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APPLICATIQ�' FOR CONSTRUCT''�N PERMIT � <br /> TO BE COMPLETED IN BLACK INK—PLEASE PRINT <br /> BUILDING DEPARTMENT HEATiNG SYSTEM: ❑GAS ❑ELEC7RIC ❑ <br /> 259-8810 <br /> L DEMOLITION Ll COMBINATION �( BUILDING l_I MECHANICAL ❑PLUMBING L SIGN <br /> OWNER MAILAOORESS CITV IIP PMONE <br /> �2ande1l D.F � I�wn Ru,�Ftr� fit� Fr' �,lvt. E�dct} 98znt C�) 252-'(9�}9 <br /> TENRNT MAILADDRE55 CITV u Ilp 11 PMONE �� <br /> 12mdall Rk{�n snm� <br />' ARCM�IT(ECTCRDESIGNER MAILp�DFF,55 QTV 21P PHONE <br /> NA1JC -- -- �- <br /> GENERALCONTRACiOR MAILAODRESS CITY 21P PHOME SiATEUCENSE• <br /> NoNt �— — <br /> MECHANICALCONTRACTOR MqILADORESS CITY ZIP PNONE STATc�ICENSE� <br /> •Iti y � �_ _� <br /> N\.IM• <br /> PLUMBMG CCNTRRCTOR MRIL AODRESS GTY ZIP PHONE STATE LICENSE� <br /> NONL ^ — <br /> CONTRACT PRICE OF WORK <br /> UESCRI9E WORN AND SOUARE FOOTAGE INVOLVED ��� Q I CONTACT PERSON AND PHONE NO.��I \. �� �S�-�e� <br /> u -� <br /> dCtk m wiA e�airs aF la�ckdoov to cili4 a�Flcr S:Is prn <br /> 7�.c v► F10U3� �IAK�� � �0.�CX�I�KpCf.�f 'F/ i HEREBY CERTIFY THAT 1 HAVE READ AND EXAMINED THIS <br /> PROPOSEDUSEOFBUILDING APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT.ALL <br /> l�tsidtniial - alrcad� �ciSFi PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br /> �L GALDESCPIPTIONOFPROPERTY�SNO enowoa PCHTWOCOPIES� 1 WGFK WILL BE COMPLETED WITH WHETHER SPEGFIED HEREIN OR <br /> T �� e�ocK� oF �� ��• EV7. NuT. 71IE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br /> AUl'HOf11TY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br /> OTHEF ;TATE OF LOCAI LAW REGULATING CONSTRUCTION OR THE <br /> — PEFFORMANCE OF CONSTRUCTION.THAT I AM AUTHORIZED BY THE <br /> � OWNER OF THIS PROPERTV TO PERFORM THE WORK FOR WHICH <br /> rnnee�rn�x�i.to.Nun+eea APPLICATION IS Ml.DE AND 1 COMPLY WITH THE STATE <br /> � 'TTI�J'OO�I'OIO'O�LD CONTRACTORS LAW 1827 RCW AND C96200 WAC. <br /> CONSTRIICTION LOAN LENOER.ADDRESS,TELEPHONE NUMBER n_ �' <br /> PROJECT ADDyRESS ,LM1.. 1Aro �{'�� '�/�I4� <br /> S�iNI UHE ��E <br /> 3�Z 1 ���u ,AYG'VK E G� Y'I� CiTYBUSME55liCENS(NO <br /> �- PLUMBING MECHANIC4L <br /> N0. TYPE OF flIC�URE OR ITEM FEE NO. TYPE OF EOUIPMENT FEE . <br /> WATER CLOSET(TO�LET) � NC—A/HNDLG UNITS—H.P. � <br /> BATHTUB ; FORCED AIR SYSTEMS--B.T.U. M E.A. � <br /> , LAVATORY(WASH BASIN) � UNIT HEATERS—B.T.U. M <br /> ' SHOWER CLOTHES DRYERS � <br /> KITCHEN SINK 8 DISP � VENTILATION FAN ; <br /> DISHWASHER � RANGE HOOD � <br /> LAUNDRYTRAY ; WATER HEATER ' <br /> CLOTHES WASHER � WpOD STOVE � <br /> '. URINAL ' METAL FIREPUICE(WOOD BURN�NG) � <br /> � DRINKING FOUNTAIN � F�REPLACE 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 /> I <br /> SUB TOTAL $ � SUE3 TOTAL $ ' II <br /> � PERMIT $ � PERMIT $ I . <br /> � TOTAL FEE $ ; TOTAL FEE $ <br /> FOR OFFICE USE ONLY: <br /> FRONT SETBACK PERR SETBACN SIDE SETBACK PLAN LHECK NUMBEfl FEE RECEIPT NO. <br /> a�� <br /> USEZONE LOTAflEA VACANTSITE FEES VALUATION FEE <br /> ❑ YES G NO gUILDING i <br /> TYPEOFLON57. NO-0FSTONIES OCNPM'Cr uoOrDv:FluNGUNns � <br /> GqWP PLUMBING i <br /> SIZE OF BIDG. FIRE SPRINKLERS REO'D BASEMENT MECHANICAL � <br /> ❑ YES ❑ NO , <br /> OCCUPANCVLORD FIFEALARMREOD HEIGHTLIMITATION ADDITIONALPLANCHECK <br /> OTHER <br /> i <br /> REASON <br /> STATE BUILDING SURCHARGE i <br /> INTAKE BV PLANS APPPOVEDBV CITY OF EYEREIT PUBLIC WORHS <br /> c}IV1 LOCAL SALES � <br /> oATe �Or� 93 TAX CODE IS 3105 IOTAL � ' <br />