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APPLICATIO►^ FOR CONSTR�RCTI `N PERMIT � <br /> TO BE COMPLETED IN ALACK INK—PLEASE PRINT <br /> �HEATING SYSTEM: U GAS ❑ELECTRIC ❑__ <br /> BUILDING DEPARTMENT <br /> 259-8810 <br /> � • DEMOLITION �OMBINATION BUILDING MECHANICAL PLUMBING SIGN <br /> OWNER M�IL�D�RESS CITY ZiP PMONE <br /> TvosvlG Rv�f. /� '�-° Si�✓tr L�1C� {�d_ L��•.��fi aBLag 2fSS- `foS3 <br /> TE��y I MRILAODRESS CITV 21P PNONE / L rt�3 s� 5'� — <br /> ^_� \ ` <br /> ARCHITECTORDESIGNER MAILA�DFESS CITY ZIP PMONE <br /> F I I 2�6 II fr{!' fl�� �.•.J. tve,.cf-(- � Q 2.a� 1'f z' �122 <br /> ENERALCONTRAGT �i�E . GUF(�C ^ O ITY 21P PNDNE STATEUCENSE• <br /> i <br /> Fo� �3��� flw� <br /> - HANICALGONTRACTOR MAIIADDRE55 CRV ZIP PNONE STATCIICENSE• <br /> PLUMBINGCOHTRRCTOR MRILA�DRESS dTY 21P PIIONE SiATEUCENSf• <br /> ClA55UF WJRK <br /> Y� NEW . '� ADDITION � ' ALTERATION K REPAIR DEMOLITION . WOODSTOVEIFRPL INSERT K BUILDING RELOCATION <br /> - q p� G NTRCT P[R N AND P1109E NO <br /> CJ'JiPA�Ti'RICEOFWORK J� �� � � . �YOSV'1 � SS' YO sj <br /> �E£�R�BE WJ{IK AND SOUARE FOOTAGE INVOIVED � 1 / 7' � ( y 0 S �i � Z�� p / Z� <br /> ( � Otx1�0^��' �'h � <br /> �e�4-Y 1i 1 <br /> PROPOSEDUSEOFBUILDING i HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br /> } N C•V G a�•-�e Z Y X 2Y APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT.ALL <br /> LEGALDESGRIPTIONOFP OP fl (SNOWNBEIOWOFATTACHFDURC aiesl PROVISIONSOFLAWSANDORDIIJANCESGOVERNINGTHISTYPEOF <br /> n WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br /> ioT u a. ' 3 oF NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br /> J�� AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANV <br /> hj---7�-y����{`� OTHER STATE OR LOCAL LAW FEGULATING CONSTRUCTION OR THE <br /> I PERFORA4ANCE UF CONSTRUCTION.THAT I AM AUTHORIZED BY THE <br /> vC f G St W � S 1� OWNER OF THI.S PROPERTY TO PERFOFiM THE WORK FOR WHICH <br /> APPLICATION IS MADE AND I COh1PLY WITH THE STATE <br /> CON�RS LAW 18.27 RCW AND 296200 WAC. <br /> /1// 7 _ �d�i / / <br /> . '`.L ' ����C� ,�9�^r.c.� /� / z.t� `1'Z- <br /> � X <br /> PROJECTADDAE55 Sit.Nnruut � � 9�� 5 Darz <br /> �_-_ f,11VpU$MESSLKENSENO <br /> PLUMBING c MECNANICAL _ <br /> NO. TVPE OF FIXTURE OR ITEM FEE Nn. TYPE OF EQUIPMENT FEE <br /> WATER CIOSET(TOILET) � !UC—A�HNDLG UNITS—H.P. <br /> BATHTUB FORCED AIR SYSTEMS—B.T.U. M E.A. <br /> I.AVATORY(WASH BASIN) � UNIT HEATERS—B.T.U. M � <br /> '�T <br /> SHOWER CLOTHESDRYERS <br /> KITCHEN SINK 8 DISP I VENTILATION FAN <br /> DISHWASf�ER RANGE HOOD <br /> LAUNDRY TRAV WATER HEATER _ <br /> CLOTHES WASHER _ WOOD STOVE _ <br /> URINAL METAL FIREPLAC[8 CHIMNEY _ ' _ <br /> DRINKING FOUNTAIN FIREPLACE INSERT <br /> FLOOR DNAIN HEAT PUMP <br /> BACKFLOW PFEVENTERS ; GAS PIPING _ <br /> ROOF DRAINS—RAINLEADERS EXH4U5T FAN <br /> SINK(SERVICF-5AR,FTC.) � <br /> SUBTOTAL $ SUBTOTAL 5 <br /> PERMIT 5 PERMIT 5 <br /> TOTALFEE $ TOTALFEE 5 �_ <br /> FOR OFFICE USE ONLV. � ,3� GS�'�'�' �� � c � �''�� <br /> FRONTSEiFAGN REARSETBPCK SIpE5E1BAGK PLANCNECKYC40[P - FEE R[GEIPTNO — <br /> , Zp ` '�� �� /29 /S 30d� <br /> USEZONE IOTARER VACANTSITE FEES VALUATION FEE <br /> (2.- 'Zl� BUILOING �ZZ 99 � <br /> TVPE Ot COH75.AIIOWABLE TVPE Oi[Oq51.ACIUAL O:anaytr va 0�o-nnuxG urns ' <br /> °O�''03 I PLUMBING <br /> ���� ' <br /> SIZEOFOIOG NOAFSTORIES BASEMENT MECNANICAL <br /> 1253 S.F FJ�I } I �J <br /> OCCUPANCVL040 FIHESPRNNLERJREJO NEIGHT�IMITATION ADDIiIONALPLANCHECK <br /> iU�/ NO SPRINIQER � <br /> REA�OR SPRINNLERS <br /> STATE 9UILDING SURCHARGE _�� <br /> MTAKEBY ?'.ANSAPPROVEDBV CITYOFEVEREIT PUBLICWORNS �Ji <br /> J� LOCAL SALES � � <br /> ��I/�Z TAX CODE IS 3105 TOTAL � Z / , <br />