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APPLICATIQ"'' FOR CONSTRUCT�"�N PERMIT �� <br /> TO BE COMPLETED IN BLACK INK—PLEASE PRINT �,:�.,,�/.,., <br /> ��_.. <br /> BUILDING DEPARTMENT [ HEATING SYSTEM: [J GAS �J ELECTRIC i] � <br /> 259-8810 <br /> ! DEMOLITION i i COMBINATION I-1 BUILDING f IMECHANICAL j(pLUMBING ❑ SIGN <br /> OV�NER h1NL 4D��[SS GTV <br /> (� 21P PHONE <br /> �-��,.�;� Qr 1;b19 /.� �bac�S��- ��r�� <br /> iENANT UAILAOGRESS //� CRY y� <br /> �/,� Y /� -X' ZIP� PMOryE '— <br /> ARCNI7ECT OR DESIGNEP M���v' �E ���� �-- � �!L./�9,�C� �3 <br /> ��T� Z�P PHONE <br /> GENERALCONTRACTOR A1qILADDRESS ��� �" � <br /> CIiV ZIP PHpNE STATEIICENSEp <br /> MECHqNICAICONTRqCTOR MAILADDRESS ��n. - <br /> Z�P PHONE STATE IILENSE a <br /> PLUMBINGCONTRACT ii MN�qpDRESS CITV <br /> ( Z�P PIIONE STAiELICENSEb <br /> �./��6' l�� 4P4e �arl�`�nnw�vah 13tio"d i(.�E l2`f�' Sf K��(.d�t� /,I3�CrrL »�u�l`IRk <br /> CONiR4LTPRICEOFWO N <br /> �ESCRIBE WORK ANO SOUA1iE FOOTAGE INVOLVED <br /> GONiqLT PERSON AND PHONE NO. <br /> aaoPoseouseoFem�oiNc i HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br /> APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT.ALL <br /> PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br /> �ecnioescaianoNOFraorenty�sHowNeeiowoaanna�TwocoPiesi WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br /> �oT aiocK oF NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br /> AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br /> OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br /> PERFORMANCE OF CONSTRUCTION. TNAT I AM AUTHORIZED BY THE <br /> OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br /> PARGELTA%I.0 NIIMBER APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> G9 CONTRACTORS L W 18. 7 RCW AND 296.200 WAC. <br /> CONSTRUCTIOt�y.OpNLENDER.npDRESS,TELEPHONENUMBER , /� <br /> L� ;� <br /> PROJECTADDRESS �� � 'G�� <br /> L'.n�i,i. DI1L <br /> PLUMBING � ������-' ��'""'`N0 - <br /> MECHANICAL - <br /> N0. TYPE OF FI%TURE OR ITEM FEE NO. TYPE OF EOUIPMENT — <br /> __�' WATER CLOSET�TOILET) FEE _ <br /> ' A%C—AiHNDLG UNITS—H.P. <br /> BATHT�B ; FORCED AIR SYSTEMS—B.T.II M E.A. ' <br /> LAVATORV(WASH BASIN) I UNIT HEATERS—B.T.U. M —� <br /> _ SHOWER CLOTHES DRYERS <br /> I KITCHEN SINK 8 DISP � ; VENTILATION FAN <br /> DISHWASHER � RANGE HOOD � <br /> LAUNDRYTRAY � ' <br /> � CLOTHES WASHER ' WATER HEATER , <br /> WOODSTOVE <br /> z URINAL ; METAL FIREPLACE(WOOD BURNING) 1 <br /> ORINKING FOUNTAIN ' FIREPLACE INSERT � <br /> FLOOR DRAIN , � <br /> HEATPUMP <br /> BACKFLOW PREVEN7ERS ; GAS PIPING , <br /> ROOF DRAINS—RAINLEADERS � EXHAUST FAN <br /> SINK(SERVICE—BAR,ETC.) � ' <br /> � � <br /> ' � — <br /> i Flona S'�n}� � <br /> _ <br /> —�-- <br /> __ SUB TOTAL S SUB TOTAL $ <br /> PERMIT $ PERMIT S <br /> TOTA�FEE 5 TOTAL FEE $ �— <br /> FOR OFFICE USE ONLY: <br /> FFONTSET[34CH REARSETBACK SIOES[TCACK FLANCHECHNIJl,I�ER FEE <br /> RF.C[iPil;p <br /> USEZONE �pTAREA VACANTSITE EES` <br /> VALUATION FEE <br /> ❑ YES C NO BUiLDwG <br /> iVPEOfCONST NO.OFSTORIES o[cUvudr NOo�Nv[urt;ai^,ns � <br /> GNWP � <br /> PLUMBING <br /> SREOFBLDG. FIRESPRINKLERSREO'D 9ASEMERT <br /> [-7 YES C� NO MECHANICAL � <br /> � <br /> OCCUPANCVLOAD FIREALARMREO'D HEIGHTLIMI7ATION ADDITIONALPLANCHECK � <br /> nEA50N OTHER � ' <br /> i <br /> S7ATE BUIL�ING SURCHAfiGE <br /> iNTAKEBY PLANSAPPROVED�Y CITYOFEVEREIT <br /> LOCALSALES P�BLICIVORKS ; <br /> onTe iAX CODE lS 3105 torn� �— <br />