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� <br /> APPLICATI4_J FOR CONSTRUCT.JN PERMIT � <br /> ' `�� TO BE COMPLETED IN BLACK INK—PLEASE PRINT <br /> � <br /> BUILDING DEPARTMENT HEATING SYSTEM: �GAS O ELECTRIC ❑ <br /> 259-6810 <br /> I ' DEMOLITION IJ COMBINATION BUILDING .,$MECHANICAL i I PLUMBING I ! SIGN <br /> OV/NEfl�� MAIL ADDPE55 � LITV ZIP PMONE ��� <br /> �►-�s 1�-�FI��ie� _ I �zo - �� -� E `�8 a�� �s g- s��ce <br /> TENANT MAILADDRE55 dTV ZIP PNONE <br /> (�407 3� „� S — �. 9 ►o� <br /> ARCHITECTOR DESIGNEfl MAIL A[ID;L.SS� ��I CIT����`�P �� P�� y�/�� �D^_ /�_ � <br /> ���(��3� � � ��,� c�y (oY��- <br /> i(9E��CON�C�� MAI��RF.o55 ��� CI��aD/ ZI��-����PHONE STATELILENSEt <br /> Y � <br /> MECHANICALCONTRACTOR MAILADDRESS CITV 21P PNONE STATELICENSE• <br /> PlUM81NGCONTRACTOR MAI�ADDRESS CIN ZIP PHONE STATELICENSE• <br /> CUSS OF �/ <br /> L 1 NEW . . ADDITION y�ALTERATION IJ REPAIR , �I DEMOLITION I i WOODSTOVFJPRPL INSERT . i BUILDING RLLOCATION <br /> � CONTACTPERSONANUPHONENO. �,/r,� <br /> � �� ^ ��y�l_��fl <br /> CONTIUGT PRICE OF WORK � ` S.� l��- � ✓ <br /> DESCRIBEWOPKANDSOU�REPOOTAGFyINV �r�I -�'� • <br /> ?Nc> �DDt�1o�J P-�IMbo��- tr��. 7 � <br /> PROPOSEDUSEOfBUIIDING -��j(}yV� �go���JT I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br /> '���j�D��n�� s�� APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT.ALL <br /> LEMLDESCRIPTIONOFPROPERTY�SHOWNBELOWORATTACNFWRCOPIES) PROVISIONSOFLAWSANDORDINANCESGOVERNINGTHISTYPEOF <br /> �l � WORK WILI BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br /> io _�_ e�ocK 1� :�p l-Tb � �}r NOT. THE GRANTING OF A PERMIT DOES NOT PRES�IME TO GIVE <br /> - \ � AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br /> b� ��v c..L�ti� OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br /> n ' / PERFORMANCE OF CONSTRUCTION.THAT I AM AUTHORIZED BY THE <br /> S�9�l.Y�-} T� �+�i� � (lS. ��-I �T. �WNER 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 296200 WAC. <br /> CCT /YO: �753-3/ —OOd-030 <br /> x� �2��.,,�n� �O/�1 ( q'� <br /> . PRO,IECTADDRESS � ��O � SiGN�iUpE oere <br /> CTV BlI5ME5S LiCEHSE NO <br /> PLUMBIN6 MECliANICAL <br /> : Np, TYPE OF flXTURE OR ITEM FEE NO. TYPE OF EQUIPMENT FEE <br /> � WATER CLOSET(TOILEn � A/C—NHNDLG UNITS—H.P. Ao � <br /> � � BATHTUB ' FORCED AIR SVSTEMS—B.T.U. M E.A. <br /> i )C LAVATORY(WASH BASIN) � UNIT HEATERS--B.T.U. M � <br /> , SHOWER ' CLOTHES DRYERS ' <br /> KITCHEN SINK 6 DISP � VENTILATION FAN � <br /> DISHWASHER � RANGE HOOD <br /> LAUNDRYTRAY ; WATER HEATER ' <br /> CLOTHES WASHER � WOOD STOVE � <br /> UHINAL ' METAL FIREPLACE 8 CHIMNEY � <br /> DRINKING FOUNTAIN � FIREPLACE INSERT � <br /> FLOOFl DRAIN � HEAT PUMP ' <br /> BACKFLOW PREVENT�RS ; J� GAS PIPING � <br /> ROOF DRAINS—RAINLE�iDERS � EXHAUST FAN <br /> SINK(SERVICE—BAR,ETC.) ; � <br /> � � <br /> � � <br /> � � <br /> SUB TOTAL S ; SUB TOTAL $ ''' <br /> PERMIT $ PERMIT $ � <br /> TOTALFEE E ' TOTALFEE $ ' <br /> FOR OFFICE USE ONLY: /�3. �v <br /> F T SET&1CK REAR SETBACK SIDE SETBRCK PIAN CHEC NIIMB R' FEE RE �PT NO. <br /> `�' ,�e 'vca � iy;� N ' �= OZ <br /> use mr�e LOTAREA VACANT SITE FEE ALUATION FEE <br /> -2-M 5 7U Nb a���o�N� � 3 �e' S�o i �ia <br /> lYPEOfCONiS.ALlOWABIE 1VPEOFLONST.ACNRL Ottuw�x:r MoOfVxFIIroGUNrtS i <br /> � PWMBING �(�J <br /> SIZE OF BL06. NO-OF STORIES BASEMENT MECHANICRL �(�C/ <br /> OGCUPANCV IOAD FIRE SPRNNLEPS REO'D HEIGHT LIMITATION ADDITIONAL PLAN CHECK i� <br /> �Q �p ' SPRINKLER �� <br /> REASON FOR SPRINKLERS <br /> STATE BUILDING SURCHARGE i SJ <br /> INTAKE BV PLANS(�;iROVEO BY CITY OF EYEREIT PUBLIC WORKS � <br /> Jr� LOCALSALES � <br /> qa TAX CODE IS 3105 T�T�� ; <br />