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r`;• , f'N' � <br /> � QPPLIC�ION FOR CONSTR�TION <br /> � PERIIAIT <br /> ` theEverpreen evcrelt <br /> I CITYOF <br /> ! ever�tt � <br /> BUILDING DEPARTMENT <br /> . 259-8810 TQ BE COMPLETED IN INK— PLEASE PRINT � <br /> OWNER 1AAI�ADOPE55 CitY ZiP PIIONE <br /> �rr�.�. .S � 1.,.��• r a �,^ /�C� /_'t� x �9/ /�•� ,�.� • ,clr t �c..:4 P',$'.jG� <br /> ENANT MAILADOFESS CILY ZiV PIIONE . <br /> /fl,�/i {� — . <br /> APGNIiECTOR0E91GNEH MAIL�ODRE55 CIIY ZIP PHONE �vp f LLL, <br /> . � t� , �/� I . <br /> � GENEPALCONiflhGTOR MA4p0UfiESS CItY 21P PHONE LIGE1!$E+ � ��� <br /> c.�f/-� ��;v�s� d /=nc.. /�>,1)O SG /q G,cl��r'>�e �f/u�•i;✓,i/G' GS,l�6.�0/ i , <br /> ' C ANICAL ONiRRC R MAILADORESS CI1V -T--ZIP r PHONE LICENSE� .�. <br /> � ; <br /> �I i <br /> ' PLUM9INGCONiRACTOR MRILAOORESS CIiY LP PIIONE LILENSE• �i �� <br /> �� CUSS OF WORK <br /> ' TE❑N�NTEMPROV❑EMLJT�ORIlOER�OOE OLOtRor�ON ❑ REPA'R L� DEMOLITION Co'OAcwO000NONoiP�NEI�SERT ❑ BUILDINGRELOG;?ION I '' <br /> CANTRACTPRICEOFWOFK �(� U! L,1 S� ll(// ' <br /> � OE,CRI9EWONKANDSOU/REFOOTpGEINVOUED I <br /> � I <br /> � <br /> PflOP05 USEOFBUtL01NG IHEFEBYCERTIFYTHATIHAVEREADANDEXAMINEDTHISAPPUCATIONAND I <br /> � '� 7 <br /> � � c �, JC�C% � -I KNOW?HESAMETOBETRUEANDCORRECT.ALLPROVISIOP�SOFLAWSAND <br /> � IEG�LOESCflIPiIONOFPRCPERTY�SMOWNBELOWORATiRCNFOURGOPtE51 ORDINANCESGUVERNINGTHISNPEOFWORKWILLBECOMPLETEDWITH I <br /> . �C� WHETHERSPEGIFIEDHEREINORNOLTHEGRANTINGOFAPERMITDOESNOT i <br /> YY ` � � G�� ��«�rF, PqESUMETOGIVEAUTHORITYTOVIOLATEORCANCELTHEPROVISION50F <br /> ' loi.LJ-L� e�ocK�,LZ or �- ��-�i�-,�,�•� qNVOTHEASTATEORLOCALLAWREGULATINGCONSTRUCTIONORTHEPER� I <br /> ' FOFMANCE OF CONSTRUCTION.THAT I AA1 AUTHORIZED B'/THE OWNER OF I <br /> aa � � ����i� THISPROPERNTOPERFORMTHEWORKFORWHICHAPPUCATIONISMA�E �, <br /> AND I COMPLY WITH THE STATE CONTRACTORS LAW 18.27 RCW AND i <br /> 296200 WAC. ` ��n <br /> � SIGN�TUREOFCONiRPCTOiORAUIHOFIZEDRGENi DAIE ,Y�U �/ <br /> O <br /> ���� <br /> PROJECTAD�RE55 / <br /> AF CANiSCI�bU51NE55LICEN5EN0.ANDBUSWESSNAME <br /> /'l _ � `: <br /> �� / - <br /> � PLUMBING MECHANICAL <br /> � N9. TYPE OF FiXTURE OR ITEM FEE NO. TVPE OF EQUIPMENT FEE <br /> WATER CLOSET(T01 LEn !VC—A/H NDL6 UN ITS—H.P. <br /> BATHTUB FORCED AIR SYSTEMS—O.T.U. h1 EA <br /> LAVATORY�WASHBASIN) � UNITHEATERS—B.T.U. td <br /> . SHOWER CLOTHESDRVERS , <br /> KITCHEN SINKS DISP. V[NTILATION FAN � ��, � <br /> . OISHR'ASHER RAIJGE HOOD '� � <br /> LAUNDRY TFiAY WATER HEATER I <br /> CLOTHES WASHER WOOU STOVE I <br /> . URINAL METALPIqEPLACEBCHIMNEY � <br /> � DRINKINGFOUNTAIN FIREPLACEINSERT � I <br /> � FLOORDRAIN HEATPUMP , <br /> ' BAC�:FLOWPfiEVENTERS GASPIPING I <br /> ROOF ORAINS—RAINLEADERS EXHAUST FAN <br /> SINK(SERVICE—BAR,ETC.� I <br /> i <br /> SUB TOTAL 5 SUB 70TAL S � <br /> _ _ I <br /> PERMIT S PEFiM1T S <br /> TOTAI.FEE S TOTAL FEE S <br /> FRONiSETBACK REARSETBACK SIDESEiB�CN PL4NCNECI(NUMDER FEE RFCEIPTNO. , <br /> usexorve LOiAREA VAGANi51IE FEES VALUATION FEE � <br /> fJ YES ❑ NO <br /> ttPEOFCONST. OCCUPANCYGFUUP ND.O�OWELLINGUNRS BUILDING � <br /> � ALLOWABLE/ACiOAL '� <br /> '� PLUMBING � <br /> S2EOFBLDa. NO.OFSiORIES BSMi. OCCLOAO <br /> ❑v MECHANICAL <br /> nN — — <br /> NEIGHiLIMI1RilON QTHER <br /> FIRESPR�NN�ERSREOl11RE0 ❑Y[5 ❑ NO <br /> -- STA7EBUILDINGSURCHARCaE <br /> STAiE ENERGY SURCHARGE �I <br /> AVPLIC4TIONAGG.�Y �ANSAPPR.pY — <br /> PUBLIC WOPKS <br /> TOTAL <br />