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APPLICATIO�'FOR COI�STRUC'T!( N PERMIT � <br /> TO BE COMPLETED IN BLACK I�K—PLEASE��RIN'f <br /> �HEATING SYSTEM: �GF.S ❑ELECTHIC ❑ <br /> BUILDING DEPARTMENT — <br /> 259•8810 � L <br /> ❑ DEMOLITION ❑ COMBINATION i 1 BUILDING ❑ MECHANICAL L�IPLUMBING ❑ SIUN <br /> OWNER MAILACORE55 CITV 21P PHON@ <br /> l,Jn W t�ak� sv�SG/pN�.,�.� ����� %�zu � zs�s'-3ssf _ <br /> TENANT MAII ADDRE55 CITV iIP P��ONE <br /> ARCHIiECTORDESIGNER MAn >ODRE55 LIiV '.IP PHJNE <br /> GENEPRLCONTRACTOR MAI: ADORE55 CIN ZIP PHONE STATEUCENSEr <br /> MECMANICAL CONTRACTOR MAIL AD�RESS CIN 21P PHONE STATE UCENSE t <br /> PLUy@ING CONTRRCTOR MAIL A.�JRBSS CITV ZIP PHONE STATE I.ICENSE t <br /> Uw <br /> CONTRACT PRICE OF WORN <br /> DESCRIBE WORK AND SOUAPE fOOTAGE INVOL�ED CONT�CT PERSON AN�PNONE NO. <br /> ✓ <br /> I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br /> PROPOSED USE OF BUILOING APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT.ALL <br /> PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TVPE OF <br /> LEGRLOESCRIPTIONOFPROPERN�SMO'NNEELOWORATTRCHTWOCOPIES) WORK WILL BE COMPLETED WITH WHFTHER SPECIFIED HEFEIN OR <br /> NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br /> �or e�ocK oF AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br /> OTHER STATE OR LOCAL LAW FEGI!LATING CONSTRUCTION OH THE <br /> PEFFORMANCE OF CONSTRUCTIO'J.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 TRX I.D.NUMBER CONTRACTORS LAW 1827 flCW AND 296200 WAC. <br /> � CONSTRUCTION LOAN LENDER,AODRESS.TELEPHONE NUMBER V ///� ` /.!%�K / �I�_�� / <br /> SDOS (e Ipn Nvu v t�/er ! � y%%� `� <br /> � PROJECUDDRESS smr+�mne o"'E <br /> GiY BIISMC$S 11LCN$E NO <br /> PLUMBING MECHANICAL <br /> N0. TYPE OF FIXTURE OR ITEM FEE NO. TYPE OF EOUIPMENT FEE <br /> WATER 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 ORYERS � <br /> KITCHEN S�NK&DISP � VENTILATION FAN <br /> DISHWASHER � RANGE HOOD ' <br /> LAUNDRY TRAY ; WATER HEATER � <br /> CLOTHES WASHER � WOODSTOVE ' <br /> URINAL ' METAL FIREPLACE(WOOD BURNING) i <br /> DRINKING FOUNTAIN � FIREPLACE INSERT � <br /> FLOOR DRAIN � HEAT PUMP ' <br /> BACKFLOW PREVENTERS ; GAS PIPING � <br /> ROOF DRAINS—RAINLEADERS EXHAUST FAN ' <br /> � <br /> SINK(SEFVICE—BAR.ETC.) � � <br /> — � � ' <br /> Q ✓ i.ra <br /> i i <br /> SUBTOTAL S ' i SUBTOTAL 5 <br /> PERMIT 5 Q � � PERMIT S � <br /> TOTAL FEE $ ' � TOTAL FEE $ ' <br /> FOR OFFICE USE ONLY: <br /> RE4RSETBACK SIDESETBFCK PLANCHECKNU B,�R� fEE RECEIPTNO. <br /> FRONTSETBACK � <br /> USE 20r1E �oT naea VACANT SITE FEES VALUATION FEE <br /> L; YES �-� N�� BWLDING ' <br /> ttPEOfCONST. NO.OFSTORIES Kmrev[v u0orox'F�.uxGuw4 � <br /> ceour PLUMBING � <br /> 52EOFBLDG. FlRESPRINKLERSBEO'D BASEMENT MECHANICAI � <br /> ❑ YES i-1 NO ; <br /> Fiae hLaRM REOD HEIGHT LIMITATION ADDITIONAL PLAN CHECK � <br /> OC W PANCV LOAD i <br /> OTHER � <br /> -�_ <br /> REASON <br /> STATE BUILDING SURCHARGE � <br /> INTANEBV PLANS�PPROVEDDY CITYOFEVERE7T PUBLICWORKS � <br /> LOCAL SALES � <br /> DFTE <br /> TA7( COOE IS 3105 TOTAL ; <br />