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APPLICATIC�1 FOR CONSTRUCT' lN PERMIT � <br /> TO BE COMPLETED IN BLACK INK—PLEASE PRINT <br /> BUILDING DEPARTMENT HEATING SYSTEM: ❑GAS G ELECTRIC U —� <br /> 259•88i0 <br /> -i DEMOLITION =! COMBINATION ❑ BUILDING i_i MECHANICAL ❑ PLUMBING i7 SIGN <br /> OWNER MFRADDRESS CITV ilP pHONE <br /> s���f� -� � �c,. �-�,r <:Zc, i cv� �kz �� Zs� y „�r <br /> TENA�NT`� � I�I MAILADDREJSIS�ry 1 CITV LP PMONE <br /> �.C� W��� J�l� JQ'I� �fTti%1l. <br /> ARCHITECTORDESIGNER MaILADDRE55 CITY ZIP PHpNE <br /> GENERALCONT TOF MAILqDDFE55 LT' ZIP PIqNE STATEUC£NSE� <br /> S�-c�"` �G ,�u t.z �-� �-z� ��z�6 Z.sr- v�� y <br /> MECNANICAL NiRACTOR MRIL AODAESS CITY ZIP PNONE STRTE IN:ENSE k <br /> PLUM9ING CONTRAGTOR MAIL RDDRESS CITY ZIP PHONE SiA'E L�CENSE I <br /> CONT �T PPICE OF\WONK `J <br /> '_� �Q�V�— � ( C�/a 2. �C7 � S� <br /> DES NIBE WORK AND SOUARE FOOTqGE INVOLVED CONTRCT PEFSON ANO VHONE NO. <br /> /e�l� � �G � <br /> '� 1l, lti�l� <br /> I HEREBY CERTIFV THAT I HAVE READ AND El(AMINED THIS <br /> PROPOSEDUSEOFBUILDING APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT.ALL <br /> �-`G- -.,E�C��2L PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br /> LEGAL ESCRIPTIONOFPqOPERTY�SHOWNBELOWORATTACHTVJOGOPIES) WORK WIIL 8E COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br /> �oT S� � e�ocK �� oF -�L'�7 E'L�' NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br /> AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br /> 2-SS�I C G L �� y OTHER S7ATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br /> PERFORMANCE OF CONSTRUCTION.THAT I AM AUTHORIZED BV THE <br /> OWNER OF THIS PROP[RTV TO PERFORM THE WORK FOii WHICH <br /> APPLICATION IS MADE AND I COMPLV WITH THE STATE <br /> PARGEL TAX I.D.NU�ABER CONTAACTORS LAW 18.27 RCW AND 296200 WAC. <br /> CONSTRUCTION 10�N LEN�ER,ADDRE55,TELEVNONE NUMBER � /� � }/ <br /> i� <br /> X I�"• Ll �-t]Z. <br /> PR T ADD9ES$ � sic�u.une o+*� <br /> �� ci*v nusixss uzcr+se rvo <br /> PLUMBIHG MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM FEE NO. TYPE OF EOUIPMENT FEE <br /> WATER CLOSEi�(TOILET) A,'C—A'HNDLG UNITS—H.P. <br /> BATHTUB ; FORCE�AIR SYSTEMS—B.TU. M E.A. <br /> LAVATORY(WASH BASIN) UNIT HEATERS—B.T.U. M <br /> SHOWER CLOTHES DRYERS <br /> KITCHEN SINK 8 DISP - VENTILATION FAN ; <br /> DISNWASHER RANGE HOOD —T— <br /> LAUNDRY TRAY ; WATER HEATER � <br /> CLOTHES WASHER W00�STOVE ; <br /> URINAL � METAL FIREPLACE(WOOD BURNING) � <br /> DRINKING FOUNTAIN � FIREPLACE INSERT <br /> FLOOR DRAIN � HEAT PUMP <br /> BACKFLOW PREVENTERS GAS PIPING ; <br /> ROOF ORAINS—RAINLEADERS � EXHAUST FAN <br /> SINK BE(iVICE—BAR,ETC.) <br /> � <br /> � <br /> � <br /> � <br /> SUB TOTAL $ ; SUB TOTAL S <br /> PERMIT S PEFiM�.T $ <br /> TOTAL FEE $ TOTAL FEE $ <br /> FOR OFFICE USE ONLY: <br /> FRONiSETBACN REARSETBACK SIDESETBAGK PLANCH[GY.NUM9ER FEE RECBPTNO. <br /> - I Tl � � �� � � �i <br /> usEzoNe � �oTnaea VACANTSItE FEES VALUATION FEE <br /> � r <br /> ❑ YES � NO BUILDINO JUJ f�_��.^v <br /> T1TE Ol CONST. NO.OF STORIES ottunixcr n0 of MrtwxG u9iis — <br /> v� /✓ �", v � pLUMBING <br /> �- <br /> SIZEOFBLDG. FlRESPRINKLERSFEO'D B0.5EMENT MECHqNICAL <br /> S -�' I� ❑ YES :�1 NO <br /> OCGOPANCY I.OAD FIPwF./nLARM PEOD HEIGHT LIN�TATION ADDITIONAL PLAN CHECK <br /> y "' V OTIIER <br /> REASON <br /> STATE Bl11LDING SURCHARGE ; ��L� <br /> MTAKEBY PLANSAPP OVE�BV CITYOFEVEREIT PUBUCWOFiKS ' <br /> �7 LOCAL SALES � <br /> DATE �/.�.,5 j TA%CODE IS 3105 ror�� ' � � 5��� <br />