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APPLICATIC'"1 FOR CONSTRUCT''�N PERMIT � <br />TO BE COMPLETED IN BLACK INK—PLEASE PRINT <br />BUILDING DEPARTMENT HEATING SYSTEM: ❑ GAS ❑ ELECTRIC ❑__ <br />259-8810 <br />❑ DEMOUTION f! COMBINAT�(;;�;v 1�`.B,UILDING�+.!': �` qfAECMANICAI [7PLUMBING i'. SIGN <br />OYMER MFILADDRESS CITY 21P PMONE <br />Taaay �-.i�Rl3c,.'1'�' c14i3 C¢�-.��lrar,� �. 9f�Zo3 252-9iiS <br />TENFNT MAILpODRE55 GITY 21P PNONE <br />ARCHITECTOF DESIGNER MAILA�DRESS CITV 21P PMONE .,` � �' <br />GENEF�LCONTRACTOR MAILADDRESS CITY _IP PNONE � °TATELICcNSEe <br />MAIL ADDRESS <br />�o� <br />MAIL ADDRESS <br />CONTI7AZT CE OF WORK � f �� O,� l <br />f� <br />DESCRIBE WORK AND SOURRE FOOTRGE INVOLVEO <br />PROPOSEO USE OF B{U�ILDING <br />�J 'K <br />LEGAL OESCRIPTION OF Pf10PEHTY �SHOWN BELOW OR RT7ACM TWO <br />�O� BLOLK OF <br />PARCELTAXID.NUMBFR <br />\ <br />CANSTRUCTION LOAN LENDEH. <br />WATER CLOStT <br />SHOWER <br />KITCHEN SINK 8 DISP <br />DISHWASHER <br />LAUNDRVTRAY <br />CLOTHES WASHER <br />URINAL <br />DRINKING FOUNTAIN <br />ROOF DRAINS—RAINLEADERS <br />FOR OFFlCE USE ONLY: <br />FNONTSETBRCN REAFlSEiBRCK <br />TYPE OF CONST <br />S2E OF BLDG. <br />REASON <br />INTAKE BY <br />LOT AREA <br />CITY <br />��r <br />ZIP PHONE <br />9g2oi 3S <br />ZIF PNONE <br />CONTACT PERSOt! AND PMONE NO. <br />STATE UGENSE t <br />�y s'Ea vi, <br />STATE LICENSE s <br />y. . <br />I' <br />� HEREBY CERTIFV THAT I HAVE READ AND EXAMINED THIS <br />APPLICATI("I AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />PROVISIQN,i OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br />" WORK�WILLBE COMPLETED WITH WNETHER SPECIFIED�HEREIN OR <br />NOT. THE GRANTING OF, A PERMIT DO,�S, NOT PRESUME TO GIVE <br />AUTHORITY TO VIOLATE OR CANCC-L THF PROVISIONS OF ANY <br />�., : OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION�.GR THE <br />PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br />OWNER OF THIS PROPER'TY TO'PERFOp1iA THEWOHiF�FOR�WHICH <br />APPLICATION IS MAD�AND .I COMPLY WITH��T,�1E iSTATE <br />- CONTRACTORS LAW 1827 CW AIJb 296200 WAC. <br />NUMBER <br />_"", %� /S� <br />. ,. i �':yWti9F1�' � nerE <br />SUB TOTAL $ <br />PERMIT $ <br />FIRE SPRINKLF.RS REO'0 <br />FIRE ALARM REO'D <br />PLANS APPROVEO OY <br />DATE <br />SIDE SETBRCK <br />, TYPE OF EOUIPMENT <br />UNIT HEATERS—B.T.U. M <br />CLOTHES DRYERS <br />' ' � ENiItATION FAN <br />RA GE HOOD <br />WATER HEATER <br />' WObD 9TOVE <br />� , .t�ET FIREPLACE�WOOD <br />FIREPLACE INSERT <br />FAN <br />VACRNT SITC hGt, <br />❑ YES C NO BUILDING <br />acwwcr woamvEwxeuvns - <br />auour PLUMBING <br />enSEMENT MECHANICAL <br />❑ YES !: i NO <br />NEICMTLIMITATION ADDITIONALPLANCHFCK <br />OTHER <br />STATE BUILDING SURCHAriGE <br />CITY OF EVEREIT PUBLIC WORKS <br />LOCAL3ALES <br />TAI( CODE IS 3105 TOTAL <br />FEE <br />M E.A. <br />PERMIT <br />TOTAL FEE <br />S <br />5 <br />5 <br />FEE <br />0 <br />