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APPLICATIC 1 FOR CONSTRUCT"�1N PERMIT � <br /> TO BE COMPLETED IN BLACK INK—PLEASE PRINT <br /> HEATING SYSTEM: �GAS ,�ELECTRIC U <br /> BUILDING DEPARTMENT <br /> 259-8810 <br /> I DEMOLITION f i COMBINATION BUILDING �MECHANICAL PLUMBING 1 SIGN <br /> OIYNER IdAILApDRE55 QiY ZIP PNONE <br /> Qi .� .�r-�sE ,s�o �/.Ez.� .P.o�ED.e Cv�ec-rr 9frao.3 �.�i-!oz?'f.�'� <br /> TENANi IdAIIADDRE55 CITY ZiP PHONE <br /> ARCHIiECTOR�E5IGNER IA/ILADDFE55 LITY ZiP PHONE <br /> GENERRL CONTRACTOR MAIL ADDRE55 QTV ZIP PHONE STFtE UCENSE� <br /> MECHANICALCONTRALIOR MPILA�DRE55 CITY ZiP�n�j� P��ONE SiATELiCENSE� <br /> Q <br /> r.��.� .�/�T..✓ i9�.�i �yna /�vELJ ,Lv.✓�✓•✓000 ��y-X.�iS S�r7iL-HA077.Ti� <br /> FWMHINGC�NTRACiOR MRRA�DR[SS CITV ZIP PHDNE STATEIICENSE� <br /> LONtRAL�iF IC�EOi'\Y`ORK^' <br /> 7 ' V � V <br /> p[SCRi EYlJFKANp50UAHEF00TAGEINVOWEO CONTAGTPER50Y FNOt1EN0 <br /> �,95 FURN c �oc3 �' �.e- <br /> — 3 iS <br /> i HEREBV CEFTIFY THAT I HAVE REA� AND EKAMWED THIS <br /> PaoaoseouseoFew�ort+c APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT.ALL <br /> PPOVISIONS OF LAWS AND ORDINANC�S GOVERNING THIS TYPE OF <br /> �e�n�oescaianor+oFvacrEarvlsNnwNoe�owoaniTncnnvocories WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br /> NOT. THE GRANTING OF F PERMIT DOES NOT PRESUME TO GIVE <br /> �ot etocK oF AUTHORITV TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br /> OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br /> PEFlFORAIANCE OF CONSTRUCTION.THAT 1 AM AUT40R12ED BY THE <br /> OWNER OF THIS PROPERTY TO PERFORh1 THE WORK FOR WHICH <br /> APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> rnRce�tnz i o.r+uueen CONTRACTORS LAW 1827 RC ND 296200 WAC. <br /> —� — 00 — � — � <br /> �GNSTRUCTIONLOANLENO[R.40�RESS.TEIEPHONENUMBER <br /> /a- 7 � � 9' -3 <br /> S�GNAIUPE ����E <br /> PROJECTADDRESS �Ja7/e>/ _ _ <br /> �ab �EtJ � t�! —�R aivous�Hcssucv,���o <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM FEE NO. TYPE Of EOUIPMENT FEE <br /> WATER CLOSET(TOILET) A�C—A�HNDLG UNITS—H.P. <br /> BATHTUB FURCED AIR SYST[MS—B.T.U.� -.A. <br /> LAVATORY(WASH BASIN) UNIT HEATERS—B.T.U. M <br /> SHOWER CLOTHES DRY[RS ' <br /> KITCHEN SINK 8 DISP VENTILATION FAN <br /> DISHWASHER RANGE HOGD <br /> LAUNDRY TRAY WATER HEATER _�_. <br /> CLOTHES WASHER � WOOD STOVE <br /> URINAL METAL FIREPLACE 1WOOD BURNINGI <br /> ORINKING FOL'NTAIN FIREPLACE INSERT <br /> FLOOR DR�IN HEAT PUMF <br /> BACKFLOW PREVENTEHS -GAS PIPINfi <br /> ROOF DRAINS—RAINLEADERS EXHAUST FAN <br /> SINK(SERVICE—BAR,ETC.) — <br /> SUB TO?AL 5 SUB TOT�L S 3� ' <br /> PERMIT S PERMIT 5 /.7 � <br /> 1�OTAL FEE 5 TOTAL FEE 5 ) <br /> FOR OFFICE USE ONLY: <br /> FRONTSET9ACn R[ARSLTB�CK SIOESETBALK Plr1NCH[CNNUMBER FEE RECFiPiNO <br /> use zor+e �or aaea VRGANT SITE FEES `/ALUATION FEE <br /> �� YES ��� NO BUILDING 1 ' <br /> �— <br /> '��'E aF CON57. NOAF STORIES �.cu�=/vc x0 0�ov::.r•.;..'.�5 <br /> G900° PLUM914G <br /> il-OFALDG FIRESPAINKLEFSR[00 BRS[MENT �,�ECHANICAL <br /> — YES "�. NO — � — <br /> , <br /> ocCUPnNCYIOno FwEn.AFMREOo HEiGHTUMItnnoN A�DITIONALFLANCHECK <br /> OTHEfl <br /> --�— <br /> R[n50N <br /> STATE BUILDING SURCHARGE <br /> iNTAk[pv PUNSAPPRWED BY GITY OF EVEREiT PU�LIC WOFKS <br /> LOCAL SALES <br /> o4;F, TAX CODE IS 3105 TOTAL <br />