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` ' O�PPLICATIOrr FOR CONSTRUCTI.�N PERMIT <br />TO BE COMPLETED IN BLACK INK—PLEASE PRINT � <br />HEATING SYSTEM: �J GAS � EL ECTRIC i] <br />BUILDING DEPARTMENT <br />259-8810 <br />DEMOLITION COMBINATION \ BUILDING MECHANICAL PLUMBING SIGN <br />OWNER MRilq0�RE55 CI1Y 21P PNONE <br />TH� %�CE .�)/-�Y �nK'.:L P6�3 � n i U "✓�rP �� tn,C� ���43 _ <br />TEN�NT II�DORc53 � GTV TiP PHONE <br />�LI�- � Iy� <br />DESIGNER M41L��DRE55 <br />�� /n�/ <br />Mr11L ROORf SS <br />r550F WORIc <br />NEW ADDITION ALTERATION REPAIR <br />� �y.va� d�� <br />iNTN�Gi PRICE OF WORK <br />SCPIBE WORN �ND SOUARE <br />IEG�L DESCNIPTION OF PROPERiY �5110WN BELOW OH AiT�GH FOUR GOPIE51 <br />lOT _ BLOCR OF <br />Pf10JEGT A�DfiFS <br />, �i�? <br />PLUMBING <br />NG. TYPE <br />���0 � _ �i _. [� <br />WAiER CLOSET (TOIL <br />BATH7U8 <br />LAVATORV�WASH BA: <br />SHOWER <br />KITCHEN SINK B DISP <br />TRAY <br />WASHER <br />URINAL <br />FLOOR DRA <br />BACKFLOW <br />ROOF DFAII <br />SINK ISERV <br />FOR OFFICE USE C+NLY: <br />FRONTSEiB�CN �ERF SEi <br />Al,P.4. <br />O � <br />U5E ZONE lOi RRE� <br />�—� <br />OR <br />SU9 TO <br />PERMIT <br />TOTAL F <br />:K SI�P SETB�C�N <br />� s.P.�. 5 <br />WC�NiSttE <br />IVPE Of COHIS �IIOW�BIF 1VPE f6 WN51 AG1p1l <br />Si2E OF BL�G <br />Ip4 �f <br />OCCUPRNCVLOAO <br />RERSON fUR SPRiNxlERS <br />IMiRN( HV �— � .. <br />_�/� <br />NO OF STOA�ES <br />�OqT � <br />i1RE SPRNNlERS RE <br />�i <br />- �inHsnrnnoveoor <br />J�+ .y/�� <br />CIiV ZIP PHONE <br />GTY IIP PNONE STnTELICENSE• <br />iREnwt i 7G /Ca <br />CITY ZIP PNONE STQEIIC[NSE� <br />CITY ZIP <br />i <br />DEMOLITION WOODSTOVEiFRPL INSERT <br />C.ONiACT PE�iSON AND PHONE NO . <br />BUILDING RELOCATION <br />I I�EREDV CEFTIFV THAT I HAVE READ AND ExAMIN[D THI� <br />APPLICATION AND KNOW THF SANf TO BE TRUE ANU CORRECT. ALL <br />PROVISIONS OF LAWS AND OaDINAIJCES GOVERNING THIS TYPE OF <br />WOFK WILL BE COMPI.FTED WITH WHETHeR SPECIfIED HEREIN OR <br />NOT. THE GRANTING GF A PERMIT DOES NO7 pRES�IME TO IiIVE <br />AU7HORITV TO VIOL�TE OR CANCEL THE PROVISIONS OF ANV <br />OTHER SiATE OR LOCAL LAW REGULATING CONSIRUCTION OR THE <br />PERFOfiMP.NCE OF CONSTFUCTION. THA7 I AM AUTHORIZED BV THE <br />OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br />APPLICATION IS MADE AND I COMPLV WITH THE STATE <br />CONTRACTORS LAW 1827 HCW AND 296200 WAC <br />�7/��l.r�� o ��, / _ / <br />N0. TVPE OF EOUIPMENT FEE <br />A'C—A HNDLG UNITS—H P <br />FORCED AIR SYSTFMS—B.T.U. M E.A. <br />UNIT HEATERS—B.T.U. M <br />CLOTHES DRVERS <br />VENTILATIGN FAN <br />RANGEHOOD <br />� WATER HFATFR _ <br />WOODSTOVE <br />METAL FIR[PLACE 8 CHIMNEY ' <br />FIREPLACE INSERT T_ <br />HEAT PUh1P <br />GAS PIPING � <br />_ —_� <br />,�Z EXHAUST FAN , <br />Pi 4N C��FCN NlIMBF� <br />3���� <br />BUIL�ING _��_ .i �� <br />rcw��yr+ Mnril�wRoucuxi❑ --- <br />.;� /— <br />PLUM9ING <br />eaSEn+t�nr MECHANICAL <br />HF.iGHi uMitnr oN ADOITIUNAL PLAN CHECK <br />SPil W K�E R <br />STATF BUILDING SUfiCHARGE <br />CITY OF EVF.RETT Pl1BUC WOfiNS <br />LOCAL SALES <br />TAl( CODE IS 3105 rora� <br />S1:8 TOTAL 8 <br />f`GRMII 8 <br />TOTAL FEE $ <br />%�� � <br />_� �/ � <br />, ��' /p RFCEIPi NO <br />� '7ic 97 <br />; J_f <br />i i% ) <br />,,-�-- <br />. .,i � " , <br />