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APPLiCAT10"� FOR CONSTRUCT►'�N PERMIT � <br /> TO BE COMPLETED IN BLACK INK—PLEASE PRINT <br /> HEATING SYSTEM: 0 GAS ELECTRIC ❑ <br /> BUILDING DEPARTMENT <br /> 259-8810 <br /> ❑ DEMOLITION ❑ COMBINATION '� BUILDING ❑MECHANICAL ❑PLUMBING ❑ SIGN <br /> O E MAILAODRESS CIN ZIP PHONE <br /> ���_�5i� ��s /,,.�e�,���-f��.�9��.03 '�3— o�5 � <br /> TEN�NT MAILADDRESS CITV T ZIP PHONE <br /> � <br /> ARCHITECTORDESIGNER MAILADDRE55 CITY ZIP PHONE <br /> GENERALCONTRACTOR MAILAODRESS CITY ZIP PHONE STATEIICENSE♦ <br /> • <br /> McCHANICALCIXJTRACTOR MAILADDRE55 CI1Y ZIP PHONE STATELICENSEs <br /> PLUMBINGCONTRACTOR MAILADDRESS CITV ZIP PHONE STATELICENSEy <br /> CONTMCT PRICE OF WORK <br /> D�BEWORKMlDSOUAR WTAGEINVq.VED CONTACTPEFSONANOPHONENO. <br /> 5 <br /> I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br /> PROPOSED USE OF BUILOING � APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT.ALL <br /> PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br /> LEGALDESCPIPTIINJOFPROPERTY�SHOWNBELOWORnTTACHTWOCOPIES) NOT THELGRA T�ING OF A ERMITJDOES NOT PR'ESUME TO GNE <br /> LOT- BLOCK oF qUTHURITY 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 PERf'ORM THE WORK FOR WHICH <br /> APPLICATION IS MADE AND I CUMPLY WITH THE STATF <br /> PAHCEL T�X I.D.NUMBER CONTRACTORS LAW 1827 RCW AND 296200 WAC. <br /> GONSTRUCTION LOAN LENDER.ADURESS.TE�EPHONE NUMBER / _ ��� �/� � �� <br /> v A <br /> i rurune o�te <br /> PHOJE ADDRE � CITYBUSME� <br /> � PLUMBIN6 MECHANICAL <br /> NO. TYPE OF FlXTURE OR ITEM FEE N0. TYPE OF EGUIPMENT FEE <br /> � WATER CLOSET(TOILET) � A/CrA/HNDLG UNITS—H.P. ' <br /> � BATHTUB ; FORCED AIR SYSTEMS—B.T.U. M E.A. ' <br /> UNIT HEATERS--B.T.U. M � <br /> � LAVATORY(WASH BASIN) � � ��p�g pqYERS ' <br /> � SHOWER � � � <br /> KITCHEN SINK 8 DISP � VENTILATION FAN <br /> � DISHWASHER � RANGE HOOD � <br /> LAUNDRVTRAY ; WATER HEATER <br /> CLOTHES WASHER � WOOD STOVE ' <br /> URINAL ' METAL FIREPLACE(WOOD BURNING) ' <br /> � DRINKING FOUNTAIN I FIREPLACE INSERT � <br /> FLOOR DRAIN � HEAT PUMP � <br /> BACKFLOW PREVENTERS ; GAS PIPING ' ' <br /> ROOF DRAINS—RAINLEADERS � EXHAUST FAN ' <br /> SINK(SERVICE—BAR,ETC.) � � <br /> � <br /> � � <br /> � � <br /> � <br /> SUB TOTAL $ ' SUB TOTAL $ � <br /> PERMIT $ � PERMIT $ � <br /> — TOTALFEE $ ' TOTALFEE $ ' <br /> FOR OFFICE USE ONLY: Aeceiar No. <br /> FRONT SETBACK <br /> REAfl SETBACK SIDE SETBACK PLAN CHECK NUMBER FEE <br /> LOTAFEA VACANTSITE FEES VALUA7iON FEE <br /> USE ZONE � yES CI NO - �� <br /> BUILDING <br /> NO.OFSTORIES atCuvextr NoOfUwELI'iNGUHrtS . � <br /> iVPE OF CONSL en0un � <br /> PLUMBING <br /> SIZE OF BLOG. FIRE SPRINNLERS FEO'0 BASEMENT MECHANICAL � <br /> ❑ YES ❑ NO ; <br /> OCCUPANCVLOAD FIREAIARMREO'� HEIGHTLIMITATION <br /> ADDITIONAL PLAN CHECK ' _ <br /> OTHER <br /> i i <br /> REASON STATE BUILDING SURCHARGE ' <br /> INTAKE B\" PIANS APPROVED BV CITY OF EYENEIT PUBLIC W�RK$ ' <br /> LOCAL SALES I�s� <br /> DATE <br /> TAl(CODE IS 3105 TOTAL <br />