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�. <br /> APPLICATIO.� FOR CON�TRUC'TI.iN PERMIT � <br /> TO BE COMFLETED IN BLACK INK—PLtASE PRINT <br /> HEATING SYSTEM: GAS 0 ELECTRIC ❑_ <br /> BUILDING DEPARTMENT <br /> 259•8810 . <br /> ❑ DEMOLITION ❑ COt�fiBINATION 'BUILDING ❑MECHANICAL ❑ PLUMBING C] 31GN <br /> CWNER MAILADDRESS GTY ZIP PHO�tE � -�,7J�. <br /> �'7.��r�Yttiat?r�;� �i.c._�,S /�/D �,ecGCi2��`'�jo~�.vr...rZ� ��19 98'007 _ - <br /> TENAN' � � MAILADDRESS CIT\' ZIP PHONE <br /> ARCHITECTOflDE51GNEfl MRILAODRE55 CITY ZIP PHONE <br /> ��V '�'� _ <br /> GENERALCONTRr1CTOR MAILAODRESS CITY ZIP PHONE STATELICENSEP <br />� �rtiu �.s �nu.- �owNr�aion��r <br /> MECNnNICAL CONTflACTOR MAILADOflE55 CRV ZIP PHONE STATE UCENSE Y <br /> PLUMBINGCONiRACTOR MAILADDRE55 CITV ZIP PNONE STATELICENSEP <br /> CONTRACT PRICE OF WCRK <br /> NC��Wn�_ 5_O�IARE�FlW�TA.rGEI�N�WEO C.rw,7Ql„r�jPE5gp�1��{ ao� ��49• fIlS�' <br /> (� �Y �VIY! G h/ J✓ <br /> V11 P <br /> . I HEREBY CERTIFY THAT I HAVE READ AND EXAMINEO THIS <br /> � PRCPOSEDUSEO�PWLDING APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT.ALL ' <br /> ^� ��� � �'� PROVISIONS OF LAWS AND OfiDINANCES GOVERNING THIS TYPE OF <br /> IEGAL SCRIPTIONOFPqOPf (SHOWNBELOWORATTACXTYJOGOPIES) WOAK WILL BE COMPLF.TED WITH WHETHER SPECIFIED HEREIN OR <br /> �oT �' e�.f,RC,—'�;;;—,,,,,,///��� ��/� o�F �,,/�'�'`�� �/ NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br /> r77��.�s-S � � V•+Z AUTHORITY T'J VIOLATE OR CANCEL THE PROVISIONS OF ANY <br /> OTHER STATE OR�OCAL LAW REGULATING CONSTRUCTION OR THE <br /> �n,^ ��C �, Z�� PERFORMANCE OF CONSTRUCTION.THAT I AM AUTHORIZED BY THE <br /> •N � J OWNER OF THIS PFiOPERTY TO PERFORM THE WORK FOR WHICH <br /> APPLICA'fION IS MADE AND I COMPI.Y WITH THE STATE <br /> PARCEL TRX I.O.NUMBER � CONTRACTORS LAW 18.27 RCW AND 296.200 WAC. <br /> 8135-v�-G ��0000 <br /> GONSTRUCTIONLOAN�ENDER,O.DORE55 TELEPHONENUMOER <br /> /''Q ` /�y./�y�.y��� ■�/�} /Jl �j�/// 1{��I1{/�� {�((� 4 24 ��� 9�- <br /> F30JECT ADDRESS `� Sq1uT <br /> Tf 1'i/ /�UI�1 Il�(� �� �V.i��j�' IVI1 • QU�� CIIYBOSINESSLICENSENO. <br /> � PLUMBING MECHANICAL <br /> N0. � TYPE OF FIX7URE OR ITEM FEE N0. TYPE OF E�UIPMENT FEE <br /> ' J7 WATER CLOSET(T011�l) � A/�!v'HNDLG UNITS—H.P. ' � . <br /> Z BATHTUB � ; FORCED AIR SYSTEMS—B.T.U. M E.A. � <br /> � LAVATORY(WASH BASIN) � UNIT HEATERS—B.T.U. M <br /> .I SHOWER � CLOTHES DRYERS � <br /> ' � I � KITCHEN SINK 8 DISP ; � VENTILATION FAN ; <br /> ( GISHWASHER � RANGE HOOD <br />� LAUNDRYTRAY ; WATER HEATER <br /> CLOTHES 4.:.SHER � PJOOD STOVE I <br /> - URINAL ; METAL FIREPLACE(WOOD BURNING) <br /> DRINKING 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 /> � , <br /> � � <br />� — � � <br /> � � <br /> � SUB TOTAL $ -; SUB TOTAL S ; — <br />� PERMIT $ � PERMIT $ � <br /> TOTAI FEE $ ; TOTAL FEE $ � <br /> FOR OFFICE USE ONLY: <br /> FRONTSETBACK REARSETBACK SICSSETBACK / PWJCHECKNUMBEfl FEE RECEIPTNJ. <br /> ZS� 2� � 7 5 `J"`1 � l'� %Cl.i.`� <br /> Uc=jONE c LOTAREA VA,C�A�NTSITE FEES VALU�TION FEE <br /> i �j 1 1 YJ YES ❑ NO DUILDING /LZZ 47 / ' <br /> TYPEOFLONSi. NO.OFSTdRIES ottUPu�tY x0.0iDwFLIiHGuxnS � <br /> . 2 �°� I PLUM21NG �Q� <br /> i <br /> SI E OF B�DG FIqE SPpINKLERS REO'0 BASEMENT MECHANICAL � ��} i —_ <br />, U51 sF 'Y <br /> ,��SF � /U ❑ YES NO ._�-LS.L_ . <br /> OLCUPANLYLOAO FIREALAqMPEO'D HEIGHTLIMITqTION ADDITIONALPLANCHECK --i. <br /> �'� '7 � , OTHER � <br /> REASON <br /> STATE BUILDING SUFCHARGE L �� <br /> INTAKEBY PIAN'aqP�OVEOBY CITYOFEVEREIT PUBLIGWORK$ 2� � <br /> LOCALSALES <br /> DATE /9 St TAX CODE IS 31�5 TOTAI /J/ �./O <br />