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APPLICATIQ"'1 FOR CONSTRUCT!'�N PEF�MIT � <br /> TO BE COMPLETED IN BLACK INK—PLEASE PRINT <br /> HEATING SYSTEM: �GAS ❑ELECTRIC ❑ � <br /> BUILDING DEPARTMENT <br /> 259-8810 <br /> ❑ DEMOLITION ❑ COMBINATION ❑ BUILDING LJ MECHANICAL !J PLUMBING I I SIGN <br /> OWNER IMIIAUDRESS CITV ZIP P110NE <br /> CoccEE.y 6v�.9� y9a, Gt�r.wvrw /w Er- 9'9�Iv9 2slf- 29Siv <br /> TENANT MAILhDDRES:+ CITV ZIP PHONE <br /> ARCHITECTORDESMaNER IMu.A0DRE55 ��Tr ZiP PM�NE <br /> GENEMLCONTRACTOP ��L�DDRESS CIT' ZIP PIWNE STATELICENSE� <br /> MECHMlIC/0.CONTRAC70R MARAODRESS GITV 21P PIWNE STATELICENSE• <br /> o�r,�w �,- rw.rr�.� ••yE IIt./.f/I7�/.l7YL1� Q'/ �10/ 251-�//S� F+'/FK6SS�L�.F7 <br /> PLUMBMNICOMTM�TOR IMILADDRESS CITV 21P Pl10NE STATELICENSE/ <br /> CONTRACT PRICE OF WONK <br /> �L��/a <br /> pE$CqIBE M/ORN AND S�UAflE FOOTAGE INVOLVEO CONTACT PERSON�NO PHONE NO. Y0 <br /> �/ <br /> I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br /> PRCPOSED USE OF BUILDING APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT.ALL <br /> PROVISIONS OF LAWS AND ORDINANCES GOVERNINCa THIS TVFE OF <br /> 4EGALDESCRIPTIONOFPlqPERTV�SMOWNBELOWOBATTACHNiOCOPIES) NOT. THELGRA T�ING OF A ERMITJDO SENOT PRIESUME TO GIOVE <br /> �or ��K � AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br /> OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR TME <br /> PERFORAIANCE OF CONSTRUCTION.THAT I AM AUTHORIZED BY THE <br /> OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br /> APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> PARLEL T/J(LD.NUMBER CONTRACTORS LAW 1827 RCW AND 296200 WAC. <br /> CONSTRUCTqN LOAN LENDER.�ODNESS.TELEPHOHE NIMABER / / /JO ��/x` � <br /> � �� <br /> ECTADDRESS � -- <br /> �nr Busmcss�K[r�sE w <br /> PLUMBING MECHANICAL <br /> FEE Np, TYPE OF EOUIPMENT FEE <br /> Np, TYPE OF flXTURE OR ITEM q��q�HNDLG UNITS—H.P. <br /> WATER CLOSET(TOILET) ' � � <br /> BATHTUB ' FORCED AIR SYSTEMS--B.T.U. .A� <br /> � LAVATORY(WASH BASIN) � UNIT R ATER�B.T.U. M � <br /> SHOWER ' CLOTHES DRVERS � <br /> KITCHEN SINK 8 DISP � VENTILATION FAN � <br /> DISHWASHER � RANGE HOOD ' <br /> LAUNDRYTRAY ' _ WATERHEATER � <br /> CIOTHES WASHER � WOOD STOVE ' <br /> URINAL ' METAL FIREPLACE(WOOD BURNING) ' <br /> DRINKING FOUNTAIN � FIREPLACE INSERT <br /> � <br /> � HEAT PUMP � <br /> FLOOR DRAIN � <br /> BACKFLOW PREVENTERS ; GAS PIPING ' <br /> ROOF DRAINS—RAINLEADERS � E%HAUST FAN ' <br /> SINK(SERVICE—BAR,ETC.) � ; <br /> � � <br /> - � <br /> � � <br /> � <br /> SUBTOTAL S ' SUBTOTAL S � <br /> PERMIT 3 ' � PERMIT S � � � <br /> TOTALFEE S ' 70TALFEE $ ' <br /> FOR OFFICE USE ONLY: FEE pECEIPT NO. <br /> FRONTSEiBACK REARSET&�CK SIDESETBACK PLANCMECKNUM� <br /> iJ .� <br /> IOTAREA VACI�NTSITE FEES VALUATION FEE <br /> use za+e ❑ YES ❑ NO BUILDING � <br /> TYPEOFCONST. ���STOflIES ottuvuxr raavMui+cuxns i <br /> �Ad�P PLUMBING <br /> SREOFBLDG. FIflESPRINKLEflSREO'0 BASEMENT MECHANICAL � <br /> ❑ YES ❑ NO � <br /> ADDITIONAL PUN CHECK ' <br /> OCCUPANCYLOAD FIRE�LARMREO'D MEKaHTLIMITATION � <br /> OTHER � <br /> RE�SO� STATE BUIL�ING SURCHARGE ' <br /> INTAKEBV PLANSAPPflOVEDBV CITYOFEYEflETT PUBLICWORKS ' <br /> LOCALSALES ; <br /> DNE TAX CODEIS 3105 TOTAL I <br />