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APPLICATIQ`` FOR CONSTRUCT'`�N PERMIT � <br /> TO BE COMPLETED IN BLACK INK—PLEASE PRINT <br /> HEATING SYSTEM: J GAS .ic�ECTRIC J <br /> BUILDING DEPARTMENT <br /> 259-8810 <br /> ' 1 DEMOLITION ; COMBINATION '/�UILDING I 7 MECHANICAL ❑PLUMBING SIGN <br /> �MARADDAI-E55 �1 GTY ZIP PNONE <br /> OWNER . � U�s('y. �V�� �;1''/Q�\. �-�. ��.�kf- Wh agzo3 7i�i�'��.'�d <br /> TENPNT IdAiLADDPE55 CITV ZIP PNONE <br /> qRCHITEGT OF OESIGNEF MAII ADDFE55 CITV ZiP FMONE <br /> u ;n„ o ,- ZNI& Cn���r. �a. P.�e. E,,�..e�{.Wh qinZel ZSz�l�o <br /> GENERA�CTOF MRIL DFE55 GTV ZiP PMONE STATE LICENSE� <br /> W�\4�C.A,.,s���- 3 3�- 3 i o�, <br /> MECNPNIGALCONTRRCTOR MPILAD�RESS CITY ZiP PNONE ST/1EUCENS[� <br /> No� <br /> I'WMBINGCONTPALTOF� MAILA�DRESS dTY ZIP PNONE STATELICENSE♦ <br /> �./DNe <br /> CONTRAGT PRICE OF WOAK <br /> � 3� 5vo C�s� > <br /> LONT T P[RSON AN�PHO E N0. 1 O <br /> DESCFIDE W(�RK I.ND SOUARE F00.`AGE INVOIVED �'�.t�o-�+� G ��S M / ��— b9 <br /> .n„y� a.�.,.d� �UVGu4aa� (U� �8�- S�l(a <br /> I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br /> vaoPosEo usE oF oui�oirvc . � APPLICATION AND NNOW THE SAME TO BE TRUE AND CORRECT.ALl <br /> , �� � ����, c � ,.i... PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br /> LEGRLD�E[S.�CRIPiIONOFPROPERttISNOWNBELO i�?�n�t.t�an� �or`�iEe�� NOT THELGRANTOING OF AD ERMITyDO SENOT PRIESUME TO GIOVE <br /> �pi�-- BLOCN OF —�=-5 t+���-- AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br /> OTHER SiATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br /> PERFORMANCE OF CONSTRUCTION.THAT I AM AUTHORIZED BV THE <br /> OWNER OF THIS PROPERTV TO PERFORM THE WORK FOR WHICH <br /> APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> Paacei tnz i,o rvuMeea CONTRACTORS LAW 18.27 RCW AND 296200 WAC. <br /> ���1/2 -�fr, -�,i� qs 3 �������i � <br /> WNSTRUCTqION L1O`A,N LE1NDERn.A�ORE55.TELEPHONt rvumeER ,11 � Z(. / ����9C' <br /> �1 Y�V�{�.Y � '1-. O� NW O�tF <br /> S�Gn�luaf <br /> PROJECT ADDRESS q �� <br /> crtv oosv+t ss uc�vs�.rvo <br /> ���� S'1�� �� S MECHANICAL <br /> PLUMBING FEE <br /> NO. TVPE OF FIXTURE OR ITEM FEE NO. TYP[OF EOUIPMENT <br /> WATER CLOSET(TOILET) A/C—A'HNDLG UNITS—H.P. _ <br /> FORCED AIR SYSTEMS—B.T.U. M E.A. <br /> BATHTUB ' <br /> LAVATORY(WASH BASIN) UNIT HEATERS—B.T.U. M � <br /> CLOTHES DRYERS <br /> SHOWEF ' <br /> KITCHEN SINK 8 DISP VENTILATION FAN <br /> DISHWASHER RANGE HOOD <br /> WATER HEATER <br /> LAUNDRY TRAV ydppD STOVE <br /> CLOTHES WASHER , � <br /> - METAL FIREPLACE(WOOD BURNING) <br /> URINAL ' <br /> DRINKING FOUNTAIN FIREPLACE INSERT <br /> HEAT PUMF' <br /> FLOOR DfiAIN GAS PIPING � <br /> BACKFLOW PREVENTERS � EXHAUSTFAN <br /> ROOF DRAINS—RAINLEADERS <br /> SINK(SERVICE—BAR.ETC.) <br /> i <br /> SUB TOTAL $ <br /> SUB TOTAL 5 pERM1T S <br /> PERMIT � TOTALFEE $ �— <br /> — TOTALFEE S � <br /> FOR OFFICE USE ONLY: S MOI� ��7er=�o�s F"� �I��u ��Z'�u Ul;�- 199� a . <br /> PLINCMECKNU BER FEE _ RECEIPTNO. <br /> PRONT SLiB�CK / P[PR SEi�K / SI�E SEiBALN / ! L r�/.� ./;....' ��� �/`�— <br /> � / Y <br /> WE ZON[ LOT AREA VACANT SITE <br /> FEES VALUATION FEE <br /> � YES . ' N� BUILDING Z�C� I / � � � <br /> iVPEOlGON51 NOAFSTOFIES usc�Rstr ii0muwui^6vin5 <br /> ��` PLUMBING ' <br /> 2 �' i <br /> SIZEOFO FIRESPRINKLERSPEO'D �ASEMENt MECNANICAL <br /> ��� � rvau + i ves ✓� // 2 i /Z <br /> 4Z� 5F �RA � �J HEiGriTUMIrATiONf ADDITIONALPLANCHECK <br /> OGGIIPANCVLOAD FIRE�LAPMRE00 �J � <br /> p �j OTHEF �T— <br /> �EA�� STATE BUILDING SURCHARGE <br /> L ' - <br /> i <br /> INTAH[AY �L�NS AP F V[�BY CITY OF EVEREIT PUBLIC WORK$ � <br /> LOCAL SALES <br /> onte <br /> � �4, TAx CODE IS 31D5 TOTAL <br />