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APPLICATIC J FOR CONSTRUCT. JN PERMIT <br /> TO BE COMPLETED IN BLACK INK-PLEASE PRINT � <br /> BUILDING DEPARTMENT HEATING SYSTEM: ❑GAS U ELECTRIC �] <br /> 259-8810 <br /> fJ DEMOLITION ❑ COMBINATION l7 BUILDING �CHANICAL Cl PLUMBING ❑ SIGN <br /> OWNER MRI�AD�yDRESS y <br /> LL�N /��F�qIFJP�IE III���/O��' �i�,or, ZIP PHONE <br /> rr yB�or— 93y �.78T <br /> TENANT MAILAODRESS <br /> CITY ZIP PHONE — <br /> APCHITECTORDESIGNEN MAILADDRE55 CITY 21P PHONE <br /> GENERAICONTRRCTOR MRILADDRESS CITY ZIP PHONE STATELICENSE• <br /> MECHA�IJ('jLGQNTqpCTOR MIIILAUORESS CITY ZIP PMONE STATELICENSEII <br /> ��r �r �� <br /> PLUMBING CONTRACTOR MAIL RDDRESS CITV ZIP PHONE STATE UCENSE� <br /> ' CONTRACTPRICEOFWORN �0. C �n '/ <br /> ' � DESCRIBE WORN AND SOU�RE FOOT�GE INVOLVED CONTACT PERSON AND PNONE NO, <br /> L <br /> i HEREBV CERTIFY THAT I HAVE READ AND EXAMINED THIS <br /> PpOPOSEO USE OF BUILDINi <br /> ��, APPLICATION AND KNOW THE SAIAE TO BE TRUE AND CORRECT.ALL <br /> PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br /> LEGAIDESCRIPT OFPROVEHTV�S1'OWNBELOWORATTACHTWOCOPIES� WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br /> �or BLOCK—_— OF NOT. THE GRANTING OF q pERMIT DOES NOT PRESUME TO GIVE <br /> AUTHOflITY TO VIOLATc OR CANCEL THE PROVISIONS OF ANY <br /> OTHER STATE OR LOCAL LAW qEGULATING CONSTRUCTION OR THE <br /> PERFORMANCE OF CONSTRUCTION.THAT I AM AUTHORIZED BY THE <br /> - OWNER OF THIS PROPERTV TO PERFORM THE WORK FOR WHICH <br /> . P�RCE�TA%I.D.NUMBER APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> ' CONTRAC RS LAW 18.27 RCW AND 296200 WAC. <br /> �i CONSTRUCTqNLWNLENDER.ADORE55.TELEPHONENUMOER <br /> •�,Q�'- p��v�'s v6 � 9 <br /> PROJECTADDRESS • 5 N�tUFE , DAIE <br /> CItY BUSMESS 110EN5E NO - <br /> PLUMBINO MECHANICAL <br /> �.. NO• TYPE OF Fl%TURE OR ITEM FEE NO. TYPE OP EQUIPMENT FEE <br /> _ WATER CLOSET(TOILE� � C—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 FAt. � <br /> DISHWASHER NGE� <br /> � <br /> LAUNDRYTRAY ' 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—RAINLEADEHS � EXHAUST FAN <br /> SINK(SERVICE—BAR,ETC.) � , <br /> � <br /> , <br /> � <br /> _ i � <br /> SUB TOTAL S , SUB TOTAL S � <br /> PERMIT $ PERMIT $ / � <br /> TOTAL FEE $ ' TOTAL FEE $ � <br /> FOR OFFICE USE ONLY: <br /> FRONT SETB�CK PE�R SETBALN SIDE SETBACK PLr1N CH CK NOMBER FEE RECEIPT NO. <br /> ��S� <br /> USE ZONE �pT pREA VACANT SITE FEES VALUATION FEE <br /> .� . ❑ YES ❑ NO BUILDING ' <br /> TYPEOFLDNST. ' NO.OFSTORIES atuvencr qomvntu�xcururs <br /> GUWO <br /> PLUMBING <br /> SIZE OF BLDG. FIRE SPRINNLERS REO'D B0.SEMENT i <br /> ❑ VES C1 NO MECHANICAL � <br /> OCCUPRNCYLOAD FIH�ALARMREO'D HEIGHTLIMITATION ADDITIONALPLANCHECK � <br /> OTHER � <br /> REASpN <br /> STATE BUILDING SURCHARGE i <br /> INTAKE BY PLANS APPROVED BY CITY OF EVEHEIT PUBLIC WORKS � <br /> LOCAL SALES <br /> DATE TAII CODE IS 3105 TaTA� � <br />