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APPLICATIQ" "' FOR CONSTRUCT��N PERMIT � <br /> TO BE COMPLETED IN BLACK INK—PLEASE PRINT <br /> HEATING SYSTEM: GAS :J ELECTRIC �.J _ —� <br /> BUILDING DEPARTMENT <br /> 259-8810 <br /> I l DEMOLITION C! COMBINATION I l BUILDWG ❑ MECHANICAL G PLUMBING 17 SIGN <br /> O�N1 F l�Y S/ OqE55 / f�IT/�� �TUti. ZIP pHONE <br /> � 71" %�Zs� �S�' - 3 L 3�} <br /> TENANT MAIL�DDRESS CITV ZIP PMONE <br /> ARCHIiECTOflDE51GNER IAAILA70RE55 CITV ZIP PHONE <br /> Mo�?Rl•� � � o.3c,� <br /> GENER4L CONTRAC70R MNL AD�RESS CITV ZIP PNONE STATE LICENSE rt <br /> /lo;� ':�, d-,� 95„� ,f�zsuFi.�,:.� l, k Ra 54� 4�w�rs C.�� p�zso 5�68-1y9S- 2//��?� <br /> h1ECNANICALCONTRACTOR IAAILAOOfiE55 CITY 21P PHONE STATEUCENSE� <br /> PLU BING WNTPACTOfl MAII ADDRE55 C"� ZIP PMONE SiATE LICENSE a <br /> � /4» b;. 3s- o -� <br /> CONTRFCT PRICE OF WOR l�` �� � � <br /> l3z oov — /'y=J�.��"� <br /> OESCRIBE Wl,]RK AND SOUARE FOOTAGE INVOLVE� s /�� CONTACT PERSON AND PHONE HO. <br /> l�o�1�c {� Y. <br /> U e�cr w.rf 8 S . T"� / C� / /O���S'o✓ J�0 — 1 l / � <br /> �w�� ��v S .�� i HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br /> PROPOSED USE O auao:ruc APPLICA710N AND KNOW TH�SAME TO BE TRUE AND CORFECT.ALL <br /> �,,, ��,,;� � PROVISIONS OF LAWS AND OqDINANCES GOVERNING THIS TYPE OF <br /> �e.AL0E5CRIPT101 OfPP,�PE9TV�5 OWNBEIOV.'ORARACHLTWOCOPIES� WORK WILL BE COMPLETED 1VITH WHETHER SPECIFIED HEREIN OR <br /> �_ �tc /`oa r„J c.• a NOT. THE GRANTING OF A PERMIT DOES NJT PRESUME TO GIVE <br /> �or BLOCN oF AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br /> ���� OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br /> n / PERFOfiMANCE OF CONSTRUCTION.THAT I AM AUTHORIZED BY THE <br /> � L5.r C R��/� .� �� � � OWNEP OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br /> �) y� � APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> PARCEL TA%I D.NUMBER CONTRACTORS LAW 18.27 RC'.V AND 296.200 WAC. <br /> 39NG - 000 _�so- ooq� <br /> CONSTRUCTIOt�LOAN LENOER.ADORESS.TELEPHONE NUTADEF / � <br /> L , �a,�',�.z.. �//G. <br /> PflOJECT ADDRESS sic.vemnc o" � <br /> crtrousv�ss c[r:scr+o <br /> PLUMBING MECHA CAL <br /> NO. TYPE OF FIXTURE OR ITEM FEE N0. TYPE OF E�UIPMENT FEE <br /> WATER CLOSET(TOILET) A�C—A�HNDLG UNITS—H.P. _ <br /> BATHTUB FORCED AIR SYSTEMS—B.T.U. M E.A. __ <br /> LAVATORY(WASH BASW) i IiNIT HEATERS—B.T.U. M � <br /> SHOWER CLOTHES URYERS ' <br /> � KITCHEN SINK 8 DISP ' VENTILATI01:�AN � <br /> OISIiWASHEF � RANGE HOOD <br /> LAUNDRY TRAY ; WATER HEATER ' � <br /> CLGTHES 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 5 SUB TOTAL 5 <br /> PERMIT 5 PERMIT 5 <br /> TOTAL FEE 5 TOTAL FEE 5 ' <br /> FOR OFFICE USE ONLY: ��a��� <br /> fRONTSETBACN FEAFSETDAG1c SI�ESCTf1�CK VLANCME NNU410G�i FE�EC�//�/�/]�, RECEIPT/N� / <br /> /J JJ � � � � / L�.�J L>J / / J•J� /V �I ,..�'.�rJ <br /> �/�� � <br /> usezoae IOTAREA VAC�NTSIiE FEES VALUATION FEE <br /> ,� I `- YES . NO BWLDING Z (�`J �[,nr � CC.�� <br /> iYPEOfCONSi NOAFSTORIES -- ",:' •- - .••...'•`.�••�5 ' <br /> ';�3 PWMBMC J iOn <br /> �SIE F[f!' • FIRESP�7INNLERSREO'D BAS��•�- { MECHANICAL ���� <br /> 5�`/S�F �A�a� O �V YES '-' NO — � <br /> OCCUPANCVLUAO FIREAIARAREOD i�EIGHt1i� ITAT10NJ ADDITIONALPLANCHECK i / <br /> /� C� � <br /> � ry O �V OTHER D �OO <br /> REASON <br /> STATEBUIL�INCaSURCHAFGE i �' <br /> itlidnEOV PlANSAP?qOVEOBV CITY OFEVEREIT PUBUCWORKS /'��l.Cl ' <br /> LOCAL SALES ,. _ , �� <br /> oqTE�•�3��j TAX CODE IS 3105 rorn� ��),� �/ ; � <br />