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APPLICATIQN FOR CONSTRUCT-ION RERMIT � <br /> TO BE ..JMPLETED IN BLACK INK—PLEASE Pk���T <br /> BUILDING DEPARTMENT HEATING SYSTEM: ❑GAS ❑ELECTRIC ❑ � <br /> 259•8810 <br /> I 1 DEMOI ITION O COMBINATION ,J�BUILDING ❑MECHANICAL ❑PLUMBING ❑ SIGN <br /> 0� MAIL AUDRE55 CITY <br /> ZIP pHONE <br /> cQz,�y� H �.f 7L F� .VE 7�/1�,,, �-(.�G <br /> TENAN M41L DORE55 CITY ZIP PMONE <br /> ARCHITF.�TpR1�C5K'iNER M�ILqpDRESS dTY <br /> ZIf` PHONE <br /> ��� <br /> �G AL CONTHnCTOR M�I�ADDRE55 qTY ¢IP PHONE .STATE UCENSE� <br /> �29 P �(�r/xii�e�R�,c� r�o r Z a0 vy' G��r�F�kl 9��0� 33)_ye� � �l�I�J�GL23d'i�3 <br /> MECM�NIGALCOi IR CT� pB MAIIADDRESS CITY IIP PNONE STATELICENSE� <br /> PIUMBINGCONTIACTOR MAIL�DDRESS CITV ZIP PMONE ST�TELIGENSE/ <br /> CONTRALT PRIq OF WORK <br /> � �J�CS!'CJ�; <br /> DESCRIBEWORN,�kDSWnNEF007AGEINVMVED CONTpt,TPER50NAND NENO. <br /> {+Q IC 2 0.t .J.: ti> � �3'7 — `�Z �e_ <br /> f��T •d / — �.a,�,� Sl/NN7zorF <br /> �`— —r— <br /> U���_� I [2 11M 4 C:IJ / �.R• T� i MEHEBY CERTIFY THAT � HAVE READ AND EXAMINED THIS <br /> rnoaose[�us or om�oinc APFLICATION AND KNOW THE SAME 70 BE TRUE AND CORRECT.ALL <br /> J �u ' — � FAOVISIONS OF LAWS AND ORDINANCES GOVERNING THIS NPE OF <br /> LEGRL�ES IPTIU40FVqOPEflTY�SMOWNBELOWOR�TT�CNTWOCOPIES� WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br /> LOT — BLOCK oF NOL THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br /> AIiTHORITY TO VIOLATE OR CANCEL THE PRnVISIONS OF ANY <br /> Ol'HER STATE OR LOCAL LAW REGULATING CONSTRUC7IGN OR THE <br /> Pk:RFORMANCE OF CONSTPUCTION.?HAT I AM AUTHORIZED BY THE <br /> O'NNER OF THIS PROPEF77Y TO PERFORM THE WOPK FOR WHICH <br /> APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> PRRCEL TA%I D.Nlll'OER GONTRACTORS LAW 18.27 RCW AND 296200 WAC. <br /> CONSTRUGTION LO�'1 LENDEA.ADDflESS,TELEPNONE NUM9ER --' r� <br /> �� /� �� ^y3 <br /> PROJECTfDDRF:SS ,/ �Ct a ��p�v� saHa*une oac <br /> /inSJh•� /��%5 7•�V7 � �' cirveuswcssi�cENscxo � <br /> PLUM8IN MECMANICA: <br /> NO. TYPE OF FI7(TURE OR ITEM FEE N0. TYPE OF E�UIPMENT FEE <br /> WATER CLOSET(TOILET) � A/C—A/HNDLG UNITS—H.P. � <br /> BATHTU3 ; FORCED AIR SYSTEMS—B.T.U. M E.A. � <br /> LAVATO!iY(WASH BASIN) UNIT HEATFRS—B.T.U. M ; <br /> SHOWE�1 CLCTHES DRYERS � <br /> KITCHEN SINK 8 DISP VENTILATIO�FAN ; <br /> DISHWASHER � RANGE HOOD � <br /> LAUNDRYTRAY � WqTER HEATEF <br /> CLOTHES WASHER WOODSTOVE � <br /> URINAL ' tdETAL FIREPLACC-(WOOD OURNING) <br /> DPINKINc,FOUNTAIN FIREPLACE INSERT . ; <br /> FLOOR GRAIN HEAT PUMP � <br /> BACKFLGW PREVENTERS ; GAS PIPING <br /> ROOF DRAINS—RAINLEADERS � EXHAUST FAN —�— <br /> SINK(SERVICE—BAR.ETC.) <br /> -- I I <br /> � <br /> SUB TUTAL $ SUB TOTAL $ ' <br /> PERMIT 5 � PERMIT $ <br /> TOTALFEE $ TOTALFEE $ <br /> FOR OFFICE USE ONLY: <br /> FflONTSETBACN REARSETBACN SI�ESETBACe PLANCN NNUMBE FEE RELEIPiNO. <br /> ��� <br /> USE ZONE lOT RRER VACANT SITE FEES VALUATION FEE <br /> ❑ YES ❑ NO BUILDING ;,� ��,�� <br /> iYl'EOiCONSi. i�0AF5TORIES o[cuwun xoaoMllixeuxns —�— <br /> �A�P PLUMBING � <br /> 52E OF DLDG. FlRF SPRINKLERS REOD PASEMENT i <br /> MECHANICAL <br /> ❑ YES ❑ NO — <br /> OGCUPANGVLOAD FIREALARMREO'0 MEIGHTLIMITATION ADDITIONALPLANCHECK <br /> � <br /> O7tiER � <br /> PE�SON <br /> STAT[6UILDING SURCHFRGE L i� <br /> INTANE OY PUNS APPpOVED 0V CITY OF EVEREIT PUBLIC WORKS i <br /> LOCAL SALES , <br /> o�Te TAX CODE IS 3105 TO7AL � <br />