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APPLICATIL J FOR CONSTRUC7 _.�N PERMIT � <br /> TO BE C�JMPLETED IN BLACK INK-PLEASE Pq1►vT <br /> BUILDING DEP, '^F.NT HEATING SYSTEM: U GAS ❑ELECTRIC ❑ <br /> 253-8810 <br /> �UEMOLITION i 7 COMBINATION BUILDING ' MECHANICAL I I PLUMBING : ' SIGN <br /> �pMMER ILAODRES �^ CI :IP PHONE � • <br /> rn a.t� �N: 1�s sv�c . �.o �3ox gb� ,c`�p�vs��i wrr <br /> TENAM MAILADURESS ~ CIlv ZIP PHONE T , <br /> �RCHITECTORUESIGNER IMILADDflESS CITY 21? PHONE <br /> GENERtiCONTRACTOR MAILAODRE55 CITY ZIP PHONE STATELICENSEY <br /> MECMMIICAL CONTPACTOR MAIL ADDRESS CITY ZIP PHONE STATE LICENSE I <br /> PLUMBINGCONTRACTOR M�ILAD�flE55 CITV ZIP PMONE STATELICENSE/ <br /> CUSS OF WOflN <br /> � I�_I NEW f 1 ADDITION I ! ALTERATION � �� REPAIR X DEMOLITION �. �� WOODSTOVE/FRPL INSERT �. I BUILDING RELOCATION <br /> CONTRACT PRICE OF WORK CONTACT PERSON ANO PH E NOO <br /> 1 v o.°= m . O 1� �rl' (�S9-(o23� <br /> DESCFIBE WOHK AND SOUARE FlJOTAGE INVOLVED <br /> PROPOSEUUSEO�aoir+ r I HEREBY CEflTIFY THAT I HAVE READ AND EXAMINED THIS <br /> � APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT.ALL <br /> LEG�L FIPTION OF PFOPERTY SHOWN BELOW OR ARACH FOUfi LGPIES) PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br /> � WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br /> ioT e�ocK oF C �Q NOT. THE GRANT�NG OF A PERMIT DOES NOT PRESUME TO GIVE <br />� S� l U' f r �`R� �Q R� ��Q� THER STATE OR LOCAL LAW EGULATING CONSTRUCOT ON OR THE <br /> PEFFORMANCE OF CONSTRUCTION.THAT I AM AUTHORIZED BY THE <br />� OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br /> APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> CONTRACNRS LAW 78.27 RCW AN 29 .200 WAC. <br />�i . . . . ' _ X V`J <br /> PRQIECT AOORESS }/� aiUaF. ��tE <br /> . . . bZ2� ���� � S�`• CIiV0115ME55LiCEN5EN0 <br /> .' - � PLUMBING MECHANICAL <br /> N0. TYPE OP FIXTURE OR ITEM FEE N0. TYPE OF E�UIPMENT rEE <br /> WATER CLOSET(TOILET) � A/C—NHNDLG UNITS—H.P. � <br /> ---�-- <br /> BATHTUB ; FORCED AIR SYSTEMS—B.T.U. M E.A. ; <br /> LAVATORY(WASH BASIN) � UNIT HEATERS—B.T.U. M � <br /> T <br /> SHOWER ' CLGTHES ORYERS � <br /> �__ <br /> K�TCHEN SINK S�ISP � VENTILATION FAN ' <br /> -T <br /> DISHWASHF.R � RANGE HOOD � <br /> LAUNDRY TRAY � WATER HEATER ' <br /> CLOTHES WASHER � WOOD STOVE � <br /> URINAL ; METAL FIREPLACE&CHIMNEY ' <br /> DRINKING FOUNTAIN � FIREPLACE INSERT � <br /> FLOOR DRAIN � HEAT PUMP � <br /> BACKFLOW PREVENTERS ; GAS PIPING ; � <br /> ROOF DRAINS--RAINLEADER5 � EXHAUST FAN <br /> SINK(SERVICE—BAR,ETC.) ; I <br /> � � <br /> � � . <br /> � <br /> T <br /> i i <br /> SUB TOTAL $ ; SUB TOTAL $ <br /> PERMIT S � PERMI7 $ � <br /> TOTAL FEE $ ' TOTAL FEE $ ' <br /> FOR OFFICE USE ONLY: <br /> FRONTSF.TBACK flEAR5ET8ACK SIDESETBACK PUNCHECKNUMBER FEE RECEIPTNO. <br /> USEIONE LOTAREA VACANTSITE FEES VALUATION FEE <br /> BUILOING � <br /> TYPEOFCONTS.ALLOWABLE ttPEOFLONSiACTUAL OctuvaNtv NaorowEWNGUNrtS � <br /> cnour � PLUMBING � <br /> SIZEOFBIDG. NU.OFSTORIES BASEMENT MECHANICAL � <br /> i <br /> i <br /> OCCUPANCV LOAD FIRE SPRNNIEHS RE.'.'D HEIGHT LIMITATION AUDITIONAL PLAN CM:CK i <br /> SPRINNLER � <br /> REASON FOR SPRINKLERti �-- <br /> STATE BUILDING SURCF'.ARGE i <br /> INTFKEBY PLAIISAPPROVEDBV CITYOFEVEREIT PUBLICWORKS � <br /> LOCAL SALES �- <br /> TAX CODE IS 3105 TOTAL � <br />