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APPLICATI( J FOR CONSTRUCT 3N PERMIT <br />TO BE COMPLETED IN BLACK INK —PLEASE PRINT <br />*$:77- <br />HEATINGSYSTEM. J GAS `..ELECTRIC ❑ —� <br />BUILDING DEPARTMENT = <br />259-8810 <br />DEMOLITION COMBINATION k BUILDING MECHANICAL PLUMBING SIGN <br />OWNER <br />MAILADDRESS CITY ZIP PHONE <br />V�VI �.1M1�{7 273I u.J�'ftil"y.'vC? <br />TENANT MAIL ADDRESS CITY ZIP PHONE <br />Q/T4t <br />ARCHITECT OR DESIGNER <br />MAR ADDRESS CITY ZIP <br />�, <br />PHONE <br />GENERAL CONTRACTOR <br />IXx- cry <br />MAIL ADDRESS <br />fo Puy ItyeT <br />CITY ZIP <br />teke;e. 9 > <br />PHONE STATE LICENSE <br />&C)i Rfboo <br />MECHANICAL CONTRACTOR <br />gcL y K�, <br />MAIL ADDRESS <br />PDP�c+c GR_2t7P, <br />CITY ZIP <br />96� <br />PHONE STATE LICENSE It <br />2413-giuo +Io LA-TAP-13 <br />PLUMBING <br />CyyO.NN.��TRACT}ORS <br />CITY ZIP <br />PHONE STATE LICENSE I <br />� <br />k-OI .LS.Ie-RT(YIL <br />�MAIL ,ADDRESS <br />_ <br />CLASS OF V/ORK <br />NEW ADOITION <br />�J <br />I ALTERATION <br />REPAIR DEMOLITION WOODSTOVE/FRPL INSERT BUILDING RELOCATION <br />_ <br />CONTRACT PRIC OF OI:K <br />CONTALC PERSO1yN�A_NyO P�H-�ON�E NO.•� �{yt" L F{}���r 1 1' 1 1 T� <br />DESCRIBE WORK AND SOUARE FOOTAGE INVOLVED <br />--- T <br />-eb <br />`J�aSMIG ✓FADE <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br />FRoaoseDUSEOFBUILDING '� <br />lu g ILr a <br />APPLICATION AND KNOW THE SA AE TO BE TRUE AND CORRECT. ALL <br />PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br />LEGAL DESCRIPTION OF PROPERTY lsHowry BELowoflarrncH OUR coPIESI <br />�p <br />WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br />LOT BLOCK BLOCK lr�% — OF 1GYr <br />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 AU. HORIZED BY THE <br />L,) <br />OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br />A PLICATION IS M DE AND I COMPLY WITH THE STATE <br />C NTRACTORS LAW 18. 7 RCW AND 296.200 WAC, <br />E GAt_a.? <br />C-'' 3 -- <br />PRG <br />BID .,NHL D.,t o23TZS <br />La <br />-_ <br />CITY BUSINESS I ICENSE ND - <br />PLUMBING <br />MECHANICAL <br />NO. <br />TYPE OF FIXTURE OR ITEM <br />FEE <br />NO. <br />TYPE OF EQUIPMENT <br />FEE <br />WATER CLOSET (TOILET) <br />I <br />A/C —A HNDLG UNITS—H.P. <br />I <br />BATHTUB <br />FORCED AIR SYSTEMS—B.T.U. M E.A. <br />LAVATORY (WASH BASIN) <br />I <br />UNIT HEATERS—B.T.U. M <br />_ <br />SHOWER <br />CLOTHES DRYERS <br />' <br />KITCHEN SINK 8 DISP <br />VENTILATION FAN <br />' <br />--� <br />_ <br />DISHWASHER <br />' <br />RANGE HOOD <br />_ <br />LAUNDRY TRAY <br />WATER HEATER <br />' <br />CLOTHES WASHER <br />I <br />WOOD STOVE <br />URINAL <br />METAL FIREPLACE & CHIMNEY <br />_ <br />DRINKING FOUNTAIN <br />i <br />FIREPLACE INSERT <br />FLOOR DRAIN <br />' <br />HEAT PUMP <br />BACKFLOW PREVENT ERS <br />; <br />GAS PIPING <br />OF DRAINS—RAINLEADERS <br />EXHAUST FAN _ <br />SINK (SERVICE --BAR. ETC.) <br />SUB TOTAL $ <br />SUB T01AL $ <br />' <br />PERMIT $ <br />PI `-'IT $ <br />TOTAL FEE $ <br />T01AL FEE $ <br />' <br />�.... ono 1100 nIJI V. "f /n 4111 e Bd -_)M <br />FRONT SETBACK <br />HEAR SETBACK <br />SIDE SETBACK <br />PLAN CH K NUMBER <br />FFE <br />RECEIPT NO <br />� �ln <br />USE ZONE <br />LOT AREA <br />VACANT SITE <br />FEES <br />VALUATION <br />FEE <br />BUILDING <br />TYPE D•F�CDN`I� <br />TUA <br />,S-ALLOWABLE <br />1L <br />•TT ��L. <br />4 GQ <br />U Z- <br />PLUMBING <br />SIZ FBL <br />NO. OF STORIES <br />BASEMENT <br />MECHANICAL <br />' <br />�. <br />✓ <br />lFi �i <br />ADDITIONAL PLAN CHECK <br />' <br />' <br />OCCUPANCY LOAD FIRE SPRNKLERS REO'DTt HEIGHT LIMITATION <br />1 ��T Yam',/ rt'/I <br />SPRINKLER <br />; <br />REASON FOR SPRINKLERS <br />O�Jr�Aj <br />STATE BUILDING SURCHARGE <br />i <br />INTAKE BY <br />PLANS APPROVED BY <br />CITY OF EVERM <br />PUBLIC WORKS <br />I <br />' <br />LOCAL SALES <br />J�� �. <br />TAX CODE1, 3105 <br />TOTAL <br />