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APPLI�CATIO FOR CONSTRUCTt�''N P�RIIAIT � <br /> TO BE COMPLETED IN BLACK INK—PLEASE PRINT <br /> BUILDING DEPARTMENT �HEATING SYSTEM: GAS LJ ELECTRIC ❑__ � <br /> 259-8810 <br /> ❑ DEMOLITION ❑ COMBINATION ❑ BUILDING f MECHANICA�L � PLUMBING i� SIGN <br /> OYJNER M�ILA��RESS CI7V ZIP F40NE <br /> l�Ai�,� �"'l�� � I i �� I� � � `�1�-��� �t� ��l y��J � <br /> TENANT MFILAOORE55 CITY ZIP PNONE <br /> ����v_e�.-��...��� P�� j� lb [ om�y� 7 qs/ ��� `t���( <br /> MITEFC CT Ofl DESIGNEF MAIL AD R SS CITY ZIP PNONE <br /> GEN RALCONTRACTOR M ILFODPESS CIN `/ ZIP PHONE ST�TE CENSEtl <br /> � 11�1 �,t�A li� F��-'a i�,K- � �7�) j(-�v��rit�- �tA `I��.���oo �,u�%r/%�iC�3 �,Z <br /> MEGMFNIC�LCONTRACiOR MAILA�DFESS CITV ZiP PMONE STATEIIGENSEF <br /> SAm�% <br /> PLU1dBING GNTRACTOR MAIL ALGRe55 GTV ZIP PHONE STATE LICENSE k <br /> _�=� / <br /> C <br /> GONTFACi PRICE OF WOR� // � <br /> 7 <br /> DESCRIBE WOPN AN SOUARE OOT V � f LG�D GONTACT PERSON AND PHONE NO. / / <br /> i'E ` %�c+� � .L �cfr ' U 1 �-- <br /> /�G/�MO : <br /> i HERFBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br /> PROPOSEO USE CF BUILDING AP?LICATION AND KNOW THE SAME TO BE TRUE AND CORRECT.ALL <br /> PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE UF <br /> LEGALOESCRIPTIONOFPFOPERiV�SHOWNB'_LOWORATiACHTVlOCOPIES� WORK WILL BE COMPLETED WITH WHETHER SPFGFIED HEREIN OR <br /> NOT. TNE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br /> �or eiocK oF AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br /> OTHER STATE OR LOCAL LAW REGULATING UCTION OR THE <br /> � PERFORMANCE O RUCTION.TH AM AU HOPIZED Y THE <br /> OWNER O 13 RT R RPA TH O WHICH <br /> APPLI TIO AND COMPL H E STATE <br /> PARCELTA%I.O.NUMBER � CONT S .2�RCW 296 <br /> �� �:o 'b <br /> CONSTRl1GTI0N LOAN LGN�ER.ADORESS.TELEPHOIJE NUIdBER /� '�r ri .pL <br /> / � <br /> PROJECT ADDRESS J- sicrvnruec o"TE <br /> �q����7�}%7 2 ci.reusirvess -r,. r�a <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM FEE NO. TYPE OF E�UIPMENT FEE <br /> WATER CLOSET(TOILET) � AIC—A/HIJ�LG UNITS—H.P. <br /> BATHTUB FORCED AIF SYSTEMS—B.T.U. M E.A. ' <br /> LAVATORY(WASH BASIN) i UNIT HEATcRS—B.T.U. M <br /> SHOWER CLOTHES DRYERS ' <br /> KITCHEN SINK 8 DISP VENTILATION FAN __� <br /> DISHWASHER � RANCE HOOD ' <br /> LAUNDRYTRAY ' WATcR HEATER <br /> CLOTHES WASHER � WOOD STOVE � <br /> URINAL ' METAL FIREPLACE(WOOD BURNING) ' <br /> DRINKING FOUNTAIN FIREPLACE INSERT � <br /> FLOOR ORAIN HEAT PUMP : _ <br /> BACKFLOW PREVENTERS ; GAS PIPING � <br /> ROOF DRAINS—RAINLEADEP.S � EXHAUST FAN ' <br /> SINK(SERVICE—BAR,ETC.) I <br /> � , F/Oi'�L/9G�- � <br /> ' . � <br /> � <br /> � <br /> � <br /> SUB TOTAL 5 ; SUB TOTAL $ p ; <br /> PERMIT S PERMIT S � <br /> TOTAL FEE 3 ' TOTAL FEE S �' <br /> FOR OFFICE USE ONLY: <br /> FRONTSETBACK REARSETBACK SI�ESETBACK PLAtlCHECNNUIdBER FEE RE::EIPTNO. <br /> / <br /> USEZONE LOTAREA VACANTSITE EES VALUATION FEE <br /> ❑ YES ❑ NO BUILDING ' <br /> NO.OFSTORIES oCcuvnN[Y AoavoWElIiNGUun9 � <br /> TYPE OF CONSi. Gaouv � <br /> PLUMBING <br /> S2EOF&_�G. FIPESPRINKLE(i5RE0'U BASEMENi MECHANICAL � <br /> i"� VES ��.� NO -- ' <br /> OCCUPANCVLOAD FIREALARldREO'D HE�GHT�IMITATION ADOITIONALPLANCHECK <br /> OTHER <br /> PEASON <br /> STATE BUILDING SURCHARGE <br /> INTANEBY PLANSAPP0.0VEDOV CITYOFEUERETT PU(3LICWORK$ T� <br /> LOCAL SALES � <br /> oATE TAX COUE IS 3105 TOTAL ; <br />