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APPLICATIf"Y FOR CONSTRUCTT13IN PERMIT <br />TO BE COMPLETED IN BLACK INK —PLEASE PRINT <br />BUILDING DEPARTMENT HEATING SYSTEM: ❑ GAS ❑ ELECTRIC <br />❑ _� <br />259-8810 <br />F nELOLITION ❑ COMBINATION ❑ BUILDING ❑ MECHANICAL ❑ PLUMBING ❑ SIGN <br />OWNER /% �UAl ADOF�� /O�',^CITY ZIP �vl P) <br />V ('�%/PPHONE <br />TENANT MAIL ADDRESS <br />CITY <br />ZIP <br />ARCHITECT OR DESIGNER MAIL ADDRESS <br />CITY <br />ZIP <br />PHONE <br />GENERAL CONTRACTOR MAIL ADDRESS <br />CITY <br />ZIP <br />PHONE STATE LICENSER <br />tea'»1 <br />AICCHI:NICAL CT R CTOR MAIL DDflE55 <br />CITY <br />ZIP <br />PHON STATE LICENSE 0 <br />PLCMBING CO TRACTOR AIL AD ESS <br />CITY <br />'LIP <br />PHONE STATE LICENSE N <br />C <br />I <br />PRICE OF WORK <br />DESCRIBE WORK AND S ARE FOOTAGE INVOLVED <br />CONTACT PERSONS AND PHONE NO <br />.SfAonNSS/rt',ti�_i J10aA <br />y06 �l I <br />/IOo <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br />APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />PROVISIONS 01- LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br />WORK WILL BE COMPLETED WITH WHETHEFI SPECIFIED HEREIN OR <br />NOT. 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 />CONTRACTORS LAW 18.27 RCW AND 296.200 WAC. <br />V OY <br />PROFOISED USE OF BUILDING <br />LEGAL DESCRIPTION OF PROPERTY (SHOWN BELOW OR ATTACH TWO COPIES) <br />LOT-- BLOCK -- OF <br />r <br />PARCEL TAX I.D. NUMBER <br />CONSTRUCTION LOAN LENDER, ADDRESS, TELEPHONE NUMBER <br />-PROJECT ADDR SS <br />S• IV ✓Q <br />`N <br />�r'(y�. <br />V• <br />SIGNATURE OATS <br />CITYBUSINESS LICENSENO <br />PLUMBIN3 <br />MECHANICAL <br />NO. <br />TYPE OF FIXTURE OR ITEM <br />FEE <br />NO. <br />TYPE OF EQUIPMENT <br />FEE <br />WA1 ER CLOSET (TOILET) <br />I <br />A/C-A/HNDLG UNITS-H.P. <br />BATHTUB <br />FORCED AIR SYSTEMS-B.T.U. M E.A. <br />LAVATORY (WASH BASIN) <br />UNIT HEATERS-B.T.U. M <br />SHONER <br />CLOTHES DRYERS <br />' <br />KITCHEN SINK & DISP <br />VENTILATION FAN <br />DISHWASHER ,!WW <br />1 <br />•RANGE HOOD <br />' <br />LAUNDRY TRAY .:-. <br />WATER HEATER <br />' <br />CLOTHES WASHER' <br />I <br />WOOD STOVE <br />URINAL <br />' ' <br />METAL FIREPLACE (WOOD BURNING) <br />' <br />DRINKING FOUNTAIN <br />i''i <br />FIREPLACE INSERT <br />FLOOR DRAIN <br />_ <br />1 <br />HEAT PUMP <br />BACKFLOW PREVENTERS <br />; <br />GAS PIPING <br />1 <br />T <br />90OF DRAINS-RAINLEADERS <br />' <br />_ <br />EXHAUST FAN <br />SINK (SERVICE -BAR, ETC.) <br />- <br />" <br />1 <br />I <br />1 _ <br />SUB TOTAL $ <br />; <br />SUB TOTAL $ <br />PERMIT $ <br />PERMIT $ <br />_ <br />TOTAL FEE $ <br />TOTAL FEE $ <br />' <br />FOR OFFICE USE ONLY: <br />FRONT SETBACK <br />REAR SETBACK <br />SIDE SETBACK <br />PLA'.NCHE K14UMBER <br />FEE <br />RECEIPT NO <br />q911969 <br />07 <br />.90 <br />- <br />USEZONE <br />LOT AREA <br />VACANT SITE <br />FEES I <br />VALUATION <br />FEE <br />BUILDING <br />El YES ❑ NO <br />TYPE OF CONST. <br />NO. OF STORIES <br />OCCUPANCY <br />NO.OFMEELINGUNUS <br />I <br />GROUP <br />PLUMBING <br />SIZE OF BLDG. <br />FIRE SPRINKLERS REO'D <br />BASEMENT <br />MEUNANICAL <br />❑ YES ❑ NO <br />- <br />ADDITIONAL PLAN CHECK <br />I_ <br />NC <br />OCCUPANCY LOAD <br />FIRE ALARM REO'D <br />HEIGHT LIMITA i;UN <br />/ <br />"-/ <br />OTHER / <br />f�� [); .✓ <br />REASON <br />STATE BUILDING SURCHARGE <br />PUBLIC WORKS <br />I!• d� <br />INTAKE By <br />PLNNS^ j'PjiOVEDE'! <br />CITY OF EYERFTT <br />vYA/� <br />LOCAL SALES <br />CODE IS 3105 <br />TOTAL <br />DATE � <br />TAX <br />