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� <br /> /��� APPLICATIt��I FOR CONSTRUC7 ON PERMIT <br /> TO BE COMPLETED IN BLACK INK—PLEASE PIiINT �rn <br /> BUILDING DEPARTMENT � HEATING SYSTEM: U GAS ELECTRIC ❑ <br /> 259-8810 <br /> CI DEMOLITION � COMBINATION I I BUILDING I ; MECHANICAL Cl PLUMBING Cl SIGN <br /> mOWNER MA ADDRE55 CITY 21P qPHONE C/ � <br /> h<U�BI.0 ��XTI�t{�_�C,'D�_� VEk '(�,.`� ��,� 6 aCSZ��77 <br /> TENANT MAIL AODPES�— CITV /�ZIP PHONE <br /> ARCHITECTORDE IG�R��CMAILADDRES/�O��� � �ITY a '2 � PHON���� � O <br /> �p. o �- ,�'.r�a �'�Q ��'o' A�3 i,�� < 9 <br /> GENERAICANTfl TOR � I AODRESS CI7Y ZIP PHONE STATELICENSE� . <br /> �S o�-FA/L� G `` a " `' <br /> ' MECHANIOALC�TOR MAILADDRESS GTY ZIP PMONE STATELICENSE� <br /> PLUMBINGCONTRACTOR MAILAODRESS CITV 21P PHONE STATELICENSE� I <br /> CLASS OF WORK���,,,rrr c�� <br /> � . C 1 NEW �ADDITION C i ALTERATION � 1 REPA�R i X DEMOLITION I i WOODSTOVEiFRPL INSERT i 1 BUILDhJG REIOCATION � <br /> �oao° .y�� 6 ��e �+ <br /> � CONTACT PERSON AND PHONE NO. <br /> I OpNTMCTPRICEOFWORN � � C V `� . O S CP �6 �� I <br /> � DESCRIBE WORK AND SOUAFE FOOTAGE INV VE !I <br /> � Q'R € R DwM f - ��f ; <br /> . PROPOSED OFBUILDING i HEREBY CERTIFY THAT I HAVE READ AND E%AMINED THIS � <br /> . � � � APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT.ALL � <br /> '� LEGAL OE5CRIPTION OFPFOPERTV(SNOWN BELOW ORATTAQ:FWRCOPIES) PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS 7YPE OF ��, <br /> .} WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREiN OR <br /> �or�(� e�ocK S� Y oF �� �AC��C 3 NOT. THE GRANTING OF A PERMIT DOES NGT PRESUME TO GIVE I <br /> AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br /> ��,C?' C�[� � ��67�� C.-UC�C S7 OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br /> �— � PERFORMANCE OF CONSTRUCTION.THAT I AM AUTHORIZED BY THE <br /> �, G e� OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br /> APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> ���� ^ CONTRACTORS LAW 18.27 RCW AND 296200 WAC. , <br /> : �. X o�—ZS" i <br /> Pfl CTADDRESS /� Sbx� AE o�iE <br /> G (J � CITY9USINESSLICENSENO <br /> PLUA�lBING MECHANICAL <br /> NO. TYPE OF FIl(TUHE OR ITEM FEE N0. TYPE OF EOUIPMENT FEE <br /> WATER CLOSET(TOILET) � A/C--A/HNDLG UNITS—H.P. � � <br /> BATHTUB ; - FORCED AIR SYSTEMS—B.T.U. M E.A. � <br /> ' LAVATORY(WASH BASIN) � UNIT HEATERS—B.T.U. M � <br /> SHOWER ' CLOTHESDRYERS � � <br /> KITCHEN SINK 8 DISP � VENTILATION FAN _T_ <br /> DISHWASHER � RANGE HOOD � <br /> . LAUNDRY TRAY ; WATER HEATER ; <br /> CLOTHES WASHER � WOOD STOVE � <br /> T <br /> � URINAL ' METAL FIREPLACE&CHIM ; <br /> ; DRINKING FOUNTAIN � FIREPLACE INSERT _� <br /> FLOOR DRAIN � HEAT PUMP <br /> � BACKFLOW PREV TERS ; GAS PIPING __� <br /> ROOF DRAIN RAINLEADERS � E%HAUST FAN �_ <br /> SINK(SERV E—BAR,ETC.) ; � <br /> , � <br /> T <br /> 1 � <br /> 1 <br /> 1 � <br /> T <br /> I �- <br /> . SUB TOTAL $ SUB TOTAL $ ' _ <br /> � PERMIT $ � PERMIT $ I <br /> �� TOTAL FEE $ ' TOTAL FEE $ ' <br /> ' FOR OFFICE USE ONLY: et' o.ve ' <br /> FRONTSETB K FEARSETBAGK SIDESETBACK PLANCHECKNUMBER FEE RECEIPTNO. <br /> A�'�A�/ �2 -9 3s7s3 n ��- -f° L 3i77 <br /> USEZONE LOTAFEA VACANTSITE FEES VALUATION FEE _ <br /> BUILDING � �� �//� �p c <br /> 1YPEOFCONTS.FLLOWABIE TYPEOFCONST.ACTOAL OLcuGeNCY NoofUwEwHGUNrtS i <br /> . �N �N R3 v � J PLUMBING i <br /> IZ LDsj eyy� NO.OFSTORIES BASEMENT MECHANICAL � <br /> yF ��,� L /U� <br /> OCCUPANCV LOAD PIRE SPRNKLEFS REO'D HEIGHT LIMITATION ADDITIONAL PLAN CHECK � i�(� <br /> No �$ ' ' <br /> SPRINKLER � <br /> REASON FOR SPPINKLER:: <br /> STATE BUILDING SURCHARGE is0 <br /> INTAKE 8V PLANS APPROVEO BY CITY OF EVEREIT PUBLIC WOflKS ---� <br /> LOCAL SALES , <br /> 3� Z �I� TAX COOE IS 3105 TOTAL 3d� � �fo <br />