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A,PPLICATIC I FOR CONSTRUCT^��N PERMIT � <br /> TO BE COMPLETED IN BLACK INK—PLEASE PRINT <br /> BUILDING DEPARTMENT HEATING SYSTEM: ❑GAS ❑ELECTRIC ❑ <br /> 25�-6810 <br /> C] DEMOLITION ❑ COMBINAI'ION ❑ BUILDING f]MECHANICAL ❑PLUMBING �_1 SIGN <br /> OWNEP MAIIRDDRE55 CITY IIP PNONE <br /> �t�lIL.LA�� P�f/CS'�lil lS3l CO�GYAv� EvE2E�T %82oJ 2�2-�o6Z. <br /> TENANT MAILADDRE55 CITV iIP PNpNE <br /> ��D y !,l A 4KE�- �fEN�02 C -N7�,e� <br /> ARCHITEGTORDESGNER MAILALDRES,.� �ii� � PNONE <br /> tr, <br /> GEN WNTiiACTOR MAILADDflE55 CITV ZIP PHONE STATELIGENSEJ <br /> ���A�1� <br /> MECHANIC�ICONTRRCTUR M�ILADDRE55 CITV ZIP PHONE STRTELICENSE+ <br /> PLUMBINGCO4TRRCTOR MAILAUORESS GTY 2ip PNONE STAiELICENSE� <br /> CONTFACT PRICE OF WOqR <br /> �ESCRIBE W(%IH AND SOUARE FOOTAGE INVOIVED CONTFCT PEFSON AND PNONE NO. <br /> . �n <br /> 1 HEREBY CERTIFV THAT 1 HAVE READ AND EXAMINED THIS <br /> PROPOSED USE OF BUILOING APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT.ALL <br /> 'L `-" PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br /> LEGAIDESCflIPTIONOFPROPERN�SHOWNBELOWOFARACNTWOCOPIES� WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br /> �oT BLOCN oF NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br /> AUTHORITY TO VIOLATE OR CANCEL THE PqOVISIONS OF ANY <br /> OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br /> PERFORMANCE OF CONS7RUCTION.THAT 1 AM AUTHORIZED BV THE <br /> OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br /> PARCELTAXID.NUMBER APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> CONTRACTORS LAW 1B27 RCW AND 296200 WAC. <br /> CONSTRUGTION LO�N LENDER,A�DRESS.TEIEPHONE NUMBEP � - _ l <br /> �/� . ll // <br /> C�j�l�.r2ccti � _ � -�� <br /> PROJECT ADDRESS � �� �,�,,,,,�qE p��E I <br /> �J� / U✓�[�/2� `-�_ <br /> � CIiY BUSMf SS IILtN�E NO <br /> PIUMBING MECHANICAL <br /> N0. TYPE OF Flf(TUpE OR ITEM FEE NO. TVPE OF E�UIPMENT FEE <br /> WATER CIOSE'I'(TOILET) A/C-AMNDLG UNITS-H.P. <br /> BATHT:IB ; FORCED AIR SYSTEMS-B.T.U. M E.A. <br /> LAVATORY(WASH BASIN) � UNIT HEATERS-B.T.U. M <br /> SHOWEfl � CLOTHES DRYERS , <br /> KITCHEN SINK 8 DISP � VENTILATION FAN <br /> DISHWASHER RANGE HOOD � <br /> LAUNDRYTRAY WATER HEATER � <br /> CLOTHES WASHER � WOOD STOVE � <br /> URINAL METAL FIREPLACE�WOOD BURNING) � <br /> DRINKING FOUNTAIN ; FIREPLACE INSERT � <br /> FLOOR DRAIN � HEA7 PUMP <br /> BACKFLOW PREVENTERS GAS PIPING � <br /> ROOF DRAINS-RAINLEADERS EXHAUST FAN <br /> SINK(SERVICE-BAR,ETC.) � <br /> � <br /> � <br /> SUB TOTAL $ ' SUB TOTAL $ <br /> PERMIT S PERMI7 $ ; <br /> TOTAL FEE $ TOTAL FEE $ <br /> FOR OFFICE USE ONLY: <br /> FRONTSETBRCK REARSETBAGK SIDESETBRCH PWNCMEC NUyBER FEE RECEIPiNO. <br /> •,�v,��c> <br /> USEZONE LpTAREA VqCpNT51TE FEES VALUATION FEE <br /> r' YES ❑ NO BUILDING �Jl � <br /> iYFEOiCON51. NOOFSTORIES o:tu�WC�' NotrpwFwNcuxrtS J(/ <br /> �p�� PLUMBING i <br /> i <br /> SIZEOFBLDG. FiqESPRIN%lER5RE0'0 BASEMENT <br /> 'J YES ❑ NO �`�ECHANICAL � <br /> OCCUPANCY LOAD flRE ALARM REOD I MEIGHT LIMITATION ADDITIONAL PLAN CHECN � <br /> REASON OTHER � <br /> STATE BUILDING SURCHARGE _ �'� <br /> INTAKEOV PUNSAPPROVEDBY CITYOFEVEREIT PUBLICWORKS � <br /> LOCAL SALES <br /> onTe iAl(CODE IS 3105 TO7AL �� <br />