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APPLICATIC^I FOR CONSTRUCT"�N PERMIT � <br /> �` TO BE COMPLETED IN BLACK INK-PLEASE PRINT <br /> V <br /> BUILDING DEPARTMENT HEATING SYSTEM: ❑GAS ❑ELEC7RIC ❑ <br /> 259-8810 <br /> ❑ DEMOLITION ❑ COMBINATION 4'i BUILDING ❑MECHANICAL ❑ PLUMBING ❑ SIGN <br /> OWNER � M�ILADDRES / / CI , Z/IP PHONE <br /> %lk.�il/�� %11'•MI'w- �i�/�����[1 i/G��`I �r. Gifr�•r � 9��-//3 <br /> TENRNT MAILADDfl� —� CITV ZIP � PMONE <br /> .SAm-� <br /> RRCHIiECTORDE5IGNE MAILADDRESS CIiV 21� PHONE <br /> L�ilsar �.o �,n, �� �/4 - �' ��A✓t .S� GV�•� �N,S �3yG/o3jE!!_s�7y<:1yGLC� <br /> GENERALCONTflACTOR MiIIL� T— CITV ZIP PNONE STATELICENSEI <br /> MECNRNICALCONTR�CTOR MAIUDDRESS CITY ZIP PHONE ST�TELICENSE� <br /> PLUMBING CONTRACTOR MAIL AUORE55 CITV ZIP PHONE STATE LICENSE� <br /> CONTRACT PflICE OF WORN <br /> • . a� <br /> DESCflI WOFlK�ND SOUARE FOOTAOE INVOLVED CONTR ERSON HONE NO./ J / �� <br /> / <br /> � i HEREBY CERTIFY THAT I HAVE READ AND E%AMINED THIS <br /> i PROPOSED USE OF BUILDING APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT.ALL <br /> PROVISIONS OF U1WS AND ORDINANCES GOVERNING THIS TYPE OF <br /> �i LEGALDESCRIPTI� OFPROPERTV(SNOWNBELOWORATTAGNM'OCOPIES) WORK WILL BE COMPLETED WITH WHETHER SPEGFIED HEREIN OR <br /> il / NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br /> LOT BLOCN� OF � W AUTHORITY TO VIULATE OR CANCEL THE PROVISIONS OF ANY <br /> - OTHER STATE OR LOCAL LAW REGULATMG CONSTRUCTION OR THE <br /> PERFORMANCE OF CONSTRUCTION.THAT I AM AUTHORIZED BY THE <br /> � OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br /> APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> P�RCEL TN(I.D.NUMBER <br /> S _O, , � CONTRACTORS LAW 1827 RCW AND 200 WAC. <br /> CONSTHUCTION LOAN LENDER.MDRESS.TELEPM E NUMBER � <br /> i <br /> ^ � 9 ' <br /> PROJECT A�DRESS sa "�E <br /> Glv BUSME53 LCENSE W. <br /> PLUMBIN6 MECHAf11CAL <br /> N0. TYPE OF Fl7(TURE OR REA1 FEE NO. TYPE OF E�UIPMENT FEE <br /> WATER CLOSET(TOILEn � A/�NHNDLG UNITS—H.P. <br /> BATHTUB ; FORCED AIR SYSTEMS—B.T.U. M E.A. ' <br /> LAVATORY(WASH BASIN) � UNIT HEATERS—B.T.U. M � <br /> SHOWER ' CLOTHES DRYERS <br /> � KITCHEN SINK 8 DISP � � VENTILATION FAN <br /> � DISHWASHER � RANGE HOOD <br /> UUN�RY TRAY ; WATER HEATER <br /> CLOTHES WASHER � WOOD STOVE � <br /> URINAL ; METAL FIREPLACE(WOOD BURNING) <br /> DRINKING FOUNTAIN � FIREPLACE INSERT � <br /> FLOOR DRAIN � HEAT PUMP ' <br /> BACKFLOW PREVENTERS ; GAS PIPING <br /> � ROOF DRAIN�RAINLEADERS � EXHAUST FAN � <br /> ' SINK(SERVICE—BAR,ETC.) ; � <br /> , � <br /> SUB TOTAL $ ' SUB TOTAL $ ' <br /> PERMIT $ PERMIT $ � <br /> TOTALFEE $ ' TOTALtEE $ ' <br /> FOR OFFICE USE ONLY: <br /> FRONTSETBACK REARSETBACN SIDESETBACK PUNCHECKNUMBER FEE RECEIPTNO. <br /> USE 2dJE LOi�PEA VFCANT SITE FEES VALUATION FEE <br /> ❑ YES ❑ NO BUILDING �03, _ <br /> 7VPEOFCONST. ���STORIES aaru1tr xodew[uixcuxrts � <br /> Gnao pLUTABING i <br /> --r— <br /> SIZE OF BLDG. FIRE SPflINKLERS PEO'D BASEMENT MECHANICAL 1 <br /> ❑ VES ❑ NO <br /> I <br /> OCCUPANCY LOAD FIRE�URM REO'D HEIGHT LIMITATION ADDITIONAL PLAN CHECY. � <br /> OTHER ' <br /> i <br /> RE�SON � <br /> STATE BUILDING SURCHARGE � '�J <br /> INTANE BY PLANS PPPROVED BV CITY OF EYEREIT PUBLIC WORKS i <br /> LOCALSALES , T� <br /> DATE TAX CODE IS 3105 T�TA� 1�� '�� <br />