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APPLICATIO. _ FOR CONSTRUCTI �N PERMIT <br /> TO BE COMPLETED IN BLACK INK-PLEASE PRINT � <br /> BUILDING DEPARTMENT HEATING SYSTEM: �]GAS ELECTRIC ❑ <br /> 259-8810 <br /> f J DEMOLI710N I� COMBINATION ik BUILDING f i MECHANICAL 1 PLUMBING � SIGN <br /> EP IMILADDRE55 <br /> ��ZJz�l�� i�i�ss���� � ��,ir�-�t Z1%�,� q�zo�; � ya�� <br /> CITY ZIP PMONE <br /> ARCMITECTOR DESI3NER MAIL�DDRESS ��p. Z�P <br /> PHONE <br /> GENER�LCpNTqACTOR MAILADOpESS CITV ZIP PHONE <br /> /.�1. ��/I STATE LICENSE• <br /> LIl/l/! <br /> MECr1N11CAlCONTRACTOR M�ILAODflESS CITY 21P PIqNE <br /> ST�IE LICENSE 1 <br /> PLUMBMGCONTR�CTOiI MAILADDRESS CITV ZIP PNONE <br /> ST�TE LICENSE f <br /> GLASS OF WORK <br /> C I NEW I_1 ADDITION I I ALTERATION I. ��. REPAIR i I DEMOLITION ! I yyppDSTOVE/FRPL INSERT I i BUILDING RELOCATION <br /> Q CONTACT PERSON AND PNONE NO. <br /> GONTRACT PRICE OF V/ORK C�� <br /> DESCR18E WORN AND SOUARE FOOT�GE I OLVED <br /> PROPOSEDUaEOFBUILDING i HEREBY CERTIFV THAT I HAVE READ AND EXAMINED THiS <br /> APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT.ALL <br /> LEGIIDESCpIPTqrypFppppERTV BELOW ORATTACXFWR COPIES� PROVISIONS OF LAWS AND ORDINANCES 60VERNING THIS TVPE OF <br /> ior�_ ��K� oF - WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br /> NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br /> t AUTHORITY 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 PROPERTV TO PERFORM THE WORK FOR WHICH <br /> APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> CONTRACTORS LAW 7827 HCW AND 296.200 WAC. <br /> J (� -� 1 J�p,r �/ l92? <br /> m <br /> PROJECT�DDRE �f o�rE �1 <br /> Cltt PUSIN[gg�ICEHSE Iq <br /> PLUMlMNi MECMANICAL <br /> �• TYPE OF FlXTURE OR I1'EM FEE Np. TVPE OF EOUIPMENT �E <br /> WATER CLOSET(TOILET) N�FVHNDLG UNITS-H.P. <br /> � BATHTUB ' fORCED qIR SYSTEMS-B.T.U. M E.A. � <br /> LAVATOqY(WASH BASIN) � UNIT HEATERS-B.T.U. M � <br /> SHOWER � CLOTHES DRYERS , <br /> � KITCHEN SINK 8 DISP ' VENTILATION FAN � <br /> DISHWASHEq � RANGE HOOD � <br /> LAUNDRVTRAY ; WATEH HEATER � <br /> CLnTHES WASHEH � WOODSTOVE � <br /> ' URINAL METAL FIREPLACE 6 CHIMNEY � <br /> DRINKING FOUNTAIN � FIREFUCE INSERT � <br /> , FLOOR DRAM � HEAT PUMP <br /> BACKFLOW PREVENTERS ; GAS PIPING � <br /> ROOF DRAINS-AAINLEADERS � EXHAUST FAN � <br /> SINK(SERVICE-BAR,ETC.) � <br /> � � <br /> � <br /> � � <br /> SUB TOTAL y ; SUBTOTAL S ' <br /> PERMIT $ � PERMIT S ' <br /> TOTAL FEE $ � TOTAL FEE E —� <br /> FOR OFFlCE USE ONLY: <br /> FRONT SETBACK RE�R SETBACK SIDE SETBACK PLAN CMECK NU�Eq FEE � RECEIPT NQ _ <br /> za' zo ' .� + 3' Z . 79 <br /> USEZ LOTAREA VAC�NTSITE FEES VAlUA710N FEE <br /> _� �� � N� BUILDING �„pJ ' <br /> TYPEOfCONiS.�LLOWABtE iYPEOfCONSTALTWL attunex[r NOorPMuinGuxrts � <br /> — � pW3 PLUMBING i <br /> i <br /> SQEOFBLOG. NO.OFSTUPIES BASEMENT MECHANICAL � <br /> E � 1ti V � <br /> OCCUPANCY IOAD FIRE SPRNKLERS REQ'D HEIGHT qLIMITp11pN ADDITIONAL PLAN CHECK � � <br /> N� Lv SPRINKLER � <br /> REA50 fORSPRINKLERS � <br /> STATE BUILDING SURCHARGE � � �O <br /> INTAKE BY PLANS�PPROVED BY CITY OF EYEREIT PUBLIC WORKS — � <br /> J� 1/11�7t TAX CODE S 9 05 �r�� <br /> Z <br />