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APPLICAYIQ� FOR CONSTRUCT�N PERMIT <br /> TO BE COMPLETED IV BLACK INK—PLEASE PRINT � <br /> � <br /> BUILDING DEPARTMENT HEATING SYSTEM: ❑GAS `�ELECTRIC ❑_ � <br /> 259-8810 <br /> C l QEMOLITION i i COMBINATION �BI�ILDING 17 MECHANICAL ❑PLUMBING SIGN <br /> OWNER A1AILqDD11ES5 <br /> � � C17V ZIP PHONE <br /> , i� ciAT�S i31� � �a.7er�e� �EAYr�c LvR- �fl� ao6- �ay-¢y-y� <br /> TENFNT MAILAODRESS CITV ZIP PNONE <br /> ARCMIT• TOROESIGNER M�ILAOOflE55 CITY ZIP PNONE <br /> � NAr�i c� �MYX�r� �( �ssv� 7.�� ���cv/.,�9 �E�-r �j3�3.��'s�' <br /> GENERAICONTRACiOi �,IqIIADDRE55 qTV IIP PMONE STqTELICENSEa <br /> - J im �AKr�Ki �3�z 5. tvEz�Fe 57 ��>;� <br /> MECHANICALCONiRACTOR AIpIL'A00RE55 CIiY Tip PHONE STqTELICENS'.-p <br /> // � <br /> PWRIBING CONTP�CTOR �IAIL AOOPESS dTY IIP PMONE STATE UCENSE♦ <br /> CONTRACT PRICE OF WORK , _ <br /> L/ <br /> DESCRIBE WOPK AND SOU�RE FOpTAGE INVOLVED / �� / ' CONi CT PER50N AN�PHONE�q <br /> (�A F� IVl �� S�-����-- <br /> I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED 1H15 <br /> PROPOSED USE OF BUILOING qPpLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT.ALL <br /> PROVISIONS OF LAWS AND ORDINANCES VOVERNING THIS TYPE OF <br /> LEGALDESLRIPTIONOFPROPERTY�SNOIVNBELO'.YORATiFCNT1VOCOPIES� WORK WILL BE COMPIET�D WITH WHETHER SPECIFIED HEREIN OR <br /> �or BIOCK oF NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIV[ <br /> AUTHORITY TO VIOLATE OR CANCEL THE PROVISIUNS OF ANY <br /> OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br /> PERFORMANCE OF CONSTRUCTION.Tl1AT I AM AUTHORIZED BY THE <br /> OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br /> PARCELTA%LU.NUAI9ER APPLICAIION IS MADE AND � COMPLY WITH THE STATE <br /> CONTRACT RS LAW 18.27 RCW AND 296200 WAC. <br /> CONSTRUCTION LOFN LENDER.ADDRE55.TELEPNONE NUMBER <br /> �� �-�2 -�, <br /> PR COT ADDRE�/���'n � n s e ne ont[ <br /> •�^'W /� CrtYBUSMESSbCCN5EN0 <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM FEE NO. TYPE OF E�UIPMENT FEE <br /> WATER CLOSET(TOILET) A1C—A�HNDLG 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 � RANGEHOOD , - ' <br /> LAUNDRY TRAY � _ "'r <br /> , WATERIIEATER � <br /> CL07HES WASHER � WOOD STOVE ' � .`,;:T�,;' <br /> URINAL � METAL FIREPLACE(W00D BURNING� � � '�,.� <br /> DRINKING FOUNTAIIJ � FIREPLACE WSERT � ;,;:��;_ <br /> FLOOR DRAIN � HEAT PUMP � ' �'�� � <br /> BACKFLOW PREVENTERS ; GAS PIPING � , � �'����`� <br /> ROOF DRAINS—RAINLEADERS � EXHAUST FAN ; . '�-.;�'�'_:t'-� <br /> SINK(SERVICE—BAR,ETC.) .� '. �_F�,f'- <br /> � � - x <br /> ' ^��� <br /> � � -- ;..,,:�.:: <br /> � _ <br /> i <br /> `r.,f ' <br /> i 'P"' <br /> 't, <br /> SUB TOTAL 5 ' SUB TOTAL $ •'•��'�` <br /> PERMIT 5 PERMIT 5 <br /> TOTALFEE 5 TOTALFEE 5 <br /> FOR OFFICE USE ONLY: �2 5� �� ������I� <br /> FRONT SETB�� REAO SETBACN SI�E SETBACK� PLA�ECK NUAIBER FEE _ �� p RECEIPT NO <br /> � -� JZ � � l% <br /> � <br /> uSezoNe �ornnen vnen TSITE FEES VALUATION FEE <br /> Z,` �j �j 0� �YES �.-1 NO BUILDING <�. 5v�'aj^ q�� ;�S <br /> tYPEOfCONSi. NO-0FSTORIES OtC��+!.[r r:0arpwou'muMrt° — <br /> — III tp�� � C.� PLUMBING i <br /> i'�[�� <br /> SREOfBI�G. F;pESPqINNLER5FE0'D BASFI T � MECHANICAL <br /> �� (o Q /E�S . . YES .'- NO - <br /> OCCl1PANACVLOAD FIREALAR(MREO'D I MEIGHTLIMRATION � ADDITIONALPLAN :NECK ' <br /> N n �f OTHER i <br /> REASON <br /> __i-- <br /> STATEBUILDINGSURCHARGE ,L/��,J <br /> INTANE BY PLAN�PRpVEDBV CITY OF EUERE7T PUBLIC WORKS <br /> LOCALSALES <br /> on.E � ,.�� _y � TAX CODE IS 3105 T�TA� /� tSs <br />