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APPLICATICod FOR CONSTRUC7.ON PERMIT <br />TO BE COMPLETED IN BLACK INK —PLEASE PRINT <br />HEATING SYSTEM: U GAS ❑ ELECTRIC U _ I <br />BUILDING DEPARTMENT <br />259-8810 <br />DEMOLITION I COMBINATION BUILDING MECHANICAL ypPLUMBING SIGN <br />O <br />WnnNER <br />(7elG FOSLTte^ <br />mna �� <br />7"(3 i 1/I,44 <br />��NM4 <br />r ✓uC �glU� <br />3 Z 7- / 7 <br />✓ I� <br />TENANT <br />MAIL ADDRESS <br />CITY <br />21P <br />PHONE <br />ARCHITECT OR DESIGNER <br />MAIL ADDRESS <br />1/ <br />CITY <br />LQ-- <br />ZIP <br />`7eze)U <br />PHONE <br />33I3/7 <br />(SsRAt Fs ti I(M <br />GENERAL CONTRACTOR <br />2 t 31 <br />MAIL ADORESS <br />./- CITY -},j /� <br />ZIP <br />q Pz"� <br />PHONE STATE UCENSEI <br />37 -/3/7 A�'I1 e✓Z <br />6eLAc rr5i c� <br />7�13I Us f <br />a <br />tJCVL l <br />ZIP <br />. <br />PHONE STATE UCENSEI <br />MECHANICAL CONTRACTOR <br />DilLl� <br />MAIL ADDRESS /4 00 <br />S <br />N, L V. <br />cite',, <br />CITV <br />MI!• Cieck <br />�ioi2 <br />7yz-U6Yy p1oRiH o9SJ/Z <br />/UW (41ecNR <br />yl Iir <br />'P <br />LITV <br />ZIP <br />PHONE STATE LICENSE I <br />PLUMBING CONTRA TOR <br />7L <br />MAIL ADDRESS <br />� <br />v <br />L✓erlr <br />-7L1Z-06yy Noe 217491 <br />N Li QL /Lc <br />�A � 5. 1�� <br />i� <br />CLASS OF WORK <br />ncAAnl mnN <br />WOODSTOVEIFRPL INSERT �� BUILDING RELOCATION <br />I I NEW I I AUUI I IUry <br />----- <br />CONTACT PERSON AND PHONE NO. <br />p. a <br />CONTRACT PRICE OF WORK <br />DESCRIBE WORK ANDD SQUARE FOOTAGE INVOLVED <br />, <br />PR±<1,-T'e <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br />PROPOSED USE OF OF BUILDING <br />APPLICATION AND KNOW THE SAME TO BE Tt;UE AND CORRECT. ALL <br />f-[S y <br />PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br />WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br />LEGAL DESCRIPTIr F PROPERTY (SHOWN BELOW OR ATTACHFOUR COPIESI <br />NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br />LOT BLOCK OF <br />- <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 />I ✓G Jp <br />APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />CONTRACTORS <br />/n�/-LLA,,W 18�27 RCW AND 296.200 WAG. U <br />X (�L./I /!" "" MG,c �t z ` IK 2- <br />��77 <br />2'7 e, Lklw #JLr, t e- 'Jl �c <br />I I <br />SIDNAtURE SATE <br />U 2 2 -% <br />PROJECT ADDRESS <br />CITV BUSNESS LICENSE NO <br />MECHANICAL <br />PLUMBING <br />UR <br />TYPE OF FIXTE OR REM <br />FEE <br />NO. TYPE OF EOUIPMENT FEE <br />NO. <br />WATER CLOSET (TOILET) <br />of '� <br />A/C-AMNDLG UNITS-H.P. ' <br />r ;- <br />FORCED AIR SYSTEMS-B.T.U. M E.A. <br />,s BATHTUB <br />_ <br />UNIT HEATERS-B.T.U. M <br />LAVATORY (WASH BASIN) <br />' <br />I <br />CLOTHES DRYERS <br />SHOWER <br />KITCHEN SINK & DISP <br />�p - <br />VENTILATION FAN ' <br />RANGE HOOD <br />DISHWASHER <br />1- <br />3 WATER HEATER , <br />LAUNDRY TRAY <br />, <br />' <br />I <br />WOOD STOVE <br />CLOTHES WASHER <br />- <br />METAL FIREPLACE & CHIMNEY <br />' <br />URINAL <br />FIREPLACE INSERT <br />DRINKING FOUNTAIN <br />HEAT PUMP <br />FLOOR DRAIN <br />BACKFPREVENTERS <br />LOW <br />GAS PIPING <br />' <br />ROOF DRAINS-RAINLEADERS <br />SINK (SERVICE -BAR, ETC.) <br />I <br />EXHAUST FAN <br />I <br />—T— <br />1; <br />SUB TOTAL $ <br />3p <br />SUB TOTAL $ <br />p <br />PERMIT $ <br />PERMIT $ <br />TOTAL FEE $ <br />' <br />TOTAL FEE $ <br />11 ' <br />FOR OFFICE USE <br />ONLY: <br />RECEIPT NO <br />FRONT SETBACK <br />REAR SETBACK <br />SIDE SETBACK <br />PLAN CHECK NUMBER FEE <br />- 3Go9 <br />FEES <br />VALUATION <br />FEE <br />USE ZONE <br />LOT AREA <br />VACANT SITE <br />' <br />�- <br />BUILDING <br />^' <br />TYPE OF CONTS.ALLOWABLE '•.� <br />TYPE OF CDNST. ACTUAL <br />OCCUPANcr <br />xa ov owFulxc uxrts <br />GROUP <br />PLUMBING <br />MECHANICAL <br />SIZE OF BLDG, <br />NO, OF STORIES <br />BASEMENT <br />ADDITIONAL PLAN CHECK <br />OCCUPANCY LOAD FIRE SPRNKLERS AEO'D HEIGHT LIMITATION <br />, <br />SPRINKLER <br />REASON FOR SPRINKLERS <br />STATE BUILDING SURCHARGE <br />PUBLIC WORKS <br />' <br />' <br />INTAKE BY <br />PLANS APPROVED BY <br />CITY OF EVERM <br />LOCAL SALES <br />TCODE IS 3105 <br />M <br />TOTAL <br />