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-� pppLICpTIQ�I FOR CONSTRUCT'`'1N PERMIT � <br /> TQ BE COMPLETED IN BLACK INK—PLEASE PRINT <br /> HEATING SYSTEM: j�,GAS ❑ELECTRIC ❑ <br /> BUILDING DEPARTM[NT <br /> 259-8810 <br /> ❑ DEMOLITION ❑ CO��nBINATION SL BUIL�ING S�.MECHANICAL 53.PLUMBING � SIGN <br /> OWNER MAILADORE55 CITY ZIP PMONE <br /> n/� :t 3 cr - .c e�'NrefY �9:��8� ?3Ts.z 7 >� <br /> TENA T AIL A DRESS CITY ZIP PHONE <br /> � <br /> , ,� /' w d .. — <br /> RRCHITECTOiDESIGNER MAILPD 55 CITV _ PNONE <br /> PAPi.�Hc.u•✓ �6/�f-A /3r�dwd.i �Edc re1�ZP �Ygi� � PMONEZSF��S'iZC�EY — <br /> GENERALCONTRACT� MA'LAOORE55 <br /> /QEMoc�� li•�,Mac�ic. /��= Y4�4 3/sfA✓��4� `✓e�Cit q$�o� �3,�.277� R�AbO.*ios9�(rN <br /> MECHANICALCONTflACfO M ADDRL55 CITY ZIP PHONE STqTEUCENSEt <br /> PLIIMBINQCONTRACTOR MAILADUPESS GITV ZIP PHONE STATELICENSE� <br /> CONTRACTPRICE WOR <br /> �> �3 <br /> DESCRIBE WORK AND SOUAPE FOOTAGE� `/OLVED CONTACT PERSON AND PHONE NO. g r <br /> �/�l4/ S .�R i.3.Z� So Fi` •✓ o � <br /> i HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br /> PROPOSED USE OF BUIL01 APPIICATION AND KNOW THE SAME TO BE TRUE AND CORRECT.ALL <br /> � � PROVISIONS OF LAWS AND OFDINANCES CaOVFRNING THIS TYPE OF <br /> �ecn�oescnirna+oFrnorean�sNow�+ae�owoennn H �ocories J WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br /> 'NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br /> �pT� e�xK oF AUTHORITY TO VIOLAT�: OR CANCEL THE PROVISIONS OF ANY <br /> OTHER STATE OR LOCAL LAW REGULATING CONSTkUCT10N OR THE <br /> — PERFORMANCE OF CONSTRUCTION.THAT I AM AUT:iORIZED BY THE <br /> OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br /> APPLICATION IS MADE ANU I COMPLY WITH THE STATE <br /> PARCEL TAX I D.NUMBER ;ONTRACTORS LAW 18.27 RCW AND 296.200 WAC. <br /> �pp�S1pUCT10N LOAN LE�R.ADDRESS,TELEPHONE NUMBER <br /> p 6'Oe -ls L 7--•:e�.r�-�, /0•-6" Yu <br /> L1 ✓ N � o�re <br /> PROJECT AD ESS SiGNAtURE <br /> 'L Cliv Bu5ME55 Li:ENSE NO. <br /> T • <br /> PLUMBING MECHANICAL <br /> Np, TYPE OF FlXTURE OR ITEM FEE N0. TYPE OF EQUIPMENT FEE <br /> WATER CLOSET(TOILEn � A!�/VHNDLG UNITS-H.P. � <br /> BATHTUB ; / FORCED AIF SYSTEMS-B.T.U. M E.A. ' <br /> ,Z 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 /> LAUNDRY TRAY ; WATER HEATER � <br /> � CLOTHES WASHER � WOODSTOVE ' <br /> � METAL FIREPLACE(WOOD BURNING) ' <br /> URINAI � � <br /> DRINKING FOUNTAIN � FIREPLACE INSERT � <br /> FLOOR DRAIN � HEAT PUMP � <br /> BACKFLON PREVENTERS � oZ 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 /> TOTAL FEE $ TOTAL FEE $ ' <br /> FOR OFFICE USE ONLY: ���� �� , � <br /> PUNCHECKNUMBER FEE RECEIPTNO. <br /> FRONTSETBPCK / REARSETBACK 31DESETBAC� / ��� � �J�/'�']�+� /O � /O <br /> �j �� / ..� (o /ri / . <br /> USEZONE LOTAflEA <br /> VACMlT SITE FEES VALUATION FEE <br /> – ❑ YES ❑ NO BUILOING ' Fi S�I V ' `J .� <br /> i <br /> IYP[OFCONST NO.OFSTORIES OtfUv��v NaofVMRUNLUNiis � � d�l <br /> Z .�°U3 ' PLUMBING � �' � <br /> ��-' <br /> SIZE OF Bl7G. FIRE SPRINRLERS REO'0 BRSEMENT <br /> MECHANICAL ���� ��� <br /> �$ S.F ❑ YES C . NO ' <br /> ADDITIONAL PLAN CHECK �LI '�'-� <br /> OCCUPANCY LOAD FIRE ALARM RE�'0 NEIGHT L�MITATION/ / � <br /> �I� � l <br /> �D ��_J OTHER �:� J ��.. � J ' 'i <br /> REASON STATE BUILDING SURCHARGE L ' `�J <br /> INTANE 9V PL�NS AP RQVED BV CITY OF EVEREiT PUBLIC WORKS ",�'� � �,�� <br /> � LOCALSALES <br /> onre I�o/z /4�! T�CODE IS 3105 <br /> TOTAL �JI:�•' � '���� <br />