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APPLICATI4V FOR CONSTRUCTIPN PERMIT <br />TO BE COMPLETED IN BLACK INK -PLEASE PRINT �w <br />BUILDING DEPARTMENT <br />259-Bd10 <br />LI DEMOLITION i7 COMBINATION <br />HEATING SYS'EM: ❑ GAS ❑ ELECTRIC ❑ <br />(' BUILDING ❑ MECHANICAL ❑ PLUMBING SIGN <br />TENANT E <br />CAFE 6`ATIFEI�M <br />ARCHITECT OR DESIGNERMAL <br />AINN)AM <br />ISUS� �iEtiJ1T <br />ADDRESS <br />�Y'e-�.r a'�2n1 <br />�IIY <br />xW <br />�-S2-lol0�°� <br />1`14OHL <br />3ENERAL CONTRACRIR <br />MAR ADDRESS <br />CITY <br />x1P <br />PHONE STATE LICENSE• <br />A-0n <br />Iv-Ii1�jI;''A,IE ti,� <br />MtR wILLe <br />9Kz11-4 <br />i-3«y hPDLW DLITS <br />.J n1�T <br />MECHANICAL COITRACTOR <br />MA, I.OUSS <br />CITY <br />Ell <br />PHONE STATE LICENSE <br />PLUMBING CONTRACTIXI MAIL ALUM CITY :IP PHONE STATE MINIM 0 <br />CONTRACT PRCE Of TAORK LL_[/T <br />.A G, V rD{� <br />R6E W01M AND SOUARE FOOTAGE( VCIVEO <br />InSA LM�wh1N nat l8¢ <br />SI�1GLc-510�N- <br />CONTACT PERSON AMID PIICNE NO <br />— <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br />APPLICATION AND KNOW THE SAME TO BE TAU- AND CORRECT. ALL <br />PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br />WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br />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 LOC AL LAW REGULATING CONSTRUCTION OR THE <br />PERFORMANCE OF CONSTRUCTION. THAT I OM AUTHORIZED BY THE <br />OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br />APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />CONTRACTORS LAW 18.27 RCW AND 296.200 WAC <br />PROPOSED USE OF BUKDING <br />LEGAL DESCRIPTION OF PROPERTY(SAIMN ULM OR ATTACH TµO COPIES( <br />Lot BLOCK OT - <br />PARCEL IA. 1 D NUMBER <br />6CN1IRUCICAt UNDER. ADDRESS. IELEPHgIENLMBER <br />PROJECT ADDRESS <br />1 �'�� A <br />E rT <br />CHI C5W A,41 Ntt NJ <br />PLUMBING <br />NO. TYPE OF FIXTURE OR ITEM FEE <br />MECHANICAI. <br />NO. TYPE OF EQUIPMENT FEE <br />WATER CLOSET (TOILET) <br />NC-AR:NDLG UNITS-H.P <br />BATHTUB <br />FORCED A;R SYSTEMS-B T.U. M E.A: <br />LAVATORY (WASH BASIN) <br />UNIT HEATERS -BTU. M <br />SHOWER <br />CLOTHES DRYERS <br />KITCHEN SINK A DISP <br />VENTILATION FAN <br />DISHWASHER <br />RANGE HOOD <br />LAUNDRY TRAY <br />CLOTHES WASHER �' fn►`ryIL.V�j <br />URINAL II � <br />DRINKING FOUNTAU O,,N �'�' <br />FLOOR DRAIN � l �I-I•/ � e <br />BACKFLOW PREVEE <br />ROOF DRAINS-RAI 'rrN E <br />Sit 'K(SERVICE-BA <br />, <br />WATER HEATER <br />WOOD STOVE <br />METAL FIREPLACE (WOOL) BURNING) <br />FIREPLACE INSERT <br />HEAT PUMP <br />GAS PIPING <br />EXHAUST FAN <br />SUB TOTAL $ <br />SUB TOTAL $ <br />PERMIT S <br />PERMIT $ <br />TOTALFEE S <br />/ TOTAL FEE E <br />_ <br />run urrwc vac <br />FRONTSETBACK <br />v,Yc,- <br />ILA" SETBACK <br />SIDE UTBM:K <br />PIAX CHECK N BCE <br />'/ <br />RECEIv1 N0 <br />"J/IA" <br />r,l 7 PCp <br />USE xONE J <br />I AREA <br />VACANT SITE <br />FEESVALUATION <br />F <br />BUILDING <br />✓ SU <br />'�a <br />.r. -- <br />❑YES O <br />iNIBTMI <br />NO OF STORIES <br />m,P+MY AM OPMURucTs <br />PLUMBING <br />SREOFBLDG <br />FIRE SPRINKLERS FULD <br />BASEMENT <br />MECHANICAL <br />CI YES ❑ NO <br />OCCUPANCY LOAD <br />HREAURMREOD <br />HECNT 11MOAYC, <br />ADDITIONAL PLAN CHECK <br />OTHER <br />IL <br />REASON <br />STATE BUILDING SURCHARGE <br />- <br />INTAKE BY <br />APPROVED BY CITY OF EVERM <br />PUBLIC WORKSLOCAL <br />SALES <br />FFANS <br />ATE y /j� TAX CODE IS 3105 <br />TOTAL <br />