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C <br /> APPLICATIO^ ROR CONSTRUCT�N PERMIT � <br /> TO BE COMPLETED IN BLACK INK—PLEASE PRINT <br /> HEATING SYSTEM• ❑GAS ❑ELECTRIC ❑ <br /> BUILDING DEPARTMENT — <br /> 259-881C <br /> ❑ DEMOLITION ❑ COMBINATION � BUILDING p`AECHANICAL $PLUMBING ❑ SIGN <br /> py/NER M�IIADDRE55 CITY ZIP PIIONE <br /> �'s�c.��,.`�.[`��-��u�1m�l.iy' P--� l3��x 3�� -�re11 9 8 � 0 3 3 3 7- 7 �s s <br /> lElWYT IM0.MONE55 CITY ZIP PIqNE <br /> " • � a <br /> ARLHITE q10ESI0NEfl /MIL/�DDflE ,CITY ZIP PIqNE <br /> 9 . � <br /> ' �` �Y <br /> OENE CONTMCTOR EUIL/�WPESS CITY ZIF PHONE A1ElICENBE� <br /> Y � �P p�E / ST�TELICENSE/ <br /> yE�wW CON{p�CTq1 AIMLMDNE55 CITV <br /> � R � <br /> Y <br /> � ���nE� CI ZIP PlIONE ST�TEIICF.NSE1 <br /> s� ( 9� <br /> T PIiICE N� <br /> pEg�qIBE�ypil(MID Sq1NiE T�OE INVOLVED CONTACT PERSON AND PHONE NO. <br /> r <br /> . <br /> , f V i HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br /> ROPOSED USE OF BU0.DING APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT.ALL <br /> � PROVISIONS OF LAWS AND ORDINANCES GOVERNINQ THIS TYPE OF <br /> � a�upEscni4ipHpFPROPERtt�SNOMMBELOWORATT�CHTWOC ies� WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br /> P �'w� � NOT. THE GRANTING OF A PERM�T DOES NOT PRESUME TO GIVE <br /> �4�— e�ocK � � AUTHORITY TO VIOLATE OR CANCEL TME PROVISIONS OF ANY <br /> OTHER STATE OR LOCAL UW REOULATING CONSTRUCTION OR THE <br /> PERFORMANCE OF CONSTRUCTION.THAT I AM AUTHORIZED BY THE <br /> OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br /> o � APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> . P�RCEL TAX 1.0.NUMBER CONTRACTORS LAW 1827 RCW AND 296200 WAO. <br /> ' ' CON9Tpl1C7pXLOANLENDEH.ADDRE55.TELEPHONENUMBER �J' <br /> 5�01U1 w� <br /> nnaecr o ��, � 1 <br /> CiT'&ISME55 LiCEMSE MD <br /> . ��s� MECHANICAL <br /> Hp, TYPE OF FlkTURE OR ITEM FEE �' aC—aHNDLG NF E�OU•IPAAENT <br /> FEE <br /> WATER ClOSET(TOILET) ' <br /> BATMTUB ' FORCEDAIRSYSTEMS—B.T.U. M E.A. ' <br /> UVATORY(WASH BASIN) � UNIT HEATERS—B.T.U. M � <br /> SHOWER CLOTHES DRYERS ' <br /> KITCHEN SINK 8 DISP ; VENTILATION FAN � <br /> � DISHWASHER i RANGE HOOD � <br /> LAUNDRY TRAY , WATER HEATER � <br /> CLOTHES WASHER � WOOD STOVE ' <br /> � METAL FIREPLACE(WOOD BURNING) ' <br /> URINAL ' <br /> DRINKING FOUNTAIN FIREPLACE INSERT <br /> FLOOR DRAIN HEAT PUMP � <br /> BACKFIOW PREVENTERS ; GAS PIPING ' <br /> ROOF DRAINS—RAINLEADERS � EXHAUST FAN ' <br /> SINK(SERVICE—BAR,ETC.) � <br /> � <br /> � � <br /> � <br /> i <br /> SUB TOTAL S ' SUB TOTAL S ' <br /> � PERMIT S � <br /> TO AL FEE S ' TOTAL FEE S ' <br /> FOR OFFICE USE ONLY: pECEiPTr+o. <br /> PUNCMELKNUMBER FEE <br /> FRONTSETBACK � PEARSETB�CK SIDESE�TBACK O� � �� <br /> USE 20NE�7 <br /> �� LOT AR� � V�CANT s re FEES VALUA710N FEE ' <br /> y ` � �YES C1 NO BUILDING gG U � �� <br /> t�= 1 i <br /> ���T. Np.OF570RIES ocwvucr xaorowFiuNGuxits � <br /> �^ ' ' PLUMBING ' <br /> �N �- K 3 -i � <br /> p� FIRESPPINKlER5RE0'D BASEM MECHANICAL � � <br /> Iqd3��""r" YES ❑ NO � <br /> :� S�F A� ADOITIONpIPUNCHECK ' <br /> OCCUP/�NCYLWD FIREAURMREQD MEIGHTLIMITATION i <br /> i <br /> �� OTHER <br /> RE�SON S7ATE BUILDING SURCHARGE '�/L� <br /> n ; <br /> INTAKE BV PLANS APPRQVED BY g�TY 0F EVEREIT PUBLIC WORKS � �r <br /> �j�" LOCALSALES 1 <br /> ,�' TAX CODE IS 3105 ror�� � � 2� <br /> o�re �Z��•1 �IJ <br />