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APPLICATIC`�1 FOR CONSTRUCT'`1N PERMIT � <br /> TO BE COMPLETED IN BLACK INK–PLEASE PRINT <br /> BUILDING DEPARTMENT NEATING SYSTEM: ❑GAS ❑ELECTRIC U <br /> 259-8610 <br /> I 1 DEMOLITION ❑ COMBINATION I� BUILDING I I MECHANICAL I ' LUMBING f� �IGN <br /> OWNER MAILADORE55 CITY ZIP PHO <br /> �`,JEr� ,IvlAi �1�1.0 �6� +� S�- �►c�'r GS��& �.�Fs— L`��3. <br /> TENANT MAILADDRE$S CITV ZIP PHONF <br /> c'��AhA Sn�i7�1 [�-11� Pir�F S ? �r�rz `?Frlo� L S2 �6�+04 <br /> ARCHITECTORDESIGNEfl MRILADDRE55 CITY ZIP PHONE <br /> GENERAL CONTRACTOq MAIL ADDRE55 �I1Y ZIP PHONE STATE LICENSE� <br /> MhCHANICALCONTqACTOR M�._ADDRESS CITY ZIP PHCNE STATEUCENSE• <br /> � PLUMBINGCONTR�CTOR MpILADDflE55 CITV ZIP PHONE STATELILENSEI <br /> G �� to63 �c S ?vu.w�Ua qS�6Fr 4Sc—�,eao CGrorec,Rio�rtsi <br /> CONTRACT PRICE OF WORK <br /> �1QO-'�a . <br /> � DESCRIBE WORK AND SWRPE FOOTRGE INVOLVED CONTACT PEFSON AND PHONE N0. <br /> " t►�I-t�+c.t�r 'o,.� •�� w v�nzrdi_ <br /> n <br /> ' i HEREBV CERTIFY THAT I HAVE READ AND EXAMINED THIS <br /> Pr10Po5ED USE OF B111L01N(i APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT.ALL <br /> , PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br /> � LEOALDESCRIPTpNOFPROPERTV�SHOWNBELOWORATiACHTWOCOPIES� WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN Of', <br /> � �or BLQ:N oF NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br /> AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br /> ' OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br /> � PERFORR7ANCE OF CONSTRUCTION.THAT I AM AUTHORIZED BV THE <br /> ; OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br /> APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> PARCELTA%I.D.NUMEER CONTRACTORS LAW 7827 RCW AND 296200 WAC. <br /> CONSTRUCTIIXJ LOAN LENDER.AOORESS.TELEPHONE NUMBER <br /> x � c`�(?o (`�a <br /> PROJECT ADDRE saeurune o�rE <br /> i3 N� S? (L1e`�T ��O � cmeus�r�ss.�ceHscra <br /> I PLUMBIN6 MECHANICAL <br /> N0. TYPE OF flXTURE OR fTEM FEE NO. TYPE Of ECUIPMENT FEE <br /> , WATER CLOSET(TGILET) A/C—NHNDLG UNITS—H.P. <br /> BATHTUB ; FORCED AIR SYSTEMS—B.T.U. M E.A. � <br /> LAVATORY(WASH BASIN) � UNIT HFATERS—B.T.U. M ; � <br /> SHOWER � CLOTHESDRYERS � <br /> KITCHEN SINK 8 DISP ; VENTILAT�ON FAN ; <br /> DISHWASHER RANGE HOOD � <br /> LAUNDRY 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 DRAINS—RAINLEADERS � EXHAUST FAN <br /> � SINK(SERVICE—BAR.ETC.) ; ; <br /> � � <br /> _ <br /> � <br /> — <br /> I <br /> SUB TOTAL $ ; SUB TOTAL 5 <br /> PERMIT $ i PERMIT $ � <br /> TOTAL FEE $ ' TOTAL FEE $ � <br /> fOR OFFlCE USE ONLY: <br /> FRONTSET6ICK REARSETBACR SIDESETBRCK PLANCHEG NUMBEF FEE RECGIPTNO. <br /> ' ��i3 <br /> usezorre LOT�REA VACANTSITE FEES VALUATION FEE <br /> ❑ YES ❑ NO BUILDING i <br /> 1vp[OFLONST. NO.OFSTORIES arivaxcr qaaDwnuxGuurts <br /> �a�P PLUMBING ' <br /> SIZEOFBLDG. � LIqESPRINKLER5PE0'0 BpSEMEHT MECHANICAL � <br /> ❑ VES ❑ NO <br /> OCCUPANCV�OAD FIRE ALARM REO'D HEIGMT LIMITATION ADDITIONAL PLAN CHECK � <br /> i <br /> OTHER ' <br /> � <br /> RE�SON <br /> STATE BUIL�ING SURCHqRGE i <br /> INTRNEBY PLANSAPPROVE�BV CITYOFEVEREIT PUBIICWORKS � <br /> LOCAL SALES ; <br /> DATE TAX COUE IS 3105 TOTAL � <br />