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APPLICATI{. � FOR CONISTRUiC7 .JN P�RMIT ���� <br /> TO BE COMPLETED IN BLACK INK—PLEASE PRINT <br /> HEATING SYSTE�A: C]GAS ❑ELECTRIC G � <br /> BUILDING DEPARTMENT <br /> 259•8810 <br /> I-; DEMOLITlON CI COMBINATION :I BUILDING i_I MECHAMICAL I_I PLUMBING I 1 SIGN <br /> OWNER MAILADDRE55 CITV 21P PHONE <br /> �ifl v�v� u�v,, � e �ob �I. 5130&veva�'¢�ial.�Rti ��evcH- lJN •yP�7p aScJ-0/9� <br /> �� ZIP PHONE <br /> TENA / �n IL AD[1RESS <br /> __.C(o�iG.e7� _/�Kn/�'�� �c<�?S'93a ✓�,evA,�c�v+� E'1/�i�� G�/.t1. 9 aa3 3S�o�3 <br /> �q 61qILA�DRE55 pTY ZIP PHONF <br /> � *� ul � ' y O <br /> GENERA ONTPAC O M�ILAUDRESS CITY ZIP PHONE S'ATEUCENSEM <br /> MELHANICAI CONTRACTOR MAIL AOORESS CITV ZIP PNONE STATE LICENSE Y <br /> �/ ��C� PHONE STATE LICENSE� <br /> PWMBINGCONTPACTOR MAIL4D�ilESS CIN ZIP <br /> CLASS OF WONK <br /> f.-I NEW ❑ ADDITION i I ALTERATION I..i REPAIR i I DFMOLITION I '' WOODSTOVE/FRPLINSERT I I BUILDINGRELOCATION <br /> — CON ACTPERSONANDPHONEN� <br /> LONTRACTPRICEOFWOHK�� S ` <br /> DESCFIBE WORK AN�5��� FOO?AGE INVOLVED �� G t ass <br /> Nev,J -O <br /> PBO?OSEDUSEOF6UIL�ING i- / I HEREBY I:ERTIF THAT I HAVE READ AND EXAMINE� <br /> T E t LI rNS�"'E"C�� �s����' APPLICATIOk AND KNOW THE SAME TO BE TRUE AND CORREGT.ALL <br /> LEGALDESCPIP110NOFPFOPERTV(SMOWNBELOWORARACHFOURCOPIES) PROVISIONSOFLAWSANDORDINANCESGOVERNINGTHISTYPEOF <br /> WORK WILL BE COMPLETED WITH N'HETHER SPECIFIED HEREIN OR <br /> �or a�ocK oF NOT. THE GRANTING OF A PEflMIT DOES NOT PRESi1ME TO GIVE <br /> AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONCi OF ANY <br /> OTHER STATE OR LOCAL LAW REGULATIIJG CONSTRUCTION OR THE <br /> FERFORMANCE OF CONSTRUCTION.THAT I AM AUTHORIZED BY THE <br /> OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICN <br /> APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> CONTRACTORS LAW 18.27 FCW AND 296200 WAC. <br /> x � �� /4-/3-9� <br /> $IGNAt�1 E pAiE <br /> PR0.IECT ADDRE55 �/Q,Tj n <br /> ���Cl L-U�G�'��u Cl�f+ �� CIttOUaiilE55LiCEN5EN0 <br /> PLUMBING � �I8�03 MECHANICAL <br /> NO. TYPE OF FIXTURF.OR ITEM FEE NO. TYPE OF EOUIPMENT FEE <br /> WATER CLOSET(TOILET) � AI�A/FINDLG UNITS—H.P. � <br /> BATHTUB ; FORCED AIR SYSTEMS—B.T.U. M E.A. ' � <br /> LAVATORY(WASH BASIN) � UNIT HEATERS—B.T.U. M � <br /> SHOWER ' CLO7HES DRYERS �_ <br /> KITCHEN SINK 8 DISP i VENTILATION FAN _ <br /> DISHWASHER � RANGE HOOD <br /> LAUNDRYTRAY ; WATER HEATER � <br /> i WOOD STOVE � <br /> CLOTHES WASHER � <br /> URINAL ' METAL FIREPLACE 8 CHIMNEY i <br /> DRINKING FOUNTAIN � rIREPLACE INSERT � <br /> FLOUR DRAIN � HEAT PUMP � <br /> BACKFLOW PREVENTERS i GAS PIPING � � <br /> � <br /> ROOF DRAINS—RAINLEADERS � EXHAUST FAN ' <br /> SINK(SERVICE—BAR,ETC.) � � <br /> _- � <br /> T <br /> 1 � <br /> � I <br /> 1 <br /> SUB TOTAL $ ' SUB TOTAL $ / � <br /> PERMIT $ � PERMIT $ �� � <br /> TOTAL FEE S ' TOTAL FEE S v ' <br /> FOR OFFICE USE ONLY: <br /> FRONT SETBACK REAF SETBACH SIDE SETBACN PLAN CHECH NUMBER FEE PECEIPT NO. <br /> �i —.�83 G'.s' <br /> USEZONE LOTAAEA VACANTSITE FEES VALUATION FEE <br /> � <br /> BUILDING ' <br /> TYPEOFCONTS.ALL0IYABLE TV7EOFCONST.ACIUAL o[tuvanfr xoOiprvFuuiGURrtS � <br /> c"�1° � PLUMBING <br /> i <br /> SRE OF B��G. NO.OF STOFIES � BASEMENT MFCHANICAL G �� <br /> i <br /> OCCUPANCY LOAD FIRE SPRNKLERS RLU'U HEIGHT LIMITATION ADDITIONAL PLAN CHECK � <br /> i <br /> SPRINKLER i <br /> p:AS'v�:FOR SPRINNLERS � <br /> STATE BUILDING SURCHARGE � <br /> — � <br /> INTAKEE{ PLANSPPPFOVEDBY CITYOFEVERE7T PUBLICWORKS � <br /> LOCALSALES <br /> TAX CODE IS 3705 TOTAL ,3a ;� <br />