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- APPLICATIO"� FOR CONSTRUCTI�N PERMIT � <br /> TO BE CONiPLETED IN BLACK INK—PLEASE PRINT <br /> � <br /> BUILDING DEPARTMENT j HFATING SYSTEM: GAS �ELECTRIC f] <br /> 259-8810 <br /> i_i DEMOLITION i 1 COMBINATION I� BU DING iIMECHANICAL iG'PLUMBING ❑ ^IGN <br /> OWNER MAILADDRE55 . <br /> PHONE <br /> A��.+o,k«it��� �A� aeC�-�E2 34U Ca�-$y ���2E;; �_,,�z� <br /> TENANT MA ADC9E55 CITV IP PHONE <br /> ��� <br /> FRCNI7ECTORDESIGNER MAILqD�RE55 GIN ZIP `�,.�E <br /> G�2Y ��2��30� �o�.aY �cse2��`i <br /> GENERnL CONTFAC`OR MRIL ADDRESS pTV ZIP PHONE ST4TE�ICENSE I <br /> ���..� ca-►s�rz . ��cz�s�«� �a� � C�5 i- a3�� <br /> M�EC�NANICUAI CONTRACTOR MAIL A�ORE55 QTY 21P PHONE ST,1Tt UCENSE� <br /> �vl—�� <br /> �Q�C`NTIi��'v ���Jp�'�� ���,� �QTO 21P PHONE STRTELICENSEI <br /> V V � � j�� <br /> CONTRRCT PRICE OP WORK <br /> V Y- <br /> DESLRIBE WORK AND SOOARE FOOTAGE INVOLVED WNTACT PERSON AND PMONE NO. <br /> ti�2�:N �-�2 �- as —Qo� <br /> PROPOSEDlISEOFBUILDn+u I HEREBY CERT�FV THAT i HAVE READ AND EXAMINED THIS <br /> APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECi.ALL <br /> PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br /> �eUnLU[SCR�F!�pNOFPROPERTV�SHOWNBELOWOHATTACHiWOCOPIES� WOFK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br /> ior e�oct aF NOT. THE GRANTING OF A pERMIT DOES NOT PRESUME TO GIVE <br /> AUTHORITY TO VIOLATE OR CANCEL THE PROVIS�ONS OF ANY <br /> OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br /> PERFOflh7ANCE OF CONSTRUCTION.THAT I AM AUTHORIZED BY THE <br /> OWNER OF THIS PROPERTV TO PERFORM THE WORK FOR WHICH <br /> PAFLELTA%ID.NUMBER PLICA N ADE AND I COMPLY WITH THE STATE <br /> NTP.A O B27 RCW AND 296.200 WAC. -� '� <br /> ; <br /> CONSTRUCTIONLO�NIENDER,AD�RE55,TElEPHONENUAIBER � � <br /> PROJECTADDRE$ // ��cN�����r o�tE <br /> LI1T OOSM65l�CFNS[NO �' <br /> PLUMBING MECHANICAI <br /> NO. TYPE Of FI%TURF OR ITEM FEE NO. TVPE OF EOUIPMENT FEE <br /> �WATER CLOSET(TOILET) � FVC—A/HNDLG UNITS—H.P. <br /> BATHTUB ; FORCED AIR SYSTEMS—B.T.U. M E.A. <br /> 3 LAVATORY�WASHBAaIN) � UNITHEATERS—B.T.U. M <br /> SHOWER � CLOTHESORYERS � <br /> � KITCHEN SINK 6 DISP VENTILATION FAN � � <br /> —� DISHWASHEfl RANGE HOOD T � - <br /> � <br /> — LAUNDRYTRAY ; WATER HEATER � <br /> CLOTHES WASHER WOOD STOVE ; <br /> — URINAL METAL FIREPLACE(WOOD BURNING) � <br /> �} DRINKING FOUNTAIN I FIFI3PLACE INSERT ' <br /> — FLWR DF41N � HEAT PUMP ---� <br /> .-- BACKFLOW PREVENTERS ; GP.S PI?ING <br /> � ROOF DRAINS—RAINLEADERS � EXFIAUST FAN � <br /> a,. SINK(SERVICE—BAR,ETC.) � ; <br /> � � <br /> � � <br /> � — -- —T <br /> SUB TOTAl. $ „�j ' — SUB TOTAL $ <br /> PERMIT $ PERMIT $ ; <br /> TOTALFEE $ ' — TOTALFEE $ � <br /> FOR OFFICE USE ONLY: <br /> PRONTSEi(lACK REFRSETBAGK SIDESETBACK PLANCHEC NUMBER FEE PECEIPTNO <br /> 3�/ <br /> USEZONE L0T4REA VACANTSITE FEES VALUATION FEE <br /> J YES ❑ NO BUILDING ' <br /> i <br /> TVPEOFCON57. NO.OFSTC!i!ES p¢�ir�ypv x0o1m4[WxGUNrtS — <br /> Gp�o PLUMBING � <br /> Ii S2ECFBIf1G. FIRESPRINNLERSREO'U BRSEMENT MECHANICAL � <br /> ❑ ves � n�o <br /> � <br /> OCCUPANCVIO�D FlREALARMRE00 HEIGHTUMITATION AD�ITIONALPLANCHECK � <br /> � <br /> OTH[R <br /> PEASON <br /> STA7E BUILOING SUFCHARGE <br /> 19Ta1<F.BY PLANSAPPNOVEO BV CITY OF EVEREIT PUBUC WOflK$ � <br /> LOCAL SALES �— <br /> on,e TAl(COOE IS 3105 rora� <br />