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APPLICATiO" ' FOR CONSTRUCTt 'N PEF�MIT � <br /> TO BE COMPLETED IN BLACK INK—PLEASE PRINT <br /> BUILDING DEPARTMENT HEATING SYSTEM: ❑GAS �ELECTRIC ❑ <br /> 259-8810 <br /> !J DEMOLITION ❑ COMBINATION Cl BUILDING f i MECHANICAL i_�PLUMBING ; ': SIGN <br /> �NT'ER MAIL�DORE55 CIiY ZIP PHONE <br /> M�. �E,�Ms a� �� F ��2FlT n �E ,E�£rr y .zo� , s�- ���7 <br /> TENRNT MAILAUDRE55 CITV ZIP PNONE <br /> MP lcEnMS 7 2// F'V�'�FTT AV �VEK�T �ly1U/ , S9 yX�7 <br /> ARCIIRECTOqDESIGNER MAILADDRESS CITV IIP PHONE <br /> GENERALGONTRFCTOfl MAILADDRESS CITY IIP PMONE STATELICENSEt <br /> MECHRNICALCONTRACTOR MAILADDRE55 GITY ZIP PNONE STATELICENSEt <br /> PWMBINGCONTRACTOR MAILADDRESS dTV ZIP PMONE STATEUCENSE! <br /> AY d/vSTE (/MBIhY /� . (30 U l LrNNwcoo 9�YOy 3 - y �! 7 D <br /> CONTRALT PRIGE OF WORK /�ff�' �l(�/Y y, <br /> DESCHIBE WORK AND SOUARE FOOTAGE INVOLVE� CONTAGT PERSON AND PNONE NO. <br /> (_'F_P/PE ON .aOr iINU ��Lp TG <br /> V LE N <br /> RAT({PG�/� I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br /> PROPOSEDUSEOFBUILDING APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT,ALL <br /> PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TVPE OF <br /> IEGALOESCRIPTIONOFPROPERTV�SHOWNBELOWORATTACHTWOCOPIES) WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEFEIN OR <br /> NOT. THE GRANTING OF A r�EFMIT DOES NOT PRESUME TO GIVE <br /> �oi e�U:K OF nUTHORITY TO V10LATE OH CANCEL THE PROVISIONS OF ANY <br /> OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br /> PERFORRIANCE OF CONSTRUCTION.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 TA%I.D.NUMBEP CONTRACTORS LAW 18,27 RCW AND 296.206 WAC. <br /> CONSTRUCTION LOAN LENDER.AD�RESS,iELEPHONE NUMBER <br /> �3i/ Ev vE v eE rr�Gi � ��f '_,,,�J,�„ ,� .��;o/�>v <br /> PROJECT ADDRESS SIGNAiU11t- OAIE <br /> GTY BUSMC55 UCENS[NO <br /> PLUM8ING MECHANICAL <br /> N0. TYPE OF FIXTURE OR ITEM FEE NO. TYPE OF E�UIPMENT FEE <br /> WATER CLOSET(TOILET) P✓C—A�HNDLG UNITS—H.P. ; <br /> I BATHTUB ; FORCED AIR SYSTEMS—B.T.U. M E.A, <br /> I LAVATORY(WASH BASIN) � UNIT HEATERS—B.T.U. M ; <br /> SHOWER � CLOTHES DRVERS � <br /> KITCHEN SINK 8 DISP ; VENTILATION FAN ; <br /> DISHWASHER � RANGE HOOD <br /> LAUNDRY TRAY ; WATER HEATER � <br /> CLOTHES WASHER � WOOD STOVE <br /> URINAL ' METAL FIREPLACE(WOOD BURNING) � <br /> DRINKING FOUNTAIN � FIREPLACE INSERT ; <br /> FLOOR DRAIN HEAT PUMP � <br /> BACKFLOW PREVENTERS ; GAS PIPING ; <br /> ROOF DRAINS—RAINLEADERS � EXHAUST FAN <br /> SINK(SERVICE—BAR,ETC.) ; � <br /> � � <br /> � i <br /> SUB TOTAL $ ; SUB TOTAL $ ; <br /> PERMIT $ � PERMIT $ � <br /> TOTAL FEE $ TOTAL FEE S <br /> FOR OFFICE USE ONLY: <br /> FRONT SETBACK REAR SETBACN SIDE SETBACK PLAN CHECK NUMBER FEE RECEIPT NO. <br /> USE ZONE LOT AREA VACANT SITE FEES VALUATION FEE <br /> ❑ YES ❑ NO BUILDING i <br /> TYPEOFCONSi. NO.OFSTORIES a[uvaHtr 4a0[oWRIMGUNus <br /> 4POUP � <br /> PLUMBING � <br /> SIZEOFBL�G. FIRESPRINKLERSREO'D BASEMENT MECHFNICAL <br /> ❑ YES ❑ NO <br /> OCCUPANLY LOAD FIRE ALARM REO'� HEIGNT LIMITATION �DDITIONAL PLAN CHECK i <br /> OTHER <br /> REFSON <br /> STATE BUILDING SUFCHARGE <br /> IN7�KEBY PLANSAPPPOVEDOV CITYOFEVEREIT PUBLICWORKS <br /> LOCALSALES <br /> oqTE TAX CODE IS 3105 TOTAL �� <br />