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APPLICATIQ : FOR CONSTRUCT'�N PERMIT � <br /> TO BE COMPLETED IN BLACK INK—PLEASE PRINT <br /> BUILDING DEPARTMENT HEATING SYSTEM: ❑GAS ❑ELECTRIC , _ l <br /> 259•8810 <br /> C] DEMOUTION �1 COMBINATION ?;+ BUILDING I- MECHANICAL CI PLUMBING i i SIGN <br /> 01VNER /s MAlLAODRESS CITV 'IP PHONE <br /> J i!.^n .�D�i� `)� ��.tf /�L-�=//�� y7%7// � .S% //�,� /G1A/��/<//Jl-Ge� L!/,� <br /> TENANT NLADORE55 CITV ZIP PHONE � <br /> � <br /> i�/��A��I �� a� S- C- �y �Z•7% <br /> AflCHITECTORJESIGNER M�ILAUDRESS CIIY 21P PHONE <br /> GENERAICONTRACTOR MAILAUURE55 CITV 21P PHONE STATELICENSE4 <br /> MECNANICALCONTRACTOR MAILADDflE55 CITV ZIP PHONE STATELICENSEa <br /> PLUMBING C7NTRACTOP M0.1L ADDRESS CITY 21P PHONE STATE UCENSE tl <br /> CONTRACT PRICE OP WORK <br /> �ESCRIBEWOFKANDSOUAREFOOTRGEINVOLVED � � IJ � CONTAC�ERSONANDPj1�NEN� /J �`�/�// <br /> C CJ Y C� <br /> OD C OG � l�i�/�i�6J-' __ <br /> i HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br /> Pfl���C oi~L�G PROV SAONS OF�LAWS AND ORDINAN ES GOVERN NG T�H S TYPE OF <br /> LEGRLOESC9IPTIONOFPROPERiV�SHOWNBELOWORATTACHTWOCOPIES� WORK WILL BE COMPLETED WITH WHETHER SPEC�FIEO HEREIN OR <br /> NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO G!VE <br /> �or BLOCK oF AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br /> OTHER STATE OR LOCAL LAW REGULATING COP�SiRUCTION OR TH[ <br /> �• PERFORMANCE OF CONSTRUCTION.THAT I AM AUTHORIZED BY THE <br /> �f /J��` ST. �'�� �� OWPJER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br /> �� APPLICATION IS MADE AND I COMPLV V:ITH THE STATE <br /> PARCEI TA%ID.NUMBER CONTRACTORS LAW 18.27 RCW AND 296200 WAC. <br /> CONSTRUCTION LOAN LENDER.ADORESS.TELEPHONE NUIdBEfi C'// <br /> �/�� � ��/ <br /> PROJECT ADDRESS s�cx,mn wre <br /> GI1V BUS�IY.SS LICENSE NO <br /> PLUMBING MECHANICAL <br /> NO. TVPE OF F�XTURE OR ITEM FEE NO. TYPE OF EOUIPMENT FEE <br /> WATER CLOSET(fOILET) � NC—lUHNDLG UNITS—H.P. _ � <br /> BATHTUB FORCED AIR SYSTEMS—B.T.U. M E.A. __ <br /> LAVATORY(WASFi BASIN) � UNIT HEATERS—B.T.U. M ; <br /> SFiOWER ' CLOTHESDRYERS <br /> —T— <br /> KITCHEN SINK 8 DISP VENTILATION FAN _ <br /> DISHWASHER RANGE HOOD � <br /> LAUNDRYTRAY ; WATERHEATER ' _ <br /> CLOTHES WASHER WOODSTOVE � <br /> URINAL ; METAL FIREPLACE(WOOD BURNING) � <br /> DRINKING FOUNTAIN FIREPLACE INSERT � <br /> FLOOR DRAIN � HEAT PUMP <br /> BACKFLOW PREVENTERS � GAS PIPING � _ <br /> ROOF DRAINS—RAINLEADERS EXHAUST FAN <br /> SINK(SERVICE—BAR,ETC.) <br /> � <br /> � � <br /> � � <br /> � � <br /> � <br /> SUB TOTAL 5 � SUB TOTAL 5 ' <br /> PERMIT $ PEAMIT S <br /> TOTAL FEE 5 ' TOTAL FEE S <br /> FOR OFFICE USE ONLY: <br /> FPONTSETBACK REARSETBACN SIDESETBACK PLANCMECKN 1�ER n FEE RECEIPTNO <br /> C// <br /> u <br /> USEZONE LOTAREA VALFNTSI7E EES VALUATION FEE <br /> �� YES :_' NO pUILDING � (�Z� <br /> TYPEOfCON51. NO.OFSTORIES Oc[uPArytr noaCdtcr.Gulns � <br /> r.aouv PLUMBING � <br /> -r <br /> S2EOF9LDG. FIPESPPINKLERSREOD BASEMENT MECHANICAL � <br /> l:i YES :- NO '--- <br /> OCCUPANCYLOAU FIRE ALARM IlEOD NEIGMT I�M:TATION ADDITIONAL PLAN CHECK � <br /> i <br /> OTHER <br /> REASON <br /> STAiE�UILDING SURCHAfiGE f �S� <br /> INTAKE BY PLANS A°PlOVED DY CITY OF EVEREIT PUBLIC WORK$ � <br /> LOCAL SALES <br /> DAiE TAX CODE IF 3�OS TOTAL '�-� � �Z� <br />