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APPLICATIG_�1 FOR CONSTRUCT�JN PERMIT �'`�'"'" <br /> TO BE COMPLETED IN INK-PLEASE PRINT � <br /> rno eve,gme� <br /> CITY OF <br /> � �p eve rett I HEATING SYSTEM� J GAS �ELECTRIC ❑ <br /> BUILDING DEPARTMENT <br /> p x 259-8810 <br /> � y y ' DEMOLITION 1 COMBINATION BUILDING �YMECHANICAL � PLUMBING SIGN <br /> MRIL AO�PESS dTV Z)P p PHONE `' <br /> H�� O W E R `/0 �,(� �� � N� <br /> � � .� � � � ��. <br /> �O y� ilE �NT MRIL RDDRE55 C�iV Z�P PMONE <br /> �IH� ` � <br /> y � CiTV ZiP PMONE <br /> y qqCMIiECT OR DESIGNEN M�IL nDDRE55 <br /> �zo <br /> F]rJ GENERRLCONTRACTOR MAILF�ORESS C�TV 2iP PMONE IILENSE• <br /> �° t�ag I��Y��{vixs-I— 31I� �It��f F�-cC �"'�t'�C.E� Cf,('2c�1 2���,�31 �/C,��fhcul�lCt3l� ��_ <br /> MECHANICnLCONTRACTOA MARAOORESS �1 J(1 CIT ZP PHONE UCENSE� <br /> Q1� OQQQ u b <br /> �y� ��I��� GIT'� 21P PHON[ UCCNSE� <br /> PWMBINGGONTNACTOR M�iLAU0PE55 <br /> H y �(�n�t' <br /> �y CUSS OF WORN <br /> ��y ' NEW � � ADDITION ALTERAl10N � REPAIR DEMOLITION � WOODSTOVE/FRPL INSERT -� BUILDING R L <br /> CONTALT PERSON ANO PHONE NO <br /> �'a �G ,,�-,'l� L�Lj ( ,l' �t �-c. r „ � <br /> CONTR�CT PRICE OF WOPN �� <br /> y�y DESCRIBE WORN�Np SOURRE FOOTAGE INVOLVED <br /> � � �� , N- ' 2� l� �; �'�,�� <br /> PR�OPOfSEn�/USEOFBVI`L''(NG I HEREBY CERTIFV TNAT I HAVE READ AND EXAMINED THIS <br /> �l(�p �r � 47� M1�1� �i � � � �, i; � qppLICATION AND KNOV!THE SAME TO BE TRUE AND CORRECT.ALL <br /> LEWLOES PTIONO ROPERT�'ISI�C NDEIOWORATtACMFOUR�OPIE51 PROVISIONSOFLAWSANOORDINANCESGOVERNINGTHISTYPEOF <br /> � WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br /> iot B��K ov NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br /> AUTHOFiITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br /> �� r��� _ � _ I _ �Cl� OTHEF STATE OR LOCAL LAW REGULATING GONSTRUCTION OR THE <br /> PERFORMANCE OF CONSTRUCTION.THAT I AM AUTH071ZED BY THE <br /> OWNER OF THIS PROPERTV TO PERFORM THE WORK FOR WHICH <br /> APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> CONTRACTORS LAW 1tl.27 FCW AND 296.200 WAC. <br /> $IGNATUREOFCONTRRCTOROR�UTHOR12EDAGENi DATE <br /> o�C�� � � ����Cr 1'�0: �i -'�i�_�i- . <br /> PPp1ECTRODAES$ qpPLICANT50(VOUSiNE55UCEN5EN0 ANpBU5�NE55NAME <br /> " PLUMBING MECHAN�CAL . <br /> 1 ' FEE <br /> � NO. TYPE OF FI%TURE OR ITEM FEE N�' n,�_A�HNOLG U�N TS uH p ENT — <br /> WATER CLOSET(TOILET) <br /> '�1 BATHTUB FORCED AIR SYSTEMS—B.T.U. M EA. <br /> LAVATORY IWASH BASIN) UNIT HEATERS—B.TU. M <br /> SHOWER CLOTHES DRYERS <br /> 1�' — ' VENTILATION FAN <br /> KITCHEN SINK 8 DISP <br /> 1 OISHWASHER RANGE HOOD <br /> LAUNDRY TRAV / WATER HEATER <br /> I CLOTHES WASHER WOOD STOVE <br /> METAL FIREPLACE 8 CHIMNeY <br /> '�1 URINAL — <br /> ORINKING FOUNTAIN FIFEPLACE INSERT <br /> FLOOR DRAIN HEAT PUMP <br /> t�' BACKPLOW PREVENTERS � GAS PIPING <br /> ROOF DRAINS—RAINLEADERS EXHAUST FAN <br /> f ' SINK(SERVICE—BAii.ETC.) <br /> ' <br /> '�' SUB TOTAL 5 SUB TOTAL S _� l= <br /> �I PERMIT 5 PERh11T S = <br /> - TOTAI FEE 5 TOTAL FEE S � ' <br /> FOR OFFICE USE ONLY: eeceivrNo <br /> PIANtHEGRNUAIlER FEE <br /> FRONT SETBACN REnN SEIBAGK S�OE iETBRGK � � <br /> USEZONE IOT�REA VAL�NTiIIE <br /> FEES VALUATION FEE <br /> BUILOING <br /> ivVEO�CONi58llOW0.8lE 1�'PEO�CONSiACip4l aG[uo�K� �a0�on¢utio.�+'. <br /> caau. PLUh101NG <br /> SREOfeLW. NOOFSTOAiES O�SEMENT AIECHAIJICAI <br /> ADDITIONAL PLAN CMEGK <br /> OCCUPANCYLOAO F�RESPRNnLERS�ECD HEIGNTLIMii�tiON __ <br /> OTMER �_ <br /> PEn50N iOR SPRMKLERS STATE BUILDING SURCHARGE <br /> iNT�NEBY FLANSAPPROVEDOY CITYOFEVEREIT PUBUCWORN$ <br /> LOCALSALES <br /> TAX CODEIS 3105 TOTAL <br />