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APPLICATIO� FOR CONSTRUCTI�N PERMIT <br /> TO BE COMPLETED IN BLACK INK—PLEASE PRINT � <br /> V—"" <br /> BUILDING DEPARTMENT HEATING SYSTEM: ❑GAS ❑ELECTRIC ❑ —� ` <br /> 259-881� <br /> DEMOLITION COMBINATION BUILDING MECHANICAL � PLUMBING SIGN <br /> OWNER MAILADDRESS CITY ZIP PMONE <br /> 141a Pr� ?4��,YYI u n t4�9 e fi Q���e aJC� �,,, �z7 ZT-.z� <br /> TENA� MAIUUDRESS CITV ZIP PHONE <br /> ARCHITECTOR DESIGNER Mpl�p009E55 CITV LP PHONE <br /> I/��'n �� <br /> GENERRLCONTRACTOR MqI�A00RES5 CITY ZIP PHONE ST EUCENSE� <br /> ������1S�1a3�� �� ��r�c5 �1.� 4fi'2Ss 33�-ys3i7 l� ' lol,�.11 <br /> MEGNANIC�L LONTRALTOR MqIL RDORESS pTV ZIP PNONE —� STATE LICENSE� <br /> PLUMBINGGONTq�GTOR MRILA�ORESS CITV ZIP PNONE STRTELIGENSE• <br /> CU55OF WORK <br /> � I I NEW � ' ADDITION I I ALTERATION x REPAIR DEMOLITION WOODSTOVE/FRPL INSERT ' ! BUILDING RELOCATION <br /> � CON7ACT PEFSON FNO PNONE NO <br /> CONTRACT PRICE OF WORK � <br /> UESCNIBE W N A�N�SO�,C��R['F�'T�GE INVOLVE� <br /> �bt�� ►��ctA � -�Ca ( ^,p - i�, 5 <br /> PROPOSEDUSEOFBUILUING i HEREBY CERTIFY THAT I HAVE READ AND E%AMINED THIS <br /> APPLICATION AND KNOW THE SAME TO BE TRUE AND CORREC7.ALL <br /> IEGRL0E5CRIPTIONOFPROPEFTYISMOWNBELJWORATIRCMFWRGOPIE51 PROVISIONSOFLAWSANDCRDINANCESGOV6RNINGTHISTYPEOF <br /> WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br /> , ior eiocK oF 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 BY THE <br /> OWNER OF THIS PFOPERTY TO PERFORM THE WORK FOR WHICH <br /> APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> � CONTRACTORS LAW 1827 RCW AND 296.200 WAC. <br /> X �.lhD i����9� <br /> PRQ1ECi RDDPE55 ciGe�iunc ��rE <br /> ��v ✓—�„'v� CirvausirvrssucEns[Hc <br /> �. PLUMBIN(i MECHANICAL <br /> � N0. riPE OF FlXTURE OR ITEM FEE NO. TYPE OF EOUIPMENT FEE <br /> ' WATER CLOSET(TOILET) P✓C—A/HNDLG UNITS—F P. <br /> �� BATHTUB FORCED AIR SYSTEMS—B.T.U. M E.A. <br /> � LAVATORV(WASH BASIN) UNIT HEATERS—B.T.U. M <br /> r SHOWEF CLOTHES ORYERS , <br /> IC�TCHEN fiINK 8 DISP VENTILATION FAN <br /> , DISHWASHER RANGEHOOD � <br /> , LAUNDRVTRAY WATER HEATER <br /> � CLOTHES WASHER WOODSTOVE <br /> � _ URINAL METAL FIREPLACE 8 CHIMNEY —T— <br /> ORINKING FOUNTAIN FIREPLACE INSERT � <br /> FLOOR DRAIN HEAT PUMP <br /> BACKFLOW PREVENTERS GAS PIPING <br /> ' ROOF DRAINS--RAINLEADERS EXHAUST FAN <br /> � SINK(SERVICE—BAR.ETC.) <br /> SUB TOTAL $ SUB TOTAL $ <br /> PEFMIT $ i PERMIT $ <br /> � TOTAL FEE $ TOTAL FEE g <br /> FOR OFFICE USE ONLY: <br /> FRONTSETBACN REAPSETBr1CK SIDESE79ACK PLANCNECNNUMOEfl FEE RECHPTNO. <br /> .�s y�� <br /> use zoNe ior naea vncnNr srce FEES VALUATION FEE <br /> dUILDING / � � <br /> TYPEOfCONTS ALIUWAPIE TYPEOfCONSi.ACiUAI crcUveutv x0 O�ow[wNGUNnS <br /> enouP � PLUMBING i <br /> SIZEOFALDG. NOAFSi0F1E5 BASEMEtIT MECHANICAL � <br /> OCCOPANCY LOFD FIRE SPRNKLERS REO'D NEI�MT LIlAIiAT10N ADDITIONAL PLAN CHECK � <br /> i <br /> SPRINHLER ' <br /> RERSON POIISPRINNLERS <br /> STATE�UILDING uURCHAqGE � 'SO <br /> iNrnKeev vinNsnar�oveoov CI7YOFEVERETf PUBLICWORKS <br /> LOCAL SALES <br /> TAX CODE IS 3105 TOTRL <br /> 3 � SD <br />