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APPLICATIC�� FOR CONSTRUCT'lN PERMIT � <br /> TO BE COMPLETED IN BLACK INK—PLEASE PRINT <br /> BUILDING DEPARTMEN– HEATING SYSTEM: l GAS ❑ELECTRIC ❑ <br /> 259-8810 <br /> f_7 DEMOUTION IJ COMBINATION Ll BUILDING ❑ MECHANICAL ❑PLUMBING ❑ SIGN <br /> OWNER MAILADDRESS CITV 21P PHONE <br /> !�fY�Ua�'�{� �r� �1�(''i�n �21� GIY�D� [=1Ji�� «j G+�� �[f��6�3 `35� ' �9�1� <br /> TENANi MAILADORE55 CITV ZIP <br /> PHONE <br /> ARCHITECTOROESIGNER MAILqD�RESS CITV ZIP PHONE <br /> GENERALCONTRACTOR MRILAODFE55 CITV ZIP PHONE STATELICENSEM <br /> MEGMANICAICONTRPCTOR MAILADDRE55 CITV ZIP PHONE STATF.LICENSER <br /> ��nv 5r�ti �trx�ht-71�� 3Krl ihr�ts ����T �l7a.c�l 2s�-zliy �=vcn�ssrz►k�- <br /> PLUMBINGCONTRFCTOR MAIIADOPE55 CITV ZIP PHONE STpTEUCENSEk <br /> CONTpACT PFICE OF WORK (,� (� <br /> "i l �5 �L�� <br /> DESCRIBE WORK AND SOUARE FOOTAGE INVOLVED CONTACT PERSON FND PHONE N0. . <br /> i HEREBY CERTIFY THAT I HAVE READ qND EXAMINED THIS <br /> PFOPOSE�USE OF BUIL�ING APPL!CATION AND KNOW THE SAME TO BE TpUE AND CORRECT.ALL <br /> �LS�(,1Q,Ji�I� I PROVISIONS OF LAWS AND ORDINANCES GUVERNING THIS TVPE OF <br /> LEGALDESCPIPTIONOFPROPERTY�SHOWNBELOWORATT�GHiWOCOPIES� WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br /> ior BLOCK oF NOT. TH� 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 AUTHORI2ED BY THE <br /> OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br /> PARCELTA%I.D.NUMBER <br /> APPU^•ATION IS MADE AND I COMPLY WITH THE STATE <br /> CONTUHCTORS LAW 1827 RCW AND 296200 WAC. <br /> CONSTFUCTION LOAN LENOER.ADDFESS.TELEPHONE NUMBEP <br /> x-�' ,�,� � � 12« 7 <br /> S,o PROJECT ADDRESS s�cn.ru� oere <br /> CIiV bVSME55 LiLENSE NO. <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FlXTURE OR ITEM FEE N0. TYPE OF EOUIPMENT FEE . <br /> WATER CLOSET(TOILET) A/C—A/HNDLG UNITS--H.P. , <br /> BATHTUB ; � FORCED AIR SYSTEMS—B.T.U. M E.A. � <br /> LAVAI�ORY(WASH BASIN) UNIT HEATERS—B.T.U. M ; <br /> SHOiNER CLOTHES DRYERS i <br /> KITCHEN SINK&DISP � ; VENTILATION FAN � . <br /> � DISHWASHER RA��GE HOOD <br /> LAUNDRY TRAY ' 1 WATER HEATER � <br /> CLOTHES WASHER WOOD STOVE ; � <br /> URINAL METAL FIREPLACE(WOOD BURNING) � <br /> ORINKING FOUNTAIN �IREPLACE INSERT � <br /> FLOOR DRAIN HEAT PUMP , <br /> BACKFLOW PREVENTERS �i GAS PIPING � <br /> ROOF DRAINS--RAINLEADERS EXHAUS7 FAN ' <br /> SINK(SERVICE—BAR,ETC.) <br /> � � <br /> � <br /> � � <br /> SUB TOTAL $ SUB TOTAL 3 3Q � <br /> PERMIT $ i pERM1T $ ',f ; <br /> _ TOTAL FEE 3 TOTAL FEE $ � <br /> FOR OFFICE USE ONLY: <br /> � FROIJTSETBACK REARSETB�CK SI�ESETBACK PLANCHECKNUMfiER FEE RECEIPTNO. <br /> USE20NE LOTAqEA VACANTSITE FEES VALUATION FEE <br /> ❑ YES C NO BUILDING ' <br /> i <br /> 7VPiJFLONSi NO.OFSTORIES xturekw xoorowElurmmin5 _ <br /> sAoua pLUMBING � <br /> SIZEOFBLCG. FIRESPRINKLERSREO'D BASEMENf MECHANICAL � <br /> ❑ YES C'� NO _. <br /> OCCUPANGV LOPD FIRE A�ARM REO'D NEIGHT LIMITATION ADDITIONAL PLAN CHECK � <br /> i <br /> OTHER i <br /> FEASON <br /> STATE Bl11LDING SURCHARGE � <br /> INTANE BY PlqNS APPPOVED BY CITY OF EVEREIT PUBLIC WOFiNS � <br /> i <br /> LOCAL SALES <br /> DATE TAX CODE IS 3105 rora� ; <br />