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� APPLICATIQ"��� FOR CONSTRUCTr`1N PERMIT � <br />�� TO BE COMPLETED IN BLACK INK—PLEASE PRINT � <br />BUILDING DEPARTMENT HEATING SYSTEM: � GAS LECTRIC ❑ <br />259-8810 <br />❑ DEMOLITION ❑ COMBINATION ❑ BUILDING L�, MECHANICAL ❑ PLUMBING � SIGN <br />OWNER MRILADDRESS CITV ZIP PHONE <br />�fT�.�sr1 EIZ.. �l►�� <br />TENANT MAILADDRE55 � CITV ZIP PHONE <br />�Zp�'TIE1� �� <br />AFCHRECTOBDESIGNER MAILADORE55 CITY ZIP PHONE <br />CITV ZIP PHONE STATELIGENSE/ <br />��1 rAlaa <br />MECHANICALCONTqACTOfl MAILADDRE55 CITV ZIP PHONE STATEUCENSEN <br />-d�-�- � Is,.,i 4�,�� 1�1TF1 �J� h i�-.T�L �If�inst 7� 4-9ct_z P�ul�-r � n9r�►J� <br />CONTRACTOR MAILAODRESS <br />T PRICE OF WORN <br />r%/Y� rvti/� 00 (��y <br />PROPoSED USE OF BUILOING <br />LEGAL DESCRIPTION OF PROPERTV (SHOWN BELOW OR ATTACH TWO COPIES) <br />LOT BLOCN OF <br />pqqCELTAX��BEfl � _ � ( _�O� <br />Z4 <br />CONSTRUCTION LOAN LENDER. ADDRESS, TELEPHONE NUMBER <br />TYPE OF flXTURE OR ITEM <br />WATER CLOSET (TOILE'f) <br />BATHTUB <br />L/1VATORY (WASH BASIN) <br />SHOWER <br />KITCHEN SINK & DISP � <br />DISHWASHER <br />LAUNDRYTRAY <br />CLOTHES WASHER <br />URINAL <br />DRINKING FOUNTAIN <br />FLOOR DRAIN <br />BACKFLOW PREVENTERS <br />ROOF DRAINS—RAINLEADERS <br />SINK (SERVICE—BAR, ETC.) <br />SUB TOTAL $ <br />PERMIT $ <br />� TOTALFEE $ <br />FOR OFFICE USE ONLY: <br />FFONTSETBACN HEARSETBACK <br />ttPE OF LONST. <br />SIZE OF BLDG. <br />LOT AREA <br />NO.OF SiORIEC <br />FIRE SPRINNLERS REO'D <br />FIRE ALAFM FEO'D <br />SIDE SETBACK <br />VACANT SIiE <br />❑ YES ❑ NO <br />acuvnxcr No.orow[uixcurvrts <br />cxour <br />❑ YES ❑ NO <br />HEIGMT LIMITATION <br />gy PLANSAPPROVEOBY CITYOFEYEREIT <br />� � LOCALSALES <br />DATE U� � TAX CODE IS 3105 <br />ZIP PHONE � STATELICENSEI'� <br />PHONENO. <br />I HEREBY CERTIFY THAT � HAVE READ AND EXAMINED THIS <br />APPL�CATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br />WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN Ofi <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 />OWNEF OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br />APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />CONTRACTORS LAW iB.27 RCW AND 296.200 WAC. <br />MECHANICAL <br />TYPE OF E�UIPMENT <br />FORCED AIR SYSTEMS—B. <br />UNIT HEATERS—B.T.U. M <br />CLOTHES DRYERS <br />VENTILATION FAN <br />WATER HEATER <br />WOOD STOVE <br />METAL FIREPLACE � <br />FIREPLACE INSERT <br />GAS PI�ING <br />EXHAUSTFAN <br />NUMBER <br />BUILDING <br />PLUMBING <br />MECHANICAL <br />ADUITIONAL PLAN CHECK <br />OTHER <br />STATE BUILDING SURCHARCaE <br />PUBLIC WORKS <br />TOTAL <br />M E.A. <br />SUBTOTAL $ <br />PERMIT $ <br />TOTAL FEE $ <br />i <br />� <br />N <br />� <br />