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APPLICATIQ"' FOR CONSTRUCTC'1N PERMIT � <br />TO BE COMPLFTED IN BLACt:1NK—PLEASE PRINT <br />BUILDING DEPARTMENT L <br />259-8810 <br />❑ DEMOLI710N ❑ COMBINATION <br />HEATING SYSTEM: U GAS U ELECTRIC ❑ <br />I:l MECHANIC •L ❑ PLUMBING ❑ SIGN <br />ONTJEF MAlll1DDRE5S p� ' CITY IIP PHONE <br />�^=—��j-�a � _, �' �o F"'�'.,.�.u�t 9 8a c 3 38 6 7 3 7 <br />��T L� 5 CItY ZIP PIqNE —. <br />MCHITECT01iDESIONEfl MAILADDRE55 GIN 21P PHONE <br />/Y /I A r+ . <br />utnewLLWNTRl1CTOR MAILADDflESS CITY ZIP PqpryE STATELICENSEI <br />RKo, ...9,,..., _ K..'.� CeY,.t 4�� S QlZe,�-, A-�.� �-�� 4 B 1 �� � S- j<2 f 7 Y SNO lY 'c l'1 !(t' (� <br />: MEC/UNICAL CONTMCTq hy1IL ADDRE55 CITY 21P PF10NE STATE LICENSE • <br />i <br />j PIUMBINaCONTRACTOR MA�LADDPESS CITV ZIP PHONE STATELIGENSE� <br />{:Ufil M114i PflIGt OF WORK <br />DESCRIBE WOflK AND SOU�HE FOpTAGE �NVOLVEO <br />� �. . <br />� S1 � �(' �a � <br />PROPOSED USE OF BUIL <br />CoJ-- 71– ✓J� c..iar�0 <br />IEdLL DESCflIPfION OF PROPEPTY (S BELOW OR AT�T�AC�H TV <br />LOT , 7` g�p�K � OF �J--� <br />� PARCELTA%I.D.NUMBEfl <br />_39:ta-op�_o�a�000� <br />CONSTRUCTION LOAN LENDER. ADDRE53, TELEPI/ONE NUMBEfl <br />nnaecr �oone s ` � <br />��0� <br />N0. TYPE OF FlXTURE OH ITEM <br />� WATER CLOSET (TOILEn <br />� BATHTUB <br />LAVATORY (WASH BASIN) <br />SHOWER <br />KITCHEN SINK 8 DISP <br />DISHWASHER <br />� LAUNDRVTRAY <br />� CLOTHES WASHER <br />I URINAL <br />� DRINKIN(i FOUNTAIN <br />FLOOR DRAIN <br />BACKFLOW PREVENTERS <br />ROOF DRAINS—RAINLEADERS <br />I SINK (SERVICE—BAR, ETC.) <br />I SUB TOTAL S <br />I PERMIT $ <br />i TOTAL FEE $ <br />FOR OFFICE USE ONLY: <br />FRONT SET&1CK REM SE�HnCK SIOE SETBACK PLAN CXE K MBEN � <br />�' S s � 3iG ' <br />useza+E �aru�� VACANTSITE FEES <br />%OX1$O' �O�,SbO ❑ YES A NO BUILDING <br />NO.OFSiORIES aauwwv xo.orowElurxuxrts <br />GRWP PLUMBING <br />FIflESPRINKLENbREO'D B�SEMENT <br />CONTACT PERSON M!D PHONE Np. j� � �• <br />/ �'6�C) t <br />i HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br />APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />FAOVIS�ONS OF LAWS AND ORDINANCES G01l�RNING THIS TVPE OF <br />WORK WILI BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br />NOT. THE GFANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br />AUTHORITY TO VIOLATE OR CANCEL THE PHOVISIONS OF ANY <br />OTHER STATE OR LOCAL LAW REGUUITING CONSTRUCTION OR THE <br />PERFORMANCE OF CONSTRUCTION, THAT I AM AUTHORIZED BV THE <br />OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br />APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />CONTFACTORS LAW 1827 RCW AND 296.200 WAC. <br />,��...� P. h� .S�S-9 � <br />eiarwtua o�ie <br />FORCED AIR SYSTEMS—B <br />UNIT HEATERS—B.T.U. M <br />CLOTHES DRYERS <br />VENTILATION fAN <br />RANGEHOOD <br />WATER HEATER <br />WOOD STOVE <br />METAL FIREPLACE (WOOD <br />FIREPLACE INSERT <br />HEAT PUMP <br />GAJ PIPING <br />EXHAUSTFAN <br />ti�:3'i-fl.7l <br />/(� ❑ YES [C�jO MECHANICAL <br />'IRE AURM flE0'0 HEIGHT LIMIT�TION ADDITIONA� PLAN CHECK <br />N� Z� OTHEP. <br />STATE BUILDING SURCHAFiGE <br />PLANS�PPROVEDBY CITY OP EVEREIT PUBLIC WOR:(S <br />,� LOCALSALES <br />onre c/p/9,1 TAX CODE IS 3105 �orA� <br />SUBTOTAL <br />3v � <br />N <br />H <br />