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APPLICATIC'1 FOR CONSTRUCT�N PERMIT � <br /> TO BE COMPLETED IN 13LACK INK—PLEASE PRINT <br /> HEATING SYSTEM: U GAS ❑ELECTRIC ❑ <br /> BUILDING DEPARTMENT <br /> 259-8810 <br /> ❑ DEMOlIT10N ❑ COMBINATION I�BUILDING ❑MECHANICAL ❑PLUMBING ❑ SIGN <br /> OWNER �' MRILADORE55 ���� CI_TY _ ZiP�� PNONE� —��� <br /> 6AI�N'1 � rlYa�l IDIS� Iw c��DIK.'�6 �l 3� <br /> TEtUNT M�ILADDRE55 CITV 21P PNONE <br /> SqM� <br /> ARCHITECiORDE51CiNER MAILADDPESS CITY 21P P�E <br /> GENERALCONTA� MAIL/�UDFESS CITV ZIP PMONE SUtELICENSE� <br /> nwktn <br /> MEGHANIC�L��{I TBACTOR M�IL�DDRESS CITV ZIP PMONE ST�IELIGENSE� <br /> ,l/� <br /> � PLUAIBINGCON ACTOR M�ILADDRESS dTY ZIP PHONE STATELILENSE� <br /> CONTAIICT PR OF WORK � `, . <br /> � w�i� <br /> OESCRRE WONK AND SOIUME FOOT�GE INVOLVEO CONTACT PERSON AND PNONE N0. <br /> ,. �• N..��"�' - <br /> � i HEREBY CERTIFV THAT I HAVE READ AND EXAMINED THIS <br /> VPOPOSED USE OF BIIILDiNG APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT.ALL <br /> � PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br /> LEGAL�DE�SC�PIP,T.IO�N,,OFPROPERTY.��5�11�0WNBE�OWOHATT1ACt�H.TWOACOPIES) WORK WILL BE COMPLETED WITH WHETHEfl SPEGfIED HEREIN OR � <br /> � �or `�' -i"'�' oixK�L— � ��t�'1 /LDD1T�ON NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br /> 1 � AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br /> 1-�7 OTHER STATE Ofl LOCAL LAW REGULATING CONSTRUCTION OR THE <br /> � �,p� PERFORMANCE OF CONSTRUCTION.THAT I AM AUTHORIZED BY THE <br /> � �OZS �l.(J(J-, OWNER OF THIS PROPERTV TO PERFJRM THE WORK FOR WHICH <br /> . � � Z pPPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> ! P�RCEI TAX I.O.NUMBER CONTFACTORS LAW 18.27 RCW AND 296200 WAC. <br /> i GOHSTPUCTION LOAN LENDER,MDRESS,TE.EPNONE NUMBER I�M/� ��]J�/�1 • foJlbl93 <br /> � lI ��_ Wr 4r1[R'l. o..e <br /> � P110JECTADDRESB SAMI� Af A'�vv� s��"�- <br /> LIiV BUSMESS LILENSE NO <br /> � ���� MECMANICAI <br /> Np. 7rpE Of FlI(TURE OR ITEM FEE NO. TIPE OF EOUIPMENT �E <br /> � WATER CLOSET(TOILEn N�NHNDIG UNITS—H.P. � <br /> BATHTUB FORCEO AIR SYSTEM�B.T.U. M E.A. ' <br /> LAVATORY(WASH BASIN) UNIT HEATER�B.T.U. M � <br /> � SHOWER � CLOTHES DRYERS <br /> KITCHEN SINK 6 DISP � ; VENTILATION FAN � <br /> � RANGEHOOD <br /> LAU DRYTERAY ; WATERHEATER � <br /> CIOTHES WASHER � WOOD STOVE � <br /> � METAL FIREPLACE(WOOD BURNING) <br /> DRINK NCa FOUNTAIN FIREPLACE INSERT � <br /> fL00R DRAIN � HEAT PUMP � <br /> BACKFLOW PREVENTERS ; GAS PIPING � <br /> ROOF DRAINS—RAINLEADERS � EXHAUST FAN ' <br /> SINK(SERVICE--BAR,ETC.) � � <br /> � i <br /> SUBTOTAL $ ' SUBTOTAL 5 ' <br /> PERMIT $ PERMIT S � <br /> TOTAL FEE $ TOTALFEE $ ' <br /> FOR OFFlCE USE ONLY: <br /> RECEIPT NO. <br /> °RONTSES9ACK RE�RSETB�CN SIDESETBACK PLANGHEC���� FEE <br /> �1SE20NE LOTAHEA VRCANTSITE FEES VALUATION FEE <br /> ❑ YES ❑ NO BUILDING \ Co 3 '�v <br /> lYPEOFCONSi. NOAFSTORIES oCCUvextv NOaoxnUxGUniiS � <br /> EKIST,�s G9�P ( PLUMBING ' <br /> SIZEOFBIOG� FIRESPRINKLERSREO'D BASEMENT MECHANICAL � <br /> i �� � ❑ res ❑ No ; <br /> qDDIT10NAL PLAN CHECK � <br /> OCCUPANLVLO�D FIREAURMPEO'0 HEIGHTLIMITRTION � <br /> � O OTHER � <br /> RE�SON i� <br /> STATE BUILDING SURCHARGE <br /> INTAKE BY PIAN�IA��D BY CITY OF EVEREIT NUBLIC WORKS ��— <br /> LOC11L SALES —r <br /> DATE� � L�' <br /> TAX CODE IS 3105 ror�� � ;50 <br />