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APPLICATIC: FOR CONSTRUCT;�)N PERMIT � <br /> TO BE COMPLETED IN BLACK INK—PLEASE PRINT <br /> � HEATING SYSTEM: (j`GAS U ELECTRIC ❑ � <br /> BUILDING DEPARTMENT <br /> 259-8810 <br /> ❑ DEMOLITION ❑ COMBINATION ❑ BUILDING ❑ MECHANICAL ❑ PLUMBING ❑ SIGN <br /> OWNER MAILADDFESS CITV ZIP PHOIJE <br /> l�fln/' F SANcoR �vv eRr., tin1 D2 CUr 98zor GSz- zL3= <br /> TENANT MRILADJRESS CIiY ZIP PHONE <br /> ARCHITECT OR DESIGNER MAIL ADORESS C�N ZIP PNONE <br /> GENERALCONTRACTOR MAILADDRESS pTV ZIP PHONE STAtELICENSEI <br /> MECHMIICQCONTRACTOR MAILADDRhSS G�V 21P PMONE STATELICENSE� <br /> �t�ilie I f��7rs,� i..?a,7 e/�s+nJtJ� �f3 EdT. 9f32or 353-33'�1�/ .�(/iHo990�- <br /> PIUMBING CONTRACTOR MALL ADORE55 CITY ZIP PHONE STATE LICENSE 1 <br /> CONTRACT PRICE OF WOflK <br /> �� <br /> OESCNIBE WOflK AND SOURRE FOOTAGE INVOLVED CONTACT PF.RSON AN�PHON�NO. <br /> i HEREBY CERTIFY THAT I HAVE READ AND EXAMINF� THIS <br /> PROPOSEDUSEOF BUIIDING APPLICATION AND KNOW THE SAME TO BE TRUE AND CORflECT.ALL <br /> ���L� �jj�� _�y PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TY°F OF <br /> LEGALDESCRIPTIONOFPROPERTY�SHOWNBELOWORATfACHiWOCOPiES� WORK WILL BE COMPLETEU WITH WHETHER SPECIFIED HEPCIN 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 REGULATING CONSTRUC710N OR THE <br /> PERFORMANCE OF CONSTRUCTION.THAT I AM AUTHORIZED BY THE <br /> OWNEF OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br /> _ APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> PARCEL TAX I.O.NUMBER CONTRA RS LAW 1827 RCW AND 296.200 WAC. <br /> CONSTNUCTIONLOANLENDFR.AODRESS.TELEPHONENUMBER <br /> PROJECT ADDRESS s�cr+ DAiE <br /> �v4 G,(N�� �Q� crtva wessuceuseno. <br /> PLUMBING M HANIC iL <br /> N0. TYPE OF FU(TURE OR ITEM FEE NO. TYPE OF EOUIPMENT FEE <br /> WATEF CLOSET(TOIL3T) A/C—A/HNDLG UNITS—H.P. � <br /> BATHTUB ; FORCED AIR SVSTEMS—B.T.U. M E.A. ' <br /> LAVATOFY(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 /> URINAL ' METAL FIREPLACE(WOOD BURNING) ' <br /> DRINKING FOUNTAIN � FIREPLACE INSERT � <br /> FLOOR DRAIN � HEAT PUMP ' <br /> BACKFLOW PREVENTERS ; L GAS PIPING � _ <br /> ROOF DRAINS—RAINLEADERS � EXHAUST FAN ' <br /> � <br /> SINK(SERVICE—BAR.ETC.) � — <br /> � ' <br /> � ' <br /> � ; <br /> � T <br /> i � <br /> SUB TOTAL $ ; SU[�TOTAL $ �/T <br /> PERMIT $ � PERMIT S � � <br /> TOTAL FEE 3 ~ TOTAL FEE $ �- ' � � <br /> FOR OFFICF USE ONLY: <br /> FRON:Gc!'dACN REAR SETBACK SIDE SETBACK PLAN�CK NUMB�O FEE RECEIpT NO. <br /> l�%7 <br /> USEZONE LOTAREA VACANTSITE FEES VALUATION FEE <br /> ❑ YES ❑ No eui�niNc � <br /> flPEOFLONST. NO.OFSTORIES acuwncv xavvnnun�Guvns ' <br /> cnam PLUIdBING � <br /> SIZE OF BLDG. FIRE SPNNKLERS REO'0 �ASEMENT MECHANICAL � <br /> ❑ YES ❑ NO ' <br /> OCLUPANCY LOAO FIRE AIARM REO'� MEIGMT LIMITATION ADDITIONAL PLAN CHECK � I <br /> OTHER _� ' <br /> REASON � <br /> STATE BUILDING SURCHARGE � <br /> INTAKEBY PUNSAPPFOVEDBY CITYOFEVEREIT PUBLICWORKS i <br /> LOCAL SALES � <br /> DA7[ TAX CODE IS 3105 TOTAL i <br />