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� <br /> APPLICATIC"1 FOR CONSTRUCT"1N PERMIT � <br /> TO BE COMPLETED IN BLACK INK—PLEASE PRINT <br /> I� HEATING SYSTEM: ❑GAS O ELECTRIC ❑ <br /> BUILDING DEPARTMENT <br /> 259-8810 <br /> ❑ DEMOLITION ❑ COMBINATION fX BUILDING Cl MECHANICAL ❑PLUMBING ❑ SIGN <br />� OWNER MFILADDRESS CITV ZIP PHGNE <br /> �IIIcEN-C llows �3�4 M�p�s ST EVEa�1r �tBzo► zsz - 4oz� <br /> TENANT MAIL ADORESS GITY 21P PMONE <br />� ARLNITECTOR�ESIGNER MAILADDRESS CITV 21P PHONE ps <br /> .18Z�o <br />�I , GENERALCONTRACTOR MAILADDRESS CITY ZIP PMON* �� STATEUCENSEIr <br />� $1.U6 2�BBetr Sl'EtL 13�Da I`lo4-A aN0[RSoN '�D P'1T. VE'RNeN 9�Z19 "$C11ERS$ Lo1 LL <br /> I MECHANICALGORTflACTOR MAILA�ORESS CITV ZIP PNONE STqTELICENSE+ <br />� d <br /> t /�T <br /> IPLUMBIN TPACTOR MAIL ADDRESS GITV ZIP PHONE STATE IICENSE+ <br /> l <br />�I C TRAG PRiGEOFWORK <br />� �4 �i z8 00 . <br /> ESCRIB ORK AN�SOUARE FOOTAGE INVOLVED CONTACT PERSON AND PHONE NO��� c p� �' I S <br />� G 1\ <br /> z °� K 36X I'Z �o,'T F�wrne �B 1-e o - 8z -8�15 <br /> i HEREBY GERTIFY THAT I HAVE READ AND EXAMINED THIS ' <br /> PROPoSED USE OF BUILDING APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT.ALL <br /> (a' �, e�tc,E PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br /> IEGMDESCRIPTIONOFPROPERTV�SHOWNBELOWORATTACHTVJOGOPIES� WORK WILL BE COMPLETED WITH WHETHEH SPECIFIED HEFEIN OR ' '4� <br /> 3� �3'Z NOT. fHE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE , , � -k�. <br /> . �or e�ocK oF AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br />� OTHER STATE OR LOCAL LAW flEGULATING CONSTRUCTION OR THE � -,� ,. <br /> y � PERFORMANCE OF CONSTRUCTION.THAT I AM AUTHORIZED BY THE <br /> ' OWNER OF THIS PRCPERTY TO PERFORM THE WORK FOR WHICH � � <br /> APPLICATION IS MAOE AND I COMPLY WITH THE S-TATE , � <br /> PARCEL TAX I.D.NUMBER COVTRACTORS LAW 18.27 RC1V AND 296.200 WAC. . <br /> 438-�zs8 -631 - � ooz i . <br /> CONSTRUCTIONLOANLENDEfl,ADDRE55.TELEPHONENUMBER <br /> . /t�v.zd�,.o S �5L-/�'¢- <br /> PROJECT ADDRESS s�c�,rune DAi[ <br /> 130 � 'H � CIivHUSiNESSUCEN5EN0 �Qb�O0 �0� <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FI%TURE OR ITEM FEE NO. TYPE OF EOUIPMENT FEE <br /> WATER CLOSET(TOILET) � A/C—A/HNDLG UNITS—H.P. � I <br /> � BATHTUB ; FORCED AIR SVSTEMS—B.T.U. M E.A. � , I <br /> , LAVATORY(WASH BASIN) UNIT HEATERS—B.T.U. M I I <br /> SHOWER ' CLOTHES DRYERS ' '� <br /> KITCHEN SINK 8 DISP ; VENTILATION FAN ; 'i <br /> � DISHWASHER � RANGE HOOD � � <br /> LAUNDRVTRAY ; WATERHEATER '- I <br /> � CLOTHES WASHEii � WOOD STOVE � <br /> URINAL ; METAL FIREPLACE(WOOD BURNING) � <br /> DRINKING FOUNTAIN � FIREPLACE INSERT ; <br /> I FLOOR DRAIN � HEAT PUMP � <br /> I BACKFLOW PREVENTERS GAS PIPING ; <br /> I ROOF DRAINS—RAINLEADERS � EXHAUST FAN � <br /> SINK(SERVICE—BAR,ETC.) ; <br /> � � <br /> ; <br /> � � <br /> � � <br /> —T <br /> � � <br /> SUB TOTAL $ SUB TOTAL $ ' <br /> PERMIT $ PERMIT $ � <br /> TOTAL FEE $ ' TOTAL FEE $ � <br /> FOR OFFICE USE ONLY: <br /> FRONT SETBpCK PEAR SETBACK SIDE SETBACK PLAN CHECR NUMBER FE RECEIPT NO. <br /> Zo, 2, 5 , y�� � �,r �,� ,05� <br /> usezoNe LOTAREA VACANTSITE ,./ FEES VALUATION FEE <br /> �Z `'�}(('��.( " YES u NO yUILDiNG (p B � <br /> TVPE Of CONST. NO.OF S70RiE5 aarevcr xo d ow[unmuwis � <br /> J'J cnauv p�UMBING —� <br /> SIZEOFBLDG. FIRESPRINKIEPSREO'D BASEMENT MECHANICAI `� <br /> 5 U ❑ YES �O , <br /> OCCUPANCY LOAU FIRE ALARM PEOD HEIGHT LIMITATION ADDITIONAL PLAN CHECK '1 <br /> i <br /> 1 � <br /> � (J Z� OTHEF -r <br /> RERSON <br /> STATE BUILOING SUR:.HARGE <br /> INTAKEBV PLANSAPPROVEOBY CITYOFEVEREIT PUBLICWORKS _T <br /> .J I� LOCAL SALES <br /> DATE � ,y./� TAX CO�E IS 3105 T�tA� � ;�� <br />