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APPLICATIC"'1 FOR CONSTRUCT�IN PERMIT � <br />TO BE COMPLETED IN BLACK INK—PLEASE PRINT <br />I HEATING SYSTEM: ❑ GAS /"Sb ELECTRIC O � <br />BUILDING DEPARTMENT {,� <br />259-8810 <br />IJ DEMOLITION I_1 COINBINATION k'BUILDING I I IuIECHANICAL A''PLUMBING (; SIGN <br />OYMER MAiLApDRE55 C�iY 2'P PHONE <br />;.��...� /...'�i�,_ �.. / f1z�[� !: l�C: r//a.n.ej;r 'J�? �//ir% <br />iFNRNT <br />L,L�� <br />GITY ].IP / <br />RRLNITECTORDESIGNEF MAI'.Ap09E55 ��TV ZIP PNONE � J"J�. /^�,�+� <br />/ / <br />S•✓o/Io '^( !' i Ti �v'�> //i17 J�.Tt�i�✓ •.'•C �i.�,..�ii JPLO� <br />�ERAI CONTRRCTpR M ADDRE55 CITV 21P � PHONE STATE LIGENSE � <br />l_�'c �%, �e-��,5�oc,��a7��ii <br />MEGMFNIGALCONiRAGWF MAIIADORESS CITV ZIP PNONE ✓ STATELIC[NSEY <br />MAIL ADDNE55 <br />DES RiB� N RND SOUnRE FOOT G NVO <br />,SNG . Sa^ �., ��: i i n/ <br />� / i <br />/.iC�/!" �mn . _ /�.7.!7� �//� <br />// <br />euaow� <br />CIiV ZIP PHONE STATELICENSE� <br />�/J r i .7- /� " �/-�i <br />IEGRL OESCRIPTION OF PROPEFTV ISMOWN BELOW OR ATTRCH TVJO COPIES) <br />iorl.2 /J /4 a�xnC�_ oF Y- o_ <br />�ot.vo// �f�'J�;/ �f`� � % O7'� <br />G.��3 i� ��> /% <'�. s S- �'v 7�7" <br />S'S � .J � <br />� PRRGELTR%ID.NUMBER <br />.� c�! i." O(J 3�- o% %- G ci% 5. <br />CONSTRUCTIONLOANLENDEP.,AODHESS.TELEPMONENUMB[R <br />- �a3y S 3' <br />BIM6 <br />TYPE OF FlXTURE OR f <br />WATtR CLOSET (TOILET) <br />BATHTUB <br />LAVATORY (WASH BASIN) <br />SHOWER <br />KITCHEN SINK 8 DISP _ <br />DISHWASHER <br />LAUNDRY TRAY <br />CLOTHES WASHER <br />URINAL <br />DRINKING FOUNTAIN <br />FLOOR DRAIN <br />BACKFLOW PREVENTERS <br />ROOF DRAINS--RAINLEADERS <br />SUBTOTAL <br />PERMIT <br />TOTALFEE <br />FOR OFFICE USE ONLY: <br />FFONTSE7BRCN REARSET94CK <br />�' ��- <br />USEZONE LOTAREA/��� <br />'2 a• <br />TYM OF CONST NO OF S10RIES <br />SRE OF BLDG. FlRE S�RINNI.E35 REO'D <br />OC.:UPANLY LOAL <br />NA <br />REASON <br />AINNM FEO'D <br />SIDE SETBAC� <br />5 <br />VAGANi SiT[ � <br />''-� YES �i✓NO <br />ocwv.nrv � voo�nw;�urcuxns <br />BASEMENi � <br />�,'-. YFS ;�NO <br />N[IGHT LIMITRTION <br />n o � <br />INTRKEBY PI.ANSAPP,ROVEDBY CITYOFEVERE7T <br />��' LOCAL SALES <br />DATE �h�/A? tAX CODE IS 3105 <br />I HEREBV CERTIFV THAT I HAVE READ AND E%AMINED THIS <br />APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS 1VPE OF <br />WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br />NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br />AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br />OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br />PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BV 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 18.27 RCW AND 296200 WAC. <br />x`���'q.na-om�•*--� a %o'7f'3 <br />s���„��� � o.,E <br />Ciiv B04NE55 UC[ NS[ NO _ <br />TYPE Qf EOUIPMENT <br />40LG UNITS—H.P. <br />AIR SYSTEMS—B.T.U. M <br />SERS—B.T.U. M <br />iDRYERS <br />"IUN FAN <br />WATER HEATEFi <br />WOODSTOVE <br />METAL FIREPLACE 1 <br />F'REPLACE INSERT <br />HEAT PUMP <br />GAS PIPIMG <br />EXHAUSTFAN <br />SUBTOTAL $ /h <br />PE aMIT 5 <br />TOTALFEE 5 <br />NpMBER FEE RELEIPTNO. <br />'l� 3 a /�`�--' /U J� 3 S <br />BUILDING <br />PLUMBING <br />MECHANICAL _ <br />ADDITIONAL PLAN CHECK <br />OTHER <br />STAT[ BUILDING SUFCHARGE <br />PU�LIC WOf9N5 <br />TOTAL <br />