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�1PPLICATIO' ` FOR CONSTRUCTf"�N PERMIT' <br /> TO BE COMPLETED IN BLACK INK—PLEASE PRINT � <br /> .��r <br /> BUILDING DEPARTMENT HEATING SYSTEM: ❑GAS ❑ELECTRIC ❑ �j <br /> 259-8810 — I <br /> f 7 DEMOLITION f-1 COMBINATION (7 BUILDING i:J MECHANICAL <br /> WNER MAI�AODRE55 ❑PLUMBING � SIGN <br /> CITY ZIP PHONE <br /> w � .�'f1,ca'1,Q�c �3/Y�'cx,�Et��< < .4�� FvF�- <br /> *ENnNr MnanooaEss F�(✓� ���0/ <br /> CITV ZIP �PHONE ��� '/, �� <br /> ARGHRECTORDESIGNER MPILADDRESS <br /> CRV plP PHONE <br /> GENERALCONTPACTOR MqILADDRE55 <br /> ��Tv Z�P PHONE <br /> STAT��ICENSE a <br /> MEC NICAL CONTRACTOq MAIL ADORESS <br /> CITY 21P PNONE <br /> ((�/�/ �4��� �� ' ,]��� STATE LIGENSE n <br /> PLUMBING CONTRACTOR �� <br /> MqIL ADDRE55 GITV <br /> Z�P PNONE STATE LICENSE a <br /> CONTRACT PRICE OF WORK <br /> DESCRIBE WORK AND SOUARE POOfqGE INVOLVED <br /> CONT TPERSpNANDPHON O. <br /> � � a-�- = -v,�AGC_ <br /> o-o .. � e _ �S -/ �� GJ. 3;'� -c�?/3 <br /> PROPOSFDUSEOFBU�DING � HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br /> S ;�/L_ APPIICATION AND KNOW 7HE SAME TO BE TRUE AND CORRECT.ALL <br /> LEGFLDESCRIPTIONOFPqOPERTV(SNOWNBELOWORqTTApNTN'OCOPIES� PROVISIONS OF LAWS AND ORDINANCES GnVERNING THIS TYPE OF <br /> WORK WILL BE COMPLETED WITH WHETH:R "�PE�IfIED HEREIN OR <br /> ��T atocK _ pF _ NOT. THE GRANTING OF A PERMIT DOEF 4�i PRES:IME TO GIVE <br /> AUTHORITY TO VIOLATE OR CANCEL i�iE HROVISIONS OF ANY <br /> OTHER STATE OR LOCAL LAW REGULAT,� � ,^,ONSTRUCTION OR THE <br /> PERFORMANCE OF CONSTRUCTION. iHAI I AM AUTHORIZ[D BY TH[ <br /> �___ OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br /> PARCELiAXID.NUMBER APPLICATION IS MADE AND I COMPLY WITH THF STAT[ <br /> CONTRACTORS LAW 18.27 RCW AND 296.200 WAC. <br /> CONSTRUCTION IOAN LENDER,ADDRESS,TELEPNONE NUMBF', <br /> PROJECTADDRESS � 1 iYf��s� ��� <br /> C . LLb� �/ �/���E'IT �' o.re - <br /> PWMBING y�'ZG� ar.eusmrssuccrvscr+o - <br /> N0. MECHANICAL <br /> TYPE OF FD(TURE OR ITEM FEE N0. TYPE OF EOUIPMENT <br /> WATER CLOSET(TOILE'f) FEE <br /> BATHTUB ' A/C—NHNDLG UNITS—H.P. <br /> � FORCED AIR SYSTEMS—B.T.U. M E.A. <br /> LAVATORY(WqSH BASIN) UNIT HEATERS—B.T.U. M <br /> SHOWER ' CLOTHES DRYERS � <br /> KITCHEN SINK 8 DISP ' VENTILATION FAN , <br /> DISHWASHER � <br /> LAUNDRY TRAY � RANGE HOOD <br /> CLOTHES WASHER ' WATER HEATER , <br /> URINAL WOOD STOVE �O � <br /> DRINKING FOUNTAIN � METAL FIREPLACE(WOOD BURNING) <br /> � FIREPLACE INSERT <br /> FLOOR DRAIN HEAT PUMP <br /> BACKFLOW PREVENTERS GAS PIPING � <br /> ROOF DRAINS—RAINLEADERS EXHAUST FAN � <br /> _ SWK(SERVICE—BAR,ETC.) � <br /> � <br /> I <br /> � <br /> T— <br /> SUB TOTAL S ' SUB TOTAL § <br /> PERMIT $ � PERMIT $ — <br /> TOTAL FEE $ TOTAL FEE $ —�— <br /> FOR OFFICE USE ONLY: � <br /> FRONT SETBFCK qEA(i SETBACK SIGE SETOqCK <br /> PLANCHECKNUhIBER FEE iiECEIPTNO. <br /> USEIONE LOTAPEA VpCANTSITE <br /> FEES VALUATION FEE <br /> . '' YES �! NO BUILDING <br /> iVPEOfCONST NOAFSTORIES OccuC/,vcr xoorwR¢i4;u4rt5 ' <br /> G900P � <br /> PLUMBING � <br /> SIZE OF ALDG. FIPE SPRINNIERS REO'D 8A5[MENT � <br /> '� YES .^ NO MECHANICAL i <br /> . OCCOPANCVLOAO FlqEn�n�vq�o�� Heicr+ruuirqnON ADDITIONALPLANCHECK � <br /> ' REFSON OTHER � <br /> i <br /> STATE BUILDING SURCHARGE <br /> INTAKEBY PLANSAPPROVEUBV CITYOFEVEREIT ' <br /> LOCAL SALES PUBLIC WORKS � <br /> oare TAX CODE IS 3105 rora� <br />