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�:.;� � �lC�,'U� <br /> ; APPLICATIQ"N FOR CONSTRUC7�'hN PERMIT � <br /> AP�; � �, ,_TO BE COMPLETED IN BLACK INK—PLEASE PRINT <br /> � r . i <br /> .... ...................... ....._......................... � <br /> CI I`i '= �4'E(�ETT HEATING SYSTEM: ❑GAS O ELECTRIC ❑ <br /> BUILDING DE��TA��NT <br /> 259-8810 �� �crlcs Dept. <br /> ❑ DEMOLITION ❑ COMBINATION ❑ BUILDING ❑MECHANICAL ❑PLUMBING ❑ SIGN <br /> py/NEp t.�ILA�DRESS CITV Z�P PHONE <br /> C�o�l"t-t3c� SNrt �TEE ��I� G��Nv.xx�� AVC EVI �< <1 �3��L, %:.�, r�''�-:,� <br /> ?ENANT MAIL ADOFE55 CITY ZIP t PHONE <br /> ARCHITECTOROESIGNER MAILADDRESS CITV 21P PHONE <br /> GENERAL CONTRACTOR MAIL ADDRESS CITV ZIP PHONE STATE LICENSE t <br /> MECHqNICAL CONTRACTOP MAIL AODRE55 CITY ZIP PNOIlE STATE LICENSE a <br /> PLUMBINGCONTRACTOR MAIIADDRE55 CITY 21P PHONE STATELICENSEa <br /> CIXJTRRCT PRICE OF WOR 1 M <br /> l Ow <br /> DESCRIBE WORN AND SOUARE FOOTAGE INVOLVED I�� � CONTACT PERSON AND PHONE NO. <br /> Q.NlO(`bL C.C�1/5 C <br /> /"T1J / 1 �'G I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br /> PROPOSED USE OF BllIL01NG APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT.ALL <br /> • PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br /> LE6ALDESCRIPTIONOFPROPERTVISHOWNBELOWORATfACHTWOCOPIES) WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br /> NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br /> �oT e�ocK oF AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANV <br /> OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br /> PERFORMANCE OF CONSTRUCTION.THAT I AM AUTHORIZED BY THE <br /> OWNEH OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br /> APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> PARCEL TAX I.D.NUMBER CONTRACTORS LAW 18.27 RCW AND 296.200 WAC. <br /> CONSTRUCTIONLOANLENOER,ADDFESS,TELEPHONENUMBER X � p � . � <br /> . l3� �11� � '-� -�'"{' =`��� <br /> PRQIECTADDFIESS S�GNA—����— OAIE <br /> CILVBUSMESSL6ENSENO <br /> �. PLUMBING MECHANICAL <br /> � NO. TYPE OF flXTURE OR ITEM FEE NO. TVPE OF E�UIPMENT FEE <br /> WATER CLOSET(TOILET) � NC—A/HNDLG UNITS—H.P. � <br /> BATHlUB ; FORCED AIR SYSTEMS--B.T.U. M E.A. ' <br /> LAVATORY(WASH BASIN) � UNI'"iEATERS—B.T.U. M � <br /> SHOWER ' CLOTHES DRYEFS <br /> KITCHEN SINK 8 DISP VENTILATION FAN � <br /> DISHWASHER � RANGE HOOD � <br /> LAUNDRYTRAY ; WATER HEATER <br /> CLOTHES WASHEF � WOOD STOVE <br /> � URINAL ' METAL FIREPLACE�WOOD BURNING) <br /> DRINKING FOUNTAIN � 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 /> � ' <br /> SUB TOTP.L $ ' SUB TOTAL 5 ' <br /> PERMIT S PERMIT S � <br /> TOTAL FEE $ ' TOTAL FEE $ ' <br /> FOR OFFICE USE ONLY: <br /> FRONTSETBACK PERRSETBACN SIDESETBACH PLANCNEGKNUMBER FEE RECEIPTNO. <br /> USE ZONE lOT AREA VRCANT SITE FEES VALUATION FEE <br /> r' VES ❑ NO j OO t�S '^ I <br /> BUILOI�G <br /> TYPEOFCONSi. NO.OFSTORIES ocCUCu¢r NoO�mvF0.ix;UxrtS � <br /> cnour PLUMBING � <br /> SIZEOFBLDfi FIRESPBINKLERSPEO'D BASEMENT MECHANICAL � <br /> G YES ❑ NO � <br /> OCCUPAN:YLOAD FIREALAFMREO'D HEIGMiLIMIT�TION ADDITIONALPLANCHECK � <br /> � i <br /> OTHER � <br /> REA50'1 <br /> STATE BUILDING SURCHARGE �S� <br /> INTAN°bV PLAN$APPROVEDBY CITYOFEUERETT PUBLIGWOflKS � ' <br /> � LOCAL SALES a �50 <br /> opTE TAX CODE IS 3105 TOTAL <br />