�'S v a.N�IV <br /> ARC,j�ITEC70ROE5 NEN MAllAUO 55 / QTY zIP prypryE <br /> CSOE�N6 �ns+.6icc�ti� ��R-P��uE-C�-✓vP. PO. 13GX "��J .MS Off-2� .5(rlFT�.E W/�l ,j��Z'� 3vz—cby� � <br /> OENERAICONiPACTOR MAILADDRE55 p CITY ,��� �� ZIP P ,Q STATELICENSEI <br /> GHLiGu-'r S�lfvGj}hRr ff�6o/(� yZ� !drvlT��S 7IVFi N',�l}a� �n/A• "��`J' Ccr�%l✓2�6Nf//60�6' <br /> MELN�qIC0.GONTMCTOH IMIL�DDRE55 CIiY 21P VNONE S7�TE LICENSE� <br /> PLUMBINOCONTRACTOR M�IL�D�NE55 CITV 21P PIIONE STATELILENSE� � _'{ <br /> 7 <br /> ClAS50FWOpN � I <br /> I i NEW ! ! ADDITION �ALTERATION � qEPA1R DEMOU710N WOODSTOVE/FRPL INSERT ; BUILDING RELOCATION ��, � <br /> ^� 7AC7 PERSON AN^O PNONE ����.��� <br /> CONiMLTPRICEOFWORK /`�� OUO �ANR'�-IJ �T��1BO�S�-I �b6 �,r�3 i <br /> DESCRIBEWWKANOSOUAREFOOTIOEINVOL ED - 3 <br /> i <br /> 'S4� <br /> PROFOSEDIlSEOFBURDINO � 1 HEREBY CEHTIFY THAT I HAVE READ AND EXAMINED THIS . ��.-:�'?{ <br /> S,CUc,v� 5 �d—>/ APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECL ALL .,�� <br /> LEMLDESCRIPTqNOFPROPERTY�SNOWNBEIOWORATTACMFWqGOPIES� PROVISIONSOFLAWSANDORDINANCESGOVERNINGTHISTYPEOF <br /> WORK WILL BE COMPLETED WITH WHETHER SPEqFIED HEREIN OR ,,{ <br /> �or e�ocK oF NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE I <br /> AUTHORITV TO VIOLATE OR CANCEL THE PROVISIONS OF ANY i <br /> OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br /> PERFORMANCE OF CONSTRUCTION.THAT I AM AUTHOflIZED BV THE <br /> OWNER OF THIS PROPERTV TO PERFORM THE WORK FOR WHICH � I <br /> APPLICATION IS MADE ANO I COMPLY WITH THE STATE I <br /> CONTRACTOFS LAW 1827 RCW AND 296.200 WAC. � <br /> I <br /> �. .l, ��-�� �/S/� <br /> PRQIECTADDRE55 6 AtUn wtF � � <br /> 3o n:i w� C RSi,�d iL�. �{Q <br /> cnrauswtssicEraErq <br /> PLUIMNIfi MECHANICAL �� <br /> NO. TYPE OF flXTURE OR REM FEE N0. TYPE OF EOUIPMENT FEE <br /> WATER CLOSET(TOIIET� � A/C—A/HNDLG UNI1S—H.P. , , <br /> BATHTUB ' FORCED AIR SYSTEMS—B.T.U. M E.A. ; � �� <br /> LAVATORY(WASH BASIN) � UNIT HEATERS—B.LU. M ; � <br /> SHOWER � CLOTHES DRYERS � <br /> _ KITCHEN SINK 8 DISP ; VENTILATION FAN � � <br /> DISHWASHER � RANGE HOOD � ,� <br /> UUNOHY TRAY ; WATER HEATER � i <br /> CLOTHES WASHER � WOOD STOVE ; � <br /> URINAL ' METAL FIREPLACE 6 CHIMNEY � <br /> � DRINKING FOUNTAIN � FIREPLACE INSEHT ; ' <br /> FLOOR DRAIN � HEAT PUMP � � <br /> BACKFLOW PREVENTERS ; GAS PIPING ' ' <br /> ROOF DRAINS—RAINLEADEHS � EXHAUST FAN � <br /> SINK(SERVICE—BAR,ETC.) ; <br /> � <br /> � i <br /> � , <br /> � , <br /> SUB TOTAL S ; SUB TOTAL S ' �, <br /> PERMIT S � PERMIT S � I <br /> TOTAL FEE S TOTAL FEE S � �� <br /> FOR OFFICE USE ONLY: <br /> FRONT6EiB�CN flE�NSETB/�CN SIDESET&1LK PWICNECKpNUMBEP FEE RECEIPTNO. <br /> J .�O 7O <br /> USE20NE �or�aee vecu�tsrte FEES VALUATION FEE <br /> BUILOING a(�L OOU � ' 'J p i sD <br /> iVYEOfCONIS.ALIOW/�BLE TYVEOfCON51/it1UAl octWu[r rqqbMwNGUNnt � <br /> I� � /1� � �. /�/ �"0°� PLUMBINO <br /> SRE BLDO t,� NO.OF6TORIES BASEMENT MECHANICAL � <br /> ��D)7 Sq, ' <br /> � ; <br /> OCGUPMlCY LOAU FIRE 6PRNNl'_RS REO'D NEIONT UMITATION �0 ���N CHECK �93 � f I <br /> �� Y[S SPRINKLEH � <br /> PEASON FOR SPflINNLEN <br /> �D O E S STATE BUILDING SURCHARGE ;�Q <br /> INi�NE BV PLANS AP qOVEO BY CITY OF EYEREIT PUBLIC WORKS ' <br /> ✓I/j� LOCAL 8ALE3 � <br /> � TA)I CODE IS 3105 ror�� ' ' <br /> iP � ?1- <br />