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APPLICATIO`I FOR CONSTRUCT�IN PERMIT � <br /> TO BE COMPLETED IN BLACK INK—PLEASE PRINT <br /> BUILDING DEPARTMENT HEA7ING SYSTEM: ❑GAS ��1 ELECTRIC J <br /> 259•8810 <br /> ❑ DEMOLITION ❑ COMBINATION f l BUILDING Q5 MECHANICAL ❑PLUMBING ❑ SIGN <br /> OWNER MAILADDRE55 � LITV ZIP pHONE <br /> ��OTi�AL �N iEtZ(aL15E-S �I �I D ��2C�CI `��(Z0�3 �SY7 —'r{3Sq <br /> TENANT AIAI� C:iY ZIP PMONE <br /> ARCHITECTOFDlSIGNER tAAILpDDRE55 CITY 21P PNONE <br /> GENEHRLCONiRRCTOR MAILADDRE55 CI1V ZIP PHONE STRTELICENSE� <br /> MECHANICALCONTRACiOR MAllA00RE55 GITY 21P PMONE $iRTELICENSE� <br /> ��.e.=n�u-�-� �S�,rr�5%�u �D. r3.�k iSc�t C�t �'YZa� ?SZ-3r�4 C-'v-L�z-GS- Sizi �� <br /> PLUMBINGCONiRRCTOR AlLAODRESS CITV LP PHONE STATELICENSE� <br /> CONTRRGT PPIGE OF WORK 00 <br /> ' OG. � <br /> UESCRI9E WORN AND SOUARE FOOTAG INVOLVEO CONTACT PERSON AND PHONE NO <br /> KcN �+�, zsz- 3i 44 <br /> :v�r���n.� .�u�-eS��•.e.�s -4-Sor..� � <br /> i HEREBY CEATIFY THAT I HAVE READ AND EXAMINED THIS <br /> PROPOSED USFE.OF BUiLDING APPIICATION AND KNOW THE SAM[TO BE TRUE AND CORRECT.ALL <br /> (�I�'�7LrC PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br /> LEGALDESCRIPPONOFPROPERTV�SHOWN�ELOWORATTACHTWOCOPIE51 WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br /> NOT. THE GRANTING OF A PEfiMIT DOES NOT PRESUME TO GIVE <br /> �or eiocn oF AUTHORITV TO VIOLATE OR CANCEL THE PROVIS�ONS OF ANY <br /> OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br />� — PERFORMANCE 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 /> PARCEL TAX I O.NIIMBER CONTRACTORS LAW 18.27 RCW AND 296.200 WAC. <br /> CONSTRUCTIONLOANlENOER.ADORE55.�ELEPHONENUMBER � <br /> x , �--a .�'e� l'- 9-5'4 <br /> PROJECT ADDRESS (� �icx�*un� oe�c <br /> LCJZ� ��I�7\ �I�� �Iu�� GiYBlISM[SSlILV6lNO <br />� PLUMBING MECHANICAL <br /> N0. TYPE OF FIXTURE OR ITEM PEE NO. TVPE OF EOUIPhtENT FEE <br /> WATER CLOSET(TOILET) � NC—AIHNDLG 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 CLOTHES DRYERS � <br /> KITCHEN SINK 8 DISP � VENTILATION FAN ; <br /> DISHWASHER RANGE HOOD <br /> LAUNDRY TRAY ; WATER HEATER ' <br /> CIOTHES WASHER WOODSTOVE � <br /> UP�.iNAL METAL FIREPLACE(WOOD BURNING) � <br /> DRI�'KING FOUNTAIN FIREPLACE INSERT � <br /> FLOJR DRAIN HEAT PUMP <br /> BACKFLOW PREVENTERS GAS PIPING ; <br /> ROOF DRAINS—RAINLEADERS � EXHAUST FAN <br /> SINK(SERVICE—BAq,ETC.) <br /> SUB TOTAL 5 ' SUB TOTAL $ ' <br /> PERMIT 5 PERMIT $ � <br /> TOTAL FEE $ TOTAL FEE $ <br /> FOR OFFICE USE ONLY: <br /> FFONi SET�AGK REAN SETBACK SIUE SETBACK PL�N CHECN NUMBEN FEE RECEIP7 NO. <br /> USE:ONE LOTAREA VACANi51TE FEES VALUATION FEE <br /> , I YES L�- NO BUILDING � <br /> TYPEOFCONSi. NOAFSTOPIES 0.'cur�M1tv unmo�vE�tmGUNrts i <br /> teouv PLUMBING i <br /> 512EOFBLDG. FIRESPFINKlERSPEQD BASEMENT MECHANICAL � <br /> ❑ YES '-': NO � <br /> OCCUPANCY LORD FIRE AL�HM REO'D MEIGHT LIh11TATi0N ADDITIONAL PLAN CHECK <br /> i <br /> OTHER � <br /> REASON <br /> STATE BUILDING SURCHARGE i <br /> MTAKEBV PLANSAPPROVEDBY CITYOFEVERE7T PUBLICWORKS � <br /> LOCALSALES , <br /> onre TAX CODE IS 3105 TOTAL � <br />