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APPLICATIC 1 FOR CONSTRUCT �N PERMIT � <br />� 1 TO BE COMPLETED IN BLACK INK—PLEASE PRINT <br />� HEATING SYSTEM: ❑ GAS ❑ ELECTRIC ❑ <br />BUILDING DEPARTMENT _ <br />259-6810 <br />DEMOLITION COMBINATION / BUILDING MECHANICAL PLUMBING SIGN <br />O�NTJ•E�R-�. .1 MAILADDPE55 (;ITY ZIP PNONE <br />�1_G NOf�WL�t S„►ra��� �o Eex �oos �„�tt� �ua �8 �` <br />TENANT MML ADDRESS dTV ZIP PHONE <br />_�t,v�w G <br />ARCHITECTORDESIGNER MAILADORESS CITV Zip ounuc <br />_... �.� rnvi�� JINItLI{i[Pl�t• <br />PLUMBMGCONTRpGTOR MAILA�DRESS CITV ZIP PHONE STATELICENSER <br />LLASS OF WORK <br />l I NEW I: ADDITION � qLTERATION <br />CONTPACT PRICE Of V/ORK �,� OD O <br />DESCRIBE WIXiK AND $OURRE TAGE INVO VED <br />r�.,..,t L e„r,��.. a.r• �'�s� <br />PROPOSEO USE OF BUILUIN(�-~�- <br />�7�1<'f. l�OivNt Sr�G:��� <br />�EGAIDESCPIPT N P ERTY�SHOWNBELOWORATTACY <br />t,� f0� �� �f� <br />LOT BLOLK �_ OF ��� <br />� NO. TYPE OF flX <br />WATF.R CLOSET (TOI <br />BATHTUB <br />i LAVATORY (WASH BP <br />� SHOWER <br />� KITCHEN SINK 8 DISI <br />DISHWASHER <br />, LAUNDRVTRAY <br />CLOTHES WASHER <br />URINAL <br />�� _ DRINKING FOUNTAIN <br />� FLOOR DRAIN <br />! BACKFLOW PqEVEN' <br />ROOF DRAINS—RAIN <br />' SINK ISERVICE—BAP <br />SUB TOTAL $ <br />PERMIT $ <br />TOTAL FEE $ <br />FOR OFFICE USE ONLY: <br />fRONTSETBr1CK REARSET9nCK SIDESETBACN <br />'�- l �i'i nl C�- ^- <br />LOTAREA VACANTSITE <br />REPAIR <br />t.... <br />DEMOLITION .� WOODSTOVE/FRPL INSERT i�. BUILDING RELOCATION <br />CONTACT PERSON AND PHONE NO. <br />• ��utl Se� % 7f3•%%e O <br />' i HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br />� APPLICATIOY AND KNOW THE SAME TO BE TRUE AND CORRECT. ALl <br />pPiEs� 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 />AUTHOFITV TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br />N OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br />PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br />OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br />APPIICATION IS MADE AND I COMPLY WITH THE STATE <br />CONTRACTORS LA CW AND 296200 WAC. <br />� N �X�a,�qE s �, I�Z• 5 Z <br />o�rE <br />USE <br />� <br />ALIOWABLE <br />OCCUPANCVLOAO <br />� <br />flE�A�5p0�N FOR SPRI� r <br />1V�1� �i <br />INTAKE BV <br />NO.OF STORIES <br />� <br />FIPE SPRNKLERS REO'D <br />N�f kt 7U+5 <br />71 M� <br />Bv <br />FEE <br />�Q <br />OLGuoqry�y NoapWflllNcuHiiS <br />6A0'JV � <br />BASEMENT <br />�,�j <br />MEIGHT LIMITRTjOt: <br />\� <br />���� <br />CITY OF EVF.RETT <br />LOCALSALES <br />TAX CODE IS 3105 <br />TVPE OF EOUIPMENT <br />A/C—A/HNDLG UNITS—H.P. <br />FORCED AIR SYSTEMS—B.T.U. <br />UNIT HEATERS—B.T.U. M <br />CLOTHES DRYERS <br />VENTILATION FAN � <br />RANGEHOOD <br />WOOD STOVE <br />METAL FIREP CE 8 <br />GAS PIPING <br />EXHAUST F/ <br />PLANCNECK <br />BUILDING <br />PLUMBING <br />MECHANICAL <br />ADDITIONAL PU1N CHECK <br />SPRINKLER <br />STATE BUILDING SURCHARGE <br />PUBUC WORKS <br />TOTAL <br />SUB TOTAL <br />� <br />T' <br />