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APPLICATIQ"1 FOR CONSTRUCT°�1N PERMIT � <br /> TO BE COMPLETED IN BLACK INK—PLEASE PRINT <br /> BUILDING DEPARTMENT HEATING SYSTEM: ❑GAS ❑ELECTRIC ❑ <br /> 259-8810 <br /> � DEMOLITION � COMBINATION �5i BUILDING ❑ MECHANICAL O PLUMBING i7 SIGN <br /> OWNER MFILADDRESS � CIN 21P PNONE <br /> M� M �Q io�- ��,e. ,v.� . l3ell���c cl.�a . 49ooy vss a4o9 <br /> TENANT MAILAD�RESS CITV ZIP PHONE <br /> Sa rv,c� � S p n c����°�� �' <br /> ARCHITECTORDESIGNER MAILAUOflE55 CITV 21P PHONE �1 <br /> iU,G.1, C�r,�M�t�ic�l �,�oa�a�.�,)�sr,.�c . S� 3�'�Quc.S�:�vc�rr� � <br /> GENERALCQNTHACTOR MAILAODRE55 CITV ZIP PHONE � $70*��JpEy$E�y/�� <br /> . —�13 /'T'1 L:.L /y F- <br /> MECHANICI CONTRACTOR MAIIADDRESS CITY ZIP PHONE STATELICENSEa <br /> �/� <br /> PLUMBINGCONTflACTOR MAILADORESS CITV ZIP PHONE STATELICEN:3EA <br /> CONTRACT PRI:E OF WORK 0 <br /> � �� <br /> OE CR� Ye yrP.�AND UARE FOOTA3E INV ED �� / CONTACT PEPSON AND PHONE NO. <br /> ,F � <br /> `f+ <br /> I HEREBY CERTIFY THAT I HAVE READ AND FXAMINED THIS <br /> P POSEDUSEOFBUILDING AppLICATION AND KNOW THE SAME TO BE TRUE A�ID CORRECT.ALL <br /> � <br /> ' PROVISIONS OF LAWS AND ORDINANCES GOVERNIlJG THIS TYPE Of <br /> LEGALOESC.RIPTIONOFPROPERTV�SHOWNBEIOWORATTACHTWOCOPIES) WORK WILL BE COMPLETED WITH WHETHER SPECIFIEU HEREIN OR <br /> �or e�ocK oF NGT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br /> AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br /> OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br /> PERFORMANCE OF CONSTRUCTION.THAT I AM AUTHORIZED BY THE <br /> OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br /> APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> PARCf:L TA%I.D.NUMBER CON RACTOR AW 18.27 RCW AND 2962 <br /> CONSTRUCTiJN O NDER.AO�FE55,TELEPHONE NUMBER � <br /> � <br /> PRWECTADDRESS ` sm u o�re <br /> U CIiY BlI51NE5S IICENSE N0. <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM FEE N0. TYPE OF EOUIPMENT FEE <br /> WATER CLOSET(TOILET) � A/C—A/HNDLG UNITS—H.P. i <br /> ' BATHTUB ; FORCED AIR SYSTEMS—B.T.U. M E.A. ' <br /> LAVATORY(WASH BASIN) I UNIT IiBATERS—B.T.U. M I <br /> SHOWER ' CLOTHES DRYERS � <br /> KITCHEN SINK 8 DISP ; VENTILATION FAN ; <br /> DISHWASHER � RANGE HOOD � <br /> LAUNDRYTRAY ; WATERHEATER ' <br /> CLOTHES WASFiER � WOOD STOVE � <br /> URINAL ; METAL FIREPLACE(WOOD BURNING) ' <br /> DRINKING FOUNTAIN i FIREPLACE INSERT i <br /> FLOOR DRAIN � HEAT PUMP � <br /> BACKFLOW PREVENTERS ; GAS PIPING � <br /> ROOF DRAINS—RAINLEADERS � E)'.HAUST FAN � <br /> SINK(SERVICE—BAR,ETC.) ; � <br /> � <br /> � <br /> � � <br /> SUB TOTAL $ ; SU8 TOTAL $ ; <br /> PERMIT $ � P�RMIT 3 � <br /> TOTALFEE $ ' TOTALFEE S ' � <br /> FOR OFFICE USE ONLY: <br /> FFONT SETBACK RFJ�R SETBACK SIOE SETOACK PLAN CHECN N MBER FEE RECEI7T NO. <br /> r� �� <br /> USEZONE LOTAREA VACANT'SITE FEES VALUATION FEE <br /> ❑ YES �, No BUILDING �a 5° �v� <br /> TVPEOFCONSi. NO.OFSTORIES cccuvaecv rm.ovmrEwxcuxit; � <br /> v�N � GA00P PLUMBING ' _ <br /> SIZEOFBLDG. FIRESPRINNLERSflEO'� BAuEMENT / MECHANICAL � <br /> /�J A 6Vp ❑ YES �NO � <br /> OLCUPANCV LOAO FIRE ALARM REO'D HEIGHT LIkIy7ATION ADDITIONAL PLAN CHECK � <br /> i✓ A N� ��.r � <br /> OTHER � <br /> REASON <br /> � STATE BUILDING SURCHARGE i SU <br /> _ i <br /> INTAKEBV PLANSA PROVEDBV CITYOFEIIERETT PUBLICWORKS i <br /> �pti LOCAL SALES <br /> OATE 7 ,a� „� TAX CODE IS 3105 TOTAL (f �SO <br />