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- APPLICATI(I��: FOR CONSTRUCi'�1N PERMIT <br />TO BE COMPLETED IN BLACK INK-PLEASE PRINT � <br />BUILDING DEPARTMENT NEATING SYSTEM_p GAS ❑ ELEC7RIC p � <br />259-8810 <br />❑ DEMOLITIUN ❑ COMBINATION ❑ BUILDING 1-1 MBCHANICAL i7 PLUMBING ❑ SIGN <br />�E� M L�FE55 I1l J_ ^ n �o �J <br />/' CITV ZIP PHONF. <br />TENFNT � �NMAIL ADDRESS �� ����( `� r A � � ���` � � � � ��� �� ! � <br />J GItV 21P PHONE <br />T\Wlll (Il \ "••• c�r PMONE <br />l� ' \7 <br />GENEqqL CONTRqGTOR MAIL ADDRESS QTY Z�p <br />PHONE STATE LICENSE • <br />MECHqNICALCUNTRACIUH MAILq�09E5$ qTY 21P <br />PHONe STATE LICENSE R <br />PLUMBINGCONTRACiOR MAILAOOPESS CITY 21P � <br />PHONE STATE UCENS� r <br />LONTRACT PRICE OF Y: . HK <br />DESCRIBE WORK AND aOUFRE FOOTAGE INVOLVED CONTAC' PEqSON ANO PHONE N0. <br />n <br />1.1�.. ��� _ � � <br />PROPOSEOl15EOFBWLDING � �— <br />LEGAL OESCFIPTIpN OF PROPERTV �SHOWN BE W P! OA ARACH TWO COYIES� <br />LOT - BLOCK OF <br />PARCELTqXI.D.NUMBEfl <br />CONSTRUCTIONLOANLENDER,AODRESS. <br />N0. TYPE OF FIXT <br />WATER CLOSET (TOIL <br />BATHTUB <br />LAVATORY(WASH BA; <br />SHOWER <br />� KITCHEN SINK 8 DISP <br />DISITYVAShiER <br />LAUNDRYTRAY <br />CLOTHES WASHER <br />� �FINKING FOUNTAIN <br />FLOOR DRAIN <br />. BACKFLOW PREVENI <br />ROOF DRAINS—RAIN <br />SINK ISERVICE—BaR <br />FOFi OFFICE USE ONLY: <br />FflONTSETBACK qEAqSETBACK <br />USE20NE LOTAREA <br />7YPEOFCONSi. <br />SREOFBLDG. <br />LOAD <br />INT/.KE BY <br />SUB TOTAL $ <br />PERMIT $ <br />TOTAL FEE S <br />FIAE SPFINKLERS FEOD <br />PLFNSAPPROVE�BY <br />DATE <br />FEE <br />I HEREBY �ERTIFY THAT I HAVE READ AND EXAMINED �HIS <br />APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE UF <br />WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br />NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br />AUTHORI7Y TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br />OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br />PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BV THE <br />OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br />APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />CONTRACTORS LAW 18.27 RCW AND 296.200 WAC, <br />�-� c � \ � 11 � I _ . /_ . . <br />-NHNDLG UNITS—H.P. <br />:ED AIR SYSTEMS—B: <br />HEATERS—B.T.U. M <br />ftANGEHOOD <br />WATER HEATER <br />WOOD STOVE <br />METAL FIREPLACE <br />HEAT <br />GASF <br />SIDE SETBACK PLAN CH CK NUMBEF <br />�va <br />VACFNT SITE FEES <br />❑ YES ❑ NO BUILDING <br />occuanucr uoorowcwxcuw�s — — <br />raouP PLUMBING <br />BASEMENT MECHANICAL <br />C YES ❑ NO <br />H[IGMTLIMITATiON AODITIONALPLANCHECK <br />OTHER <br />STATE BUIL�ING SURChIARGE <br />CfTY OF EVERE'R pUBLIC WORKS <br />LOCALSALES <br />TAX COUE IS 3105 TOTAL <br />FEE <br />SUB <br />M E.A. <br />$ <br />$ <br />$ <br />