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APPLICATI�1 FOR CONSTRUC7''�N PERMIT � <br />�,\ TO BE COMPLETED IN BLACK INK—PLEASE PRINT <br />,.� <br />� <br />HEATING SYSTEM: ❑ GAS ❑ ELECTRIC ❑ <br />BUILDING DEPARTMENT <br />259-8810 <br />; DEMOLITION f] COMBINATION XBUILDIN�, � i MECHANICAL L 1 PLUMBING f] SIGN <br />J�d:C? MFILADDFE55 pTV ZiP PMONE <br />%1 _ _ �nL...__ �Sna t�..Y..:alls.r G✓v+tf� <br />MAIL ADORE55 <br />CITV ZIP <br />ARGHITECT OF DESIGNER MAIL A�DRESS CITV ZIP PNONE <br />GENERRLGONTRAGTOR MARADDPESS CITV ZIP PHONE <br />MEGHANICALCONTRRCTOR MAILA�DRESS <br />PLUMBING CONiRACTOR MRIL ADDPE55 <br />CONTRACT GPRICE OF WORK <br />D �� <br />DESLRIBE WONK AND SOUARE FQ'JTRGE INVOWED <br />Pf70PO5ED IISE OF BUILDING <br />�� <br />LEGAL DESCflIPT10N OF PROPERTV ISHOWN BELOW OF ATTNCH <br />LOT �'�r � BLOCN � �F ��� <br />PARCELTAXID NUMBER <br />t�� i -Sb 3-oz9 -a <br />COhSTRUCTION IOAN LENDER. AODRE55, <br />TYPE OF fll <br />WATER CLOSET (TC <br />BATHTUB <br />LAVATORY(WASH B <br />SHOWER <br />KITCHEN SINK 8 Di: <br />DISHWASHER <br />LAUNDRYTRAY <br />CLOTHES WASHER <br />URINAL <br />DRINKING FOUNTAI <br />FLOOR DRAIN <br />ROOF <br />FG9 �FFICE USE ONLY: �j <br />FflONTSETBACN FEARSEiBACK <br />TYCE OF GON51.. I <br />�— N <br />S12E OF BLLG. <br />lOOi Sf + <br />OCCUPANCYLOAD <br />flEASON <br />INTAKE BY <br />GITV ZIP <br />..� <br />S�' X 1 � O <br />�qE NUMBER <br />ITEM PEE <br />� <br />� <br />SUB TOTAL $ � <br />PERMIT $ � <br />TOTAL FEE $ <br />�KoK�- P.`�tc'c-ro�s <br />SIOE SETBAGN <br />Z�p PHONE <br />CONTFCi PER W N ANO PNONE NO. <br />STATE LICENSE t <br />STATE UCENSE � <br />I HEREBV CERTIFY T'�AT I HAVE PEAD ANU EXAMINED THIS <br />APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPF OF <br />WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br />NOT. THE GRANTING OF A PERMIT DOES NOT PFESUME TO GIVE <br />AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br />OTHER STATE OR LOCAL LAW REGULATING CONSTAUCTION OR THE <br />PERFORMANCE O� CONSTRUCTION. THAT 1 AM 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 1827 RCW AND 296200 WAC. <br />�i�..� L-�� o,�/���3 <br />SCN E <br />LiTY9USMESSIiCENS[ NO <br />TYPE OF EQUIPMENT <br />A/C—A/HNDLG UNITS—H.P. <br />FORCED AIR SYSTEMS—B.T.U. M <br />UNIT HEATERS—B.T.U. M <br />CLOTHES ORYERS <br />VENTILATION FAN <br />RANGEHOOD <br />WATER HEATER <br />WOOD STOVE <br />METAL FIREPLACE (WOOD BURNIN( <br />FIREPLACE INSEAT <br />HEAT PUMP <br />SUB TOTAL� <br />PERMIT $ <br />TOTALFEE $ <br />j210 Up� 2='P'n <br />PLAN CHE K NUMBEF // D RECaE�PT NO. <br />/�7� %/� FE'7�i(l�i / � / <br />lOT RREA VACANT SITE rcca <br />i L YES ���� BUIL�ING <br />NOAPS70FIE5 acuoexcv xoo�bN[LuuGUNrts <br />n69ny,° PLUMBING <br />( F'I � <br />PIFESPRINKLEFSPEOD BASEMENT ��� MECHANICAL <br />N� �"'� YES _✓NU <br />FwE nlnnM REo�o NEjijGN�T�{u/jMIiAT10N , ADDITIONAL PLAN CHECK <br />/�/J ry(,��_� OTHER <br />STATE BUILDING SURCHARGE <br />PLANS APPRO�EO BV I CITY OF EVEREIT PUBLIC WORKS <br />J N LOCAL SALES <br />onre � �/�ti �A3 TAX COUE IS 3105 rorn� _ <br />YX <br />E <br />