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APPLICATIQ�! FOR CONSTRkICY' �1W PERMIT � <br /> TO BE COMPLETED IN BLACK INK—PLEASE PRINT <br /> HEATING SYSTEM: GAS ❑ELECTRiC ❑ <br /> E' !G DEPARTMENT <br /> _ 0 <br /> .OLITION ❑ COMBINATION CJ BUILDING ,..�..#AECHANICAL J�tlM81NG I� SIGN <br /> p���,��:, MAILAODRESS CIN ZIP PMONE <br /> �'��i�, 1� �44, �-r� ��v.�+-����c�.l 1���1�,.r-�r� °�1'zvZ �7�i'j �9�� <br /> TENANT MAII ADUFi� dTY ZIP PHONE <br /> ARCHITECT OR DESIGNER MAIL ADORE55 GIN ZIV PHOkE <br /> G[NERAL CONTiiACTOR MAIL ADDi1ES5 CITY ZIP PHONE STATE LICENSE R <br /> MEL�/AIJ��LGoj TRAGTQR �IM ILADDRE55 CI1Y ZIP PHONE STATELICENSE� <br /> I\I %\ I V'JI <br /> PLUMBING ON RACTOR MAIL AODAESS CITV ZIP PMONE STRTE LICENSE t <br /> CCNTqACT PRICE OF WORK <br /> UESCPIB WO�f�ND ARE f AGE I OLVED � _ _ CONTACT PEfl50N AND PHONE NO. <br /> � <br /> -�+�� � � •�,., � �, h �' ��vaz �/�f 3 <br /> I HEREBY CERTIFY THAT 1 HAVE READ AND EXAMINED THIS <br /> PFOPOSED USE OF BUILDING A?PLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT.ALl <br /> PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TY°E OF <br /> IE�ALUESCRIPTIONJFPROPERTV�SHOWNBELOWORARACHTWOCOPIES) WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br /> NOT. TtiE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br /> toT BLOCK oF 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 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 /> PARCEL TA%I. UM — — '—� CONTRACTORS LAW �2'l'1�CW A .200 WAC. �� <br /> GONSTRUCTIONLOANIENUER. ODRESS.TELEFMONENUMBER . � � /� <br /> L <br /> PROJECT ADDRESS siexr.+uae — o^�E <br /> Lilv BUS W E55�ICENSE NO <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXT:IRE OR ITEM FEE N0. TYPE OF E�UIPMENT FEE <br /> WATEF CLOSET(TOILET) � A/C—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 � WOOD STOVE � <br /> URINAL ; METAL FIREPLACE(WOOD BURNING) ' <br /> DRINKING FOUNTAIN � FIREPLACE INSERT � <br /> FLOOR DRAIN � HEAT PUMP ' <br /> BACKFLOW PREVENTERS ; 'Z GAS PIPING � <br /> ROOF DRAINS—RAINLEADERS � EXHAUST FAN � <br /> SINK(SERVICE—BAR,ETC.) <br /> � <br /> � <br /> � ' <br /> SUB TOTAL 5 ; SUB TOTAL 5 ' <br /> PERAl1T S PERMIT S � <br /> TOTALFEE S ' TOTALFEE $ <br /> FOR OFFICE USE ONLY: <br /> FRONT SETBACK FEAR SETBACK SIOE SETBACK PLAN CNECN NUMBEF FEE PECEIPT NO. <br /> USEZONE LOTAREA VACANTSI7E FEES VALUATiDN FEE <br /> ❑ YES '�' NO gUILDING ' <br /> TYPEOFLONSi. NOAFSTORIES OC[uP+uw NoO�o'tiuu',6eVn5 � <br /> teauv PLUMBING i <br /> SIZEOFBLDG. FIRESPRINHIERSREO'D B4SEMENT MECHANICAL � <br /> �i YES : -� NO <br /> oCCUanNCY LOAo FIRE ALARM FEOD HEIGHT LIMITATION ADDITIONAL PLAN CHECK i <br /> � <br /> OTHER ' <br /> fiEA50N <br /> STATE BUILDING SURCHARGE <br /> i <br /> ItR4N[OY PLANSAPPROVE�BV CITY OF EVEREIT PUBLIC W�RKS <br /> LOCAL SALES <br /> opTE TAX CODE IS 3105 TOTAL ; <br />