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�. <br /> APPLICATIC`l FOR CONSTRUCT'�N PERMIT � <br /> TO BE COMPLETED IN BLACK INK—PLEASE PRINT <br /> BUILDING DEPARTMENT HEATING SYSTEM: J GAS ❑ELECTRIC ❑_ � <br /> 259-8610 <br /> DEMOLITION COMBINATION BUILDING MECHANICAL PLUM8ING SIGN <br /> �/pWN /1'�IlF00PE55 C�i 21P 'PH/ONE <br /> lD��S �/Sd.�� S��S ����� � �i� S�" /�'GL� _. <br /> TEN4NT MAILADDRESS CITY 21P PHONE <br /> /3� �r-ct- C( c�, 9�iI <br /> ARGHRECTGROESIGNER �dAILA07RE55 GTY ZIP PHONE <br /> G,fE�E3^L ONT�IOR NFILADORESS C17Y ZIP PHONE STATELICENSEa <br /> /�*-V✓�o0 I`I— f�Uy,�.q s 8Sd � l.�£ (3�y-ec �� � f�13vT1� /7'�f�v <br /> 9M� HANICALWN:RACTOR MFILAD�RESS , CITV ZIP PMONE STATEUCEIISEa <br /> ` ��_U���'�z s rlk�rr T� � S�� w-�. 4�, i� ✓�.vrae i ccic � <br /> LUMBINGCONTRACTOR MAIL�.JJRESS �ITY ZIP PHONE STATELICENSEa <br /> CLASS CF WOFiH <br /> 'IrMF.W ADDITION '�� � AL?ERATION REPAIR DEMOLITION WOODSTOVE/FRPL INSERT ' �. BUILDING RELOCATION <br /> CONTACT PERSON AND PHONE N0. <br /> CONTRACT PflICE OF WORk <br /> �ESCHIBE WOFK AND SOUARE FOO�TAGj,E�IN�VG�LVED <br /> �Q� 4/�w� �— �Xe.W !- <br /> e oaoseouseoFnuaoiN;� �� ,� i HEREBY CERTIFY T.1AT I HAVE PEAD AND EXAMI:IED THIS <br /> � � � �A APPLICATION AND KNGW THE SAME TO BE TRUE AND CORRECL ALL <br /> LEGAL�ESCRIPTION OF PROPERTV(SHOYJN ELOW OR 4TiACNfOUR GOPIEtii PROVISIONS OF LAW i AND ORDINANCES GOVERNING THIS TYPE OF ' <br /> WORK WILL BE COCiPLETED WITH WHETHER "��EGFIED HEREIN OR <br /> �or e�ocK _ oF _ .__ NOT. THE GRANTNG OF A PEFMIT DOES NOl' PRESUN�E TO GIVE <br /> AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br /> � OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OF THE <br /> PERFORMANCE OF CONSTRUCTION.THAT I AM AUTHORIZED BY THE <br /> OWNER OF THIS PROPERT' TO PERFORM THE WORK FOR WHICH <br /> APPLICATION IS MADE %��ND I COMPLY WITH THE STATE <br /> CONTRACTORS LAW 1827 RCW AND 296.200 WAC. <br /> X �'ii,4-rtP.l � ( //�vn_ <br /> PRQIECTA�GNESS S�c tuRE JRE / <br /> r �- �- <br /> 'yLZti,_ rtr ous�nEss ucc�+sE r�o <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM FEE NO. TYPE OF E�UIPMENT FEE <br /> � WATER CLOSET(TOILET) � A/C—NHNOLG UNITS—H.P. <br /> BATHTUB FORCFD AIR SYSTEMS—B.T.U. M E.A. ' <br /> LAVATORY(WASH BASIN) !.'NIT HEATERS—B.T.U. M � <br /> SHOWER ' CLOTHES DRYERS ' <br /> KITCHEN SINK&Dlgp VENTILATION FAN ; <br /> DISHWASHER � (J RANGE HOOD <br /> LAUNDRY THAV ; WATER HEATER <br /> CLOTHES WASHER � WOOD STOVE � <br /> URINAL ; METAL FIREPLACE&CHIMNEY o.� �u <br /> DRINKING FOUNTAIN � FIREPLACE INSERT � <br /> FLOOR DRAIN � HEAT PUMP <br /> BACKFLOW PREVENTERS ; GAS PIPING <br /> ROOF DRAINS—RAINLEADERS EXHAUST FAN ' <br /> SINK(SEAVICE—BAR,ETC.) � � ' 30 '—� <br /> � <br /> � Co �,� a �— <br /> � 30 " °/a �— <br /> � <br /> �i� <br /> SUB TOTAL S ' SUB TOTAL 5 � ' '` <br /> PERMIT 5 PERMIT S 'f � <br /> TOTAL FEE 5 ; TOTAL FEE $ ' ' <br /> FOR OFFICE USE ONLY: <br /> FROYT SET6ACH FEAR SETBACI< SI�E SETBACK PIAN CHECK NU1dBER FEE RECEIPT NO. <br /> - ,f'S3� <br /> ❑SGZONE LOTAREA VACANTSIT[ FEES VALUATION FEE <br /> BUILDING � <br /> lYPEOFG@1iS.ALLOWABIE iVPEOfCOqSi.AC1UAL OCCuvnxtv r.00FowEwrmunrt5 i <br /> cr,oua PLUMBING � <br /> SREOPOIDG. NO.OfSTOFIES �ASEMENT M�[CHANIC�L d�� �_ <br /> OCCUPqNGYLOAD FIRESPRNNLERSREO'D NEIGHTLIMITATILN ADL`ITIONALPLANCHECK �i <br /> i <br /> SPRINM<LEP ' <br /> REASON FOR SPPINKLERS --� <br /> STA7E BUILDING SUHCHARGE � <br /> INTANEBY PL�NS�PPROVEDBV CITYOFEVERE7T PUBLICW07KS <br /> LOCALSALES � <br /> TAX CODEIS 3105 TOTAL �'L f � <br />