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� <br /> , <br /> APPLICATIG.� FOR CONSTRUCT�uN PERMIi' e�e�e« <br /> riia Eve�grean TO BE COMPLETED IN INK—PLEASE PRINT � <br /> y � � ceverett <br /> m � HEATING SYSTEM:�GAS O ELECTRIC U � <br /> � � H BUILDING DEPARTMENT . <br /> � H m 259-8810 <br /> H � � DEMOLITION �,COMBINATION �BUILDING ❑MECHANICAL ❑PLUMBING ❑ IGN <br /> OWN AIAIIPD�NESS CIiY � / ZP PO'E /AI� ���� �� ,„, <br /> " y � �Un�z rK Tauius � �UZD n'�u.�n �c� -�s>�' <br /> � M � IENANT CITY � <br /> � MAILADDRESS 21P PHO E <br /> � <br /> �+ y� ARCNITECTOROESIGNE� ^ �`��nlr� /1 I r`�L7�,�� LLII( PMONE���^I �✓� <br /> l+J C�] Tl)� /� � <br /> 1J (J� <br /> GEN �ICONTRAGTOR M�ILf�D�PE55 CITV ZIP NMONE LIGENS • <br /> H� g �`rurr��'� .�ndus �'�'-� l � fl__ <br /> �� n GITY ZiP PNOHE LICIiNSE� <br /> F-I MECHeNiCALCONTRAGTOR IAAILAODRE55 <br /> H <br /> `1.' H <br /> PLUM0INGCJNiRALTOR MAILA�DRE55 CIiY ZIP PHO��L l�L2tl5E• <br /> � HH <br /> y <br /> ��y CL 50�WJRK <br /> NEW ❑ ADDITION ❑ ALTEPATION ❑ REPAIR L7 DEMOLITION ❑ WOODSTOVF1FRPl INSERT G BUILDING RELOCATIOtI <br /> WNTACT PEFSON AND PNONE HO. <br /> y � �x�� f�,�uc �� s��`/-�35�-��v y��._ <br /> H O V1 CONTR/.CTiPiCEOFWORN <br /> OESGRieEwORKAN�SW�REF00TAGEINY�YED ' ,�� , ,/ ��� 3S3—y�;0; <br /> ' r . � <br /> PROPOSEDUSF.OFBU�L01 G � I HEREBY CERTIFY THAT I HAVE READ AND EXAh11NED THIS <br /> `S. � ! L� � � J APPLICATION AND KNOW THE SAtdE TO BE TFUE AND CORRECT.ALL <br /> �ec.ioe PIPTIOHOF PROPERIV�SMO N BELOW ON n�cH FouacoPiesl ., PROVISIONS OF LAWS AND ORDIWANCES GOVERNING THIS TYPE OF <br /> V�L WORK WILL BE COMPLETED WlTii WHETHER SPECIFIED HEREIN OFi <br /> ioT e�ocK oF 4 NOT. THE GRANTING OF A PERh'IT DOES NOT PRESUME TO GIVE <br /> AUTHORITY TO VIOLATE OR CANCEL THE PAOVISIONS OF ANV <br /> ' " OTHER STATE OR LOCAL LAW FEGULATING CONSTFUCTION OR THE <br /> PERFORMANCE OF CONSTFUCTION.THAT I AM AUTHORIZED BY THE <br /> � //� ' OWNER OF THIS PROPERN TO PERfORM THE WORK FOR WHICH <br /> / APPLICAiION IS MADE AND I COMPLY WITH THE STAT'c <br /> CONT(iACTORS L(�W 18�7 RCW AND 296200 WAC. <br /> �IGNATUREOFCO/r{��\tAG�T.OR AUTHOARE�AGENT DATE <br /> / .' l`C(!:'/—�/:��1C r.� . <br /> , -- 5�l��.�- `' i V k'cJ ;. ` �.v. (��`�.�`�-- <br /> '�' �OJEGTAODRESS � <br /> APPUCANiSCITYBU51NE55LICEN5EN0 �f:�OUSiNESS��a�Ac <br /> I ' PLUMBING MECHANICAL <br /> N0. TYPE OF FIXTURE OR ITEIA FEE N0. TYPE OF EOUIPMENT FEE <br /> ��� � WATEFi CLOSET(TOILET) r� NC�NHNDLG UNITS—H.P. <br /> ' ' BATHTUB !� ; FORCED AIR SYSTEh1S—B.T.U. M E.A. <br /> � LAVATORY�WASHBASIN�- � � UNITHEATERS—B.T.U. 1d <br /> SHOWER <br /> �� CLOTHES DRYERS <br /> ' ' KITCHEN SINK 8 DISP �� j VENTILATION FAN <br /> DISHWASHER � � RANGEHOOD <br /> '�I �LAUNDFY TRAY WATER HEATER <br /> CLOTHES WASHER a � WOOD STOVE � <br /> fp' __ URINAL METAL FIREPLACE 8 CHIMNEY O1 U' <br /> ' _i DRINKING FOUNTAIN FIREPLACE INSERT <br /> FLOOR DRAIN HEAT PUMP ' <br /> � BACKFLOW PREVENTERS GAS PIPING <br /> i� ROOF DRAINS—RhINLEAOERS EXHAUST FA.J ; �D � <br /> I SINK(SE-RVICE—BAR,ETC.) S) <br /> �v <br /> � -. <br /> ' SUB T� '1L 5 � SUB TOTAL S <br /> PERMIT S PERl.11T S <br /> TOTALFEE S TOTALFEE S ' <br /> FOR OFFICE USE ONLY: <br /> FRONTSETBACK REARSF�SAC�' SIDESEIBM1GN PIANLHECKNUMBER FEE PECEIPTNO.. ' . <br /> ZC> f GL' � s 7 ' ��3� sd � �i° ��1" <br /> useza+e �o AREA /� VACANTSIiE FEES VALUATION FEE <br /> � �� I��7 ;l BUILDING 4J�a1.ry,J{ :G/C71 Sl/'7 �=- � <br /> I�VEOiCOHIS.FIlOWl9lf ttPEOfLONSLIiGNAL OCwcu.R WIXVnRu�.:wu2 � <br /> °Par ' PLUMOING a�J lJ.� <br /> SREOFBIDf. NO.OFSTORIES �.�SEMENT h1ECMANICAL � (� ; I � <br /> I�bl S��+GAZ J _ _ <br /> OCCUPAI:GYL0�0 FlFESPRNKLERSNE00 tiEIGMt4MITATION ADDITIONALPIANCHECK <br /> () �.IJ OTHER <br /> REASON fOfl SPRINKLERS <br /> S7A7E BUILDING Sl1RCHARGE �,�J <br /> iNtAMEBY PWIS�PPflOVEDBY CITY OF EVEHEIT Pl1BUCWORK$ ,�+U ��� <br /> LOCALSALES , <br /> J b �/� y;, TAX CODE IS 3105 70TAL <br />