Laserfiche WebLink
APPLICATIO'�' FOR CONSTRUCTI^N PERMIT � <br /> TO BE COMPLETED IN BLACK INK—PLEASE PRINT <br /> HEATIN3 SYSTEM: ❑GAS ❑ ELECTRIC ❑ <br /> BUILDING DEPARTMENT <br /> 259-8810 <br /> I 1 DEMOLITION I_l COMBINATION ❑ BUILDING I�CHANICAL ❑ PLUMBING L SIGN <br /> OYlNER MAIIADORE55 CITY 7.P PMONE <br /> �oha�e� �0��1� A1C ��� ��_ ,�r,-�cic��_� ��o�� � a7 '� 7G'v <br /> T[NANT h1A1LAD�RESS CIiV 21P PHONE <br /> �t�o rw��DS aG I�P � �Ao�. N✓���tf S�Pa�/ �ra..Fiy�G — <br /> RCNIiECTORDESIGNEP IAAILAOORE55 � CITV 21P PHONE <br /> GENER�LCONTMCTON IAAIIADDRE55 GITY ZiP PHONE STATELICENSEa <br /> /hcibn� n�n I�o ,✓'E�'o���t D�-�'.3� Y�rYln.,d 9.tbs.� ►k� �,�c_o�o <br /> MECMANICALCp NTRACOR MAILAUORESS GTV ZIP PHONE S�iEUCENSEp <br /> ,�n�r_ aier�dsPvr /slao SE 30� ./�i'� pf�HJ' l.�/-.2/�7 JTrc Cz' �FZAoT.s� <br /> PLUAIOINGCONTRAC70R h1�ILMOR[SS CITV Z�P PMONL STpTELICENS@� <br /> CONTRACT PRICE OF WOPK <br /> .� Zo 0.��° <br /> O`ESC51��R�p SOU�RE F���GF�IV�O�E���,O ���r� CONT�CT PEPSON AN�PHONE NO.�� � �f� <br /> /' �y /� �� <br /> 1�/e j o�� �-v.rJ�.r,�v hE� !��`r <y/-.z�.z 7 <br /> �lJ�iS�1X.� �"/D.�+�1/O/� � HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br /> PROPOSE�USE OF OUILDING APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT.ALL <br /> PROVISIONS OF IAWS AND ORDINANCES GOVERNING THIS TYPE OF <br /> LEGALDE�SC.,RIPT�IO�N�OFPROPERTV���S,�M,O�\rYNOELOWORATTACHTYOCOPIES) WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br /> �or--J-���o�ocrc�Y—"�— oF �-atl�1-� �gl•I4P D! -��� THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br /> — AUTHORITV TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br /> OTHER STATE OR LOCAL LAW REGULAiING CON•iTRUCTION OR THE <br /> PERFORMANCE OF CONSTRUCTION.THAT I AM AUTHORRED BY THE <br /> OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br /> APPLICATION IS tdADE AIJD I COMPLY WITH THE STATE <br /> PARGEL TAX ID.NUMOER CONTRACTORS 1827 RCW AND 296.20D WAC. <br /> GONSiBUCTION LO�N LfE DER.ADD(ij�55.TLIGFI NE NUTA�EF /�/� � / ��L� <br /> �l'�.� L�/')LO Gl/l (/' /• v�f <br /> PROJECT AD RESS ��y� 9 sr �un�� ,�9 o.�i <br /> GiV PUSINE53liCU1iE 1!C <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FI%TURE OR ITEM FEE NO. TYPE OF EQUIPMENT FEE <br /> WAT[R CLOSET(TOILET) AiC—NHNDLG 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 /> SfiOWER CLOTHES DRYERS _ <br /> KITCHEN SINK& DISP __T VENTILATION FAN <br /> DISHWASHER � RANGE HOOD <br /> LAUNDRY TRAY ' 6VATER HEATER _ <br /> CLOTHES WASHER VJOOD STOVE � <br /> URINAL ; METAL FIREPLACE(WOOD BLRNING) ' <br /> DRINKING FOUNTAIN FIREPIACE INSERT <br /> FLOOR DRAIN � HEAT PUA1P ' <br /> BACKFLOW PREVENTERS ; GAS PIPING _ <br /> ROOF ORAINS—RAINLEADEaS —r EXH�UST FAN _ <br /> SINK(SERVICE—BAR.ETC.' I y � � <br /> � <br /> — ' — �tf.Ut�� <br /> — �i:i _ � <br /> —--�— <br /> _ , <br /> SUB TOTAL � ' SUB TOTAL S ' <br /> PERMIT S PERMIT S _ <br /> TOTAL FEE S TOTAL FEE 5 �— <br /> FOR OFFICE USE ONLY: <br /> FRONTSETBFCN REARSETBACK SIOESETOAGK FLANGMECKNlIMOER FEE FiF.CEiPTNO. <br /> y ��r� ��� ���,53��1 <br /> usezorve LOTAREA VACANTSITE FEES VALUATION FEE <br /> ❑ YES ❑ NO BUiLOINu <br /> IVPC�iCON57. NO,OFSTORIES acuru�cr imolPn'uuu�mms — <br /> cnour PLUMDING <br /> GIZE OF OLOG. FIRE SPRINNIERS REO'D BASEM1IENT MECHANICAL <br /> ❑ YES ❑ NO — <br /> OCCUPANCVLOAD FIREAIMMREO'D HEIGMTLIMITATION ADDITIONALPLANCHLCK � <br /> OTHER � ; � <br /> RFASON <br /> STATE OUILDIN SURCHAfiGE <br /> �r�TnHc nr r�nHs nrrnoveoov CITY OF EVERFTf nuouc woaKs <br /> ' JM LOCAL SALES , <br /> onre �•� TAXCODEIS3i05 TOTAL l�0 '', � <br />