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�_ �,. <br /> : � � APPLICATI�O�: FOR CONSTRUCTCIN PERIAIT � <br /> . TO BF.COMPLETED IN BLACK INK—PLEASE PRINT <br /> BUILDING D�PAR+'MENT HEATING SYSTEM: �GAS �ELECTRIC f] � <br /> 2S9 8910 <br /> i_ DEMULITION I_1 COMBINATION ,(�BUIIDfNG f_: 'ECHANICAL ❑ PLUMBING [_7 SIGN <br /> OWNEF MAILA��RESS C!TY ZIP PHONE <br /> _C'�-�Z���-nc�-C ��Jic� Px.� �:l iC��'?r_�� i�,�.e�v� �XC�-7 ��-s�-,� 3��3 <br /> iENANi MAIL d[1DflESS CITV ZIP PMONc <br /> ARCHITECTOPDESIGNER MAIL>DDRE55 CITV 21P PHONE � <br /> ��ru ��,5 Ut�n�-,� _ <br /> G(E�NERALCONTii�CTOR MPiLqDDF"�5 CITV ZIP PHONE STA7EUCENSEa <br /> �GGf9qP 2,� C/I.�`72e,l� __ i.'G'GLNiI �1G iN�T <br /> MECHANICALCONTRACTOR h1AILADDRESS CITY ZIP PMONc uTATELICENSEM <br /> I <br /> PWMBINGCONTFACTOfl MAILFD�RESS CITV ZIP PHONE 57'.TELICENSEP <br /> CONTRACT PRICE OF WORN <br /> UESCRIBE WOFK AND SOUARE PlJOTAGE INVOLVED � G�CT PERSON�ND FHONE NO. <br /> lVf c�J <�h:Yy7-GcL���- �i�i7 �Y�.r�Y - � � Z,n.,�G-/ c_L�vrcc�.�� �i"f r1� ��s� <br /> ' — — <br /> __ I HEREBY CERTIFY THAT I HAVE RF.AD AND EXAMINED THIS <br /> P OPOS'E"D�U"SE Oi d�II�DING �/J APPLICATION A�+D KNOW THE SAMF.TO BE TRUE AND CORRECT.ALL <br /> y�14u�Le. ��GL/I[,�Iy /�_G,a-r/�<2 G-2- PROVISIONS OF LAWS AND ORC^�ANCES GOVF.RNING THIS TYPE OF <br /> LEG�SCRIPTIONOFPRO V�SHOWNBELOWORATfACMTWOCOF�ES� WORK WILL BE COMPLFTFC UVITH WHETHER SPECIFIED HEREIN OR <br /> � �T�cL�L.'-l�I1Z! �� NOT. Th'E GRNNTING OF A PERMIT DOES NOT PRESUME TO GIVE <br /> �cr BI.00K oF AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br /> C�� L����{� OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br /> PE'iFORMANCE OF CONSTRUCTION.THAT I AM AUTHORIZED BY THc <br /> � `�!� �7.%.� ��,��G �' �� OWNER OF THIS PROPERTY TO PERFORM THE WCRK FOR WHICH <br /> U APPLICATION IS MADE AND COMPI_Y WITH THE STATE <br /> P /,TJL'7'UG�BEU G'2- OL��C�O --- - CONTHACTORS LAW 1827 R.W ANP 296.200 WAC. <br /> CONSTRUCTIONLOANLENDER.ADDRESS,iELEPHONE NOMBER /'� I/� / ^� j <br /> �( i.'T/-i..s L/L�� Y�L�<�t.Ge_.C_ .�' e�'._J'�r / <br /> � PROJECT ADDRESS SIGNALUFE onre <br /> '7.5`�`'' A " 4✓. E✓er�tf i Y2L� 0���—S:�La _. <br /> ei*v ouswess ucervse Ho <br />. PLUMBING MECHANICAL . <br />� NO. TYPE OF FI%TURE OR ITEM FEE NO. TYPE OF EOUIPMENT FEE <br /> WATER CLOSET(TOILET) A/�A/HNDLG UNITS—H.P. I " i <br /> ,T BATHTUB FORCED AIR SYSTEMS—B.T.U. M E.A. �. <br /> LAVATORY(WASH 6ASIN) � UNIT HEATERS—B.T.U. UI � <br /> � SHOWER ' � CLOTHES DRYERS <br /> � KITCHEN SINK 8 DISP � VENTILATION FAN �_ <br /> DISHWASHER � RANGE HOOD � <br /> LAUNDRYTRAY ; � WATER HEATER ' � <br /> CLOTHES WASHER ^ WOOD STOVE <br /> URINAL ; METAL FIREPLACE(WOOD BURNING) � — <br /> DRINKING FOUNTAIN � FIREPLACE INSERT � I � <br /> FLOOR DRAIN � HEF'°UMP � <br />' BACKFLOW PREVENTERS GAS PIPINU <br /> ROOF�RAINS—RAINLEADERS � f_XHAUST FAN � � <br /> SINK(SERVICE—BAR,ETC.) ; � <br /> ; , <br /> — <br /> , <br /> � � <br /> —�— <br /> SUB TOTAL 5 -"; SUB �'OTAL $ ' I <br /> PERMIT $ PERA4IT $ � �. <br /> TOTALrEE $ TOTALFEE $ � <br /> FOR OFFICE USE ONLY: <br /> FRONTSETB�, •�EARS�TBACK� / SIDESETB,G�K PLAN�ECANU%BER FE� L� RECEIP�� / i <br /> ��, 7 / / <br /> usEzor+e LOTAREA VACANTSITE FEES VALUATION FEE <br /> ��S �� Q i! YES �! NO BUILDING 2Z'� G� � <br /> i — <br /> iYfE OF CONSi. NO.GF STO IE a[uPu:tv uo af ov�ELLmGmins <br /> ,� � �PO�'3 1 FLUMBING _ �L�� <br /> SREOF9LDjF � FIRESPRINKLERSREO'D BASEMENT MECHANICAL G./ <br /> 3� . G� � f! YES �NO - � <br /> OCCUPANCyLOAD FIRE�LFRMREO'G HEIGHiLIMITAiION ADDITIONALPLANCHECK i <br /> �� _�V� f OTHER ___ l� ; <br /> REAS�)N <br /> STATE BUILDING SURCHARGE � �� <br /> INTAKE 9V PLAN54PPROVEO BY CITY OF EYERE7T PUBLIC WOflKS � — <br /> .J/�' L� • �L SALES <br /> oA,e 3 8 �.f TAX GUDE IS 3105 TOTAL � <br />