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,� <br /> �� <br /> �-,.,.,�- "w'"� <br /> ; A.PPLICATI�i�I FOR CC�N5�RUC ��N PERMIT � � <br /> TO BE COMPLETED IN BLACK INK-PLEASE PRINT <br /> � HEATING SYSTEM: U GAS ❑ELECTRIC ❑ � <br /> �� BUILDING DEPARTMENT <br /> � 259-8810 / "'�'"V <br /> Q � ' I 1 DEMOLITION COMBINATION ✓�UILDING MECHANICAL ' PLUMBING SIGN ye <br /> ,�y �� I 0'NNER MRRpODRE55 GITY 21P PHONE 1 <br /> ���e, � �coiv Cvr��s L r�r� �i` 98Zo3 3�8-39.5 / <br /> TEN/J1T MRILRDDRE55 CITV ZIP PHONE <br /> �I�� � �RC�RECTIfl0E51GNER A-!LA��PESS �� �� `�C , / Z���� PHONE ��.�O� I <br /> � 7r <br /> r' <br /> ��� . J MAILADDflESS CITY ZIP P�IONE STATELICENSE• <br /> nH <br /> �3�� � MEC �C��CONTR�CIOR MRIL pUDRE55 CRY 21P PMONE ST�TE LICENSE I <br /> fl ' <br /> � CITY ZIP PHONE STRTE LICENSE/ <br /> fl � PIUMBING CONTRRGTOR MRII�ODRESS . <br /> t+y <br /> �y CU350F WORK <br /> �rJ q M :. I i NEW � ! ADDITION �� ALTERATION i '�. REPAIR DEMOLITION � WOOOSTOVBFFPL INSERT ' BUILDING RELOCATION <br /> Q��� , M � [M�{J GONTRCT PERSON�ND PHONE NO. <br /> CONIR�CTPRIGEOFWOFKB� L�D•W W� / • <br /> 7 <br /> y t D CNIBE WOR AND SW�AE F TAGE INVIO.IYAED <br /> Q Y � W`Y,1 � \ <br /> - - rq�s usFOFaunowc I HEREBY CEPTIFY THAT I HAVE READ AND ERAMINED TH�S <br /> � / '��^�Y C APPLICATION AND KNOW THE SAME TO DE TRUE AND CORRECT.ALL <br /> l H � PROVISIONS OF LAWS AND ORDINANCES 60VERNING THIS NPE OF <br /> � � IEWLDESCRIPTIONOFPROPERTY�SHOWNBELOWORRTTACNFO�RCOPIES� y�rpRK WILI BE COMPIETED WITH WHETHER SPECIFIED HEREIN OR <br /> '>`. � � �aT BLOCN oF NUT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE . <br />� � � AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br /> 'rt�`� 4�' � OTHER STATE OR LOCAL LAW iEGULATING CONSTRUCTIO�OR THE <br /> `�G � PERFORMANCE OF CONSTRUCTION.THAT I AM AUTHORI2ED BY THE <br /> J <br /> M1� f OWNEF OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br /> �x� <br /> .i:Y'ia..i i <br /> �.�y.!�,. � APPUCATION IS MADE AND I COMPIY WITH THE STATE <br />�'��,,"C+'=" � � � CONTRACTqRS LAW 7827 flCW AN[?256200 WAC. <br /> :s(� . <br /> _ ' � �°,,.�� ����-�. a -i9- 9 z <br /> '� smumnc oeic <br /> � PRPIECTAUDRESS b /^/^/ <br /> � G' � 9O f/`�� CIIYBJS�NFSSIif.EV5CN0 I <br /> ' v I <br /> ' PLUMBINQ MeCHANICAI. <br /> �� � NO. TVPE OF FIXTURE OR REM FEE NO. TVPE OF EOUIPMENT FEE <br /> � ( — AIC—NNNDLG UNITS—H.P. i <br /> � � WATER CIOSET(TOILET) <br /> � � BATHTUB FORCED AIR SYSTEMS—B.T.LL M E.A. I <br /> LAVATORV(WASH BASIN) UNIT HE4TERS—B.T.U. M � I <br /> � ' ��� � SHOWER CLOTHE>DRYENS _ � ; <br /> � � KITCHEN SINK 8 DISP ; VENTILATION FAN �' <br /> � DISHWASHER � RANG[FOOD <br /> �l , LAUNDRY TRAY WATER HEATER ' <br /> , �� Cl OTHES WASHER WOOD SIOVE i <br /> i URINAL METAL FlREPLACE 8 CHIMNEY —� <br /> ' DRINKING FOUNTAIN FIREPLACE INSERT T_ <br /> , HEAT PUMP ' � <br /> FLOOR DRAIN � i ; <br /> �I�I BACKFLOW PREVENTERS ; GAS PIPM3 ii <br /> � • ROOF DRAINS—RAINLEAOEFS EXHAUST fAN ' <br /> i �I <br /> . SINK(SERVICE—BAR,ETC.) � , <br /> , <br /> � � �1� � <br /> , <br /> t � <br /> i <br /> � SUBTOTAL 5 ; SUBTOTAL 5 � I <br /> PERMIT $ � PERMIT S � <br /> � TOTALFEE 5 ' TOTALFEE 5 <br /> FOR OFFICE USE ONLY: <br /> FRONTSETBRCK REMSEiBACN S�DLSEiBPLK PLANCHECNNOM�ER <br /> FEE RECEIPT N0. <br /> J <br /> � USE ZONE LOT AREA VACANT SITE FEES VALUATION FEE <br /> BUILDING I��-- <br /> iVPEOfCONiS.ALLOWl.BIE iYP�LAO-I9.ALNAI ocG W'n xOofoMt�iu4n5 � i <br /> � C PLUIdBING � <br /> i� <br /> i <br /> SRE OF BLOG qNOAF STORI�EpS� BASEMEN/T� MECHANICAL � � <br /> � L ���IVi �l/ � <br /> OCCUPANGYLOAD FIRESPRNNIEli5RC0'D HEIGHTLIMITATION pDDIiIONALPLANCHECK � _ I <br /> i <br /> n�d SPRINKIER � � <br /> �— II <br /> RUSON FOR SPRINRLERS � <br /> STATEBUILDINGSURCHARGE � 7 <br /> � ' <br /> INTRKEBV PLANSAPPROVEOBY CITYOFEVEREIT PU6LICWORK$ � <br /> LOCAL SALES p-'- <br /> �� 9Z �JM TAX CODE IS 3105 TOT^� � / � � <br />