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' APPLiCAT10C^FOR CONSTRUCTIC�N PERMIT <br /> , TO BE COMPLETED IN BLACK INK—PLEASE PRINT � <br /> HEATING SYSTEM: GAS ❑ELECTRIC ❑ <br /> BUILDING DEPARTMENT <br /> 259-8810 <br /> ❑ DEMOLITION ❑ COh7BINATION f�BUILDING ❑MECHANICAL ❑ PLUMBING ❑ SIGN <br /> OWNEfl MAIL.ODDRESS CIN ZIP PHONE <br /> �m.�, r.� hrra-.C.. /S�/0 �!�icf�s"',�v �. . �� 9�'c'1C%7 Cr�'-�- �3 '�-� <br /> TENANT U MAILADDflE55 CIN ZIP , PNONE <br /> ARcC..H_ITECTORDESIGNER MAILADORESS CITY 21P PHONE <br /> Or��N,�- Cc�S �Gsn-a-�^ <br /> G�+ERALCONTRACTOR MAILADDRE55 CITV ZIP PYONE STATELICENSEI <br /> dZ�nr.a a-S Gv�� c'otcNr�.;�iv rx,T <br /> MECHMlICALCONTRRCTOR MAILADDRE55 CITV ZIP PIONE STATELICENSE• <br /> PLUM9IRG CONTflACTOR MAIL ADDNE55 CITY ZIP FHONE STATE LICENSE M <br /> CONTRACT PR'CE OF WORK <br /> DESCRIBE W4RK AND SOUARE F TAGE INVOLV D Cg0�!�CT PERSON AND PHONEN Q � <br /> �!i..) �Dryl��'YL(1�07'i ���� �) � //LL-s�-�� -� LL�/'[Gti.E-' 'y[ ' �7 <br /> i HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br /> P OPOSED USE OF BUILDING APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT.ALL <br /> ��� ,���,��y �����.L (�, PAOVISIONS OF LAWS AND OFDINANCES GOVERNING THIS TYPE OF <br /> LE�dESCRIPTIONOFPRO (SHOWNBELOWOP TTACHTYlOCOPIES� WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br /> �P����'�� NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br /> �or� e�ocK oF AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br /> • ��� �' OTHEfi STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br /> PERFORh1ANCE OF CONSTRUCTION.THAT I AM AUTHORIZED BY THE <br /> P q�I /�'�� ��L�_ APPLICATIONISISRMAD ANOPE COMP Y WIT�HKT ER STATE <br /> P CEL TAX I.D.NUMBER —. CONTRACTORS LAW 1827 RCW AND 296200 WAC. <br /> ��,�-vcx�- v �pv-�aao <br /> CONSTRUCTION LOAN LENDER.ADDRE55.TELEPHONE NUMBEP ^ —� � /��L� 2 � <br /> � ., � � ' �/ �.�: � <br /> , Tw`. .' o�te <br /> � PROJECT ADDRESS SIGNATMEO �1 ��L'�/. <br /> 1�/ n °7 8 303 "� "� <br /> � �� � VE W I/(.-`� LT'BJSiNESSLICEN5EN0. �� , <br /> � PLUMBING ' MECHANICAL <br /> ��. N0. TYPE OF FIXTURE OR ITEM FEE N0. �C—A/HNDLG NFTS—H.p ENT <br /> FEE <br /> WATER CLOSET(TOILET) � , <br /> BATHTUB ; FORCED AIR SYSTEMS—B.T.U. M E.A. . �� <br /> LAVATORY(WASH BASIN) � UNIT HEATERS—B.i.U. M � �����F� <br /> SHOWER ' CLOTHES DRYERS � � <br /> � � KITCHEN SINK 8 DISP ; VENTILATION FAN � � <br /> , ', <br /> �� � DISHWASHER � I RANGE HOOD <br /> � � ( WATER HEATER � � <br /> LAUNDRY T�AY ' - „�" <br /> � CLOTHES WASHER � WOOD STOVE ' � � '�� -� �� <br /> � � METAL FIREPLACE(WOOD BURNING) ' . .. <br /> � URINAL � FIREPLACE INSERT � � <br /> �RINKING FOUNTAIN , HEAT PUMP � <br /> FLOOR DRAIN GAS PIPING ' <br /> BACKFLOW PREVENTERS � ' , <br /> ROOF DRAINS—RAINLEADERS � EXNAUST FAN — <br /> � SINK(SERVICE—BAR,ETC.) � _ � <br /> i <br /> i <br /> � SUB TOTAL $ � , <br /> SUB TOTAL $ � � <br /> PERMIT $ � PERMIT S ' . <br /> TOTALFEE $ ' TOTALFEE $ ' <br /> FOR OFFICE USE ONLY: RECEIP No. <br /> FRONTSETBAj REARSETBAC�� � ,DESETBAOK PLANCHE��I� FEE ^ ^I <br /> �r N � �� FEE <br /> �� IOTAAEA VACANTSITE FEES VALUATION <br /> USEZONE <br /> � c� ✓Z ❑ YES ❑ N� BUILDING Z 3� O� <br /> �� 7 <br /> TYPEOFCONST. NO.OFSTO�IIES octuvehtv xo.ovov�u�xcuxrt5 � �J � <br /> � GFOUP PLUMBING � <br /> _„/ 2-3 <br /> 512 OFBLDG. FIBESPflINNLEPSREO'0 BASEMENT MECHANICAL �D � <br /> 3�"3� Sf 't' � ❑ YES �NO � <br /> 2 pDDITIONAL PLAN CHECK ' <br /> OCCUPANCV LOAD FNE ALARM RE�'D HEIGHT IIMITATION/ �h� <br /> A J _ OTHER � <br /> i <br /> p��N STATE BUILDING SURCHARGE ' <br /> IMAKEBY PlANSAPP OVF�DB� CITYOFEVEREIT PUBLICWORNS �i✓ ' <br /> %� LOCALSALES � 8'C� <br /> DA7E <br /> 3 8�c�c�,c TAX CODE IS 3105 TOTAL � <br />