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APPLICATIQ^: FOR CONSTF�UCT: )N PERMIT � <br />TO BE COMPLETED IN BLACK INK--PLEASE PRINT <br />�EATING SYSTEM: ❑ GAS ❑ ELECTRIC ❑ I <br />BUILDING DEPARTMENT <br />259•8810 ' pLUMBING L ] SIGN <br />J�--DE _ LITION i7 COMBINATION , 1� BUILDING I', MECHANICAL �� <br />r�rone �y <br />OWNER 1/ MAILADDRES�`'�'�� ✓v ��T�, �`G'� ZS �% s J�=S <br />u �N .V_. � �L� £L{iLf� �" PHONE —. <br />��'�� GITY 21P <br />TEN�N7 MRILADDRE55 <br />OH DESIGNER MFIL <br />:1�� <br />MPIL <br />CONiRAGT FRICC OP WORK <br />DESCRIBE WORK PNO SOUARE FOOTAGE INVOLVEO <br />PROPOSEDUSEOFOUnILDING / <br />�/�i <br />LEGRL �ESGRIPTION OF PROPEfiTV (SNOYM BELOW OR �TTACII TWO COPIE^�1 <br />l0T BLWK —�- OF <br />PRRCELTR%ID.NUMBEP <br />CONETFUGTIOH IOAN LENDER, <br />SINK 8 DISP <br />HER <br />'THAY <br />DRINh f <br />FLOOP <br />BACK� <br />R001= I <br />SWM: (: <br />TOTAL S <br />�11T 5 <br />1L FEE $ <br />FOR OFFICE USE ONLY: _ <br />FRONT SETORCN REPR $ETBACN <br />USE2011E LOTAREA <br />1VPE OF CON57 NO OF STORIES <br />SIZ[ OF BLDG. FlRE SPRINKlERS REO'0 <br />PLANS <br />DRiE <br />CITV ZIP <br />cm Z'� <br />CITY ZiP <br />CITV Z�P <br />FEE <br />PHONE <br />PHONE <br />CONTPCT PEFSON AND PHONE NO <br />SiATE LIGENSE � <br />STRTE LICENSE t <br />51ATE LIClNSE � <br />I HEREBY CEiiTIFY THAT I HAVE READ AND EXAMINED THIS <br />APPLICATION AND KNOW THE SAME TO BE TRUE ANG COFRECT. ALL <br />PROVISIONS OF LAWS AND ORDINANCES GOVEFNING THIS NPE 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 FiEGULATING CONSTRUCTION OR THE <br />PERFORMANCE OF C7NSTRUCTION. TIiAT I AM AUTHORIZED BY THE <br />OWNER OF THIS PROPERTY TO PERFCRM THE WORK FOR WHICH <br />APPLICATION IS MADE AND I C061PLV WITH THE STATE <br />CONTRACTORS lA\N 1627 RCW AND 29620�1 WAC. <br />i ��� n�' L �/ <br />" — <br />o.n <br />sicHerun[ _ __ <br />AIR SYSTEMS—B.T.U. M E.A. <br />�TERS—B.T.U. M <br />� WATER HEAIt <br />WOOD STOVE <br />� METAL FIREPL <br />FIREPLACE IN; <br />HEAT PU�1P <br />' GAS PIPING <br />EXHAUSTFAN <br />iIDE5ET0ACN PLRNGHtC1trvUM6cn <br />vacnNi sre FEES <br />�_—i YES i :� NO BUILDING <br />ucwu:a ua awrtuiuccvns <br />�^�'�° PLUMBWG <br />BaSEUENi MECHANIC��. <br />f i YES ' 1 NO �— <br />HEIGHT LIMiTqiION ADDITIONAL PLAN CHECK <br />OTMER <br />SiPTE DUILDING SURCHARGE <br />CITY OF EVEREiT auau;, woaKs <br />LOCAL SALES <br />TAX COUE IS 3105 TOiAL <br />SUB TOTAL S <br />PERMIT 5 <br />