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APPLICATlO:� FOR CONSTRUCTC`iN PERMIT � <br /> TO dE COMPLETED IN BLACK INK—PLEASE PRINT <br /> BUILDING DEPART HEATING SYSTEid: J GAS J ELECTRIC U <br /> 259-8810 �����CL��o� 'j n �,3�-�J��1� <br /> DEMOLITION COMBINATIQN� BUILDING �XMECHANICAL PLUMBING SIGN <br /> OWNEF MALLAD�RE55 GTV ZIP PHONE <br /> '�_c�� l�Rue ��a� coi�v C�e�e-li- Z59 - 8525 <br /> TCNANi MAILA�DRE55 CITY 21P PHONE <br /> �\fe TORD SIGNEIY � M�� �'�� ��'r�� LIP PHONE ��� —��� � <br /> ARGHIT <br /> GFNERRICONTPACTOR :AAILAD�RESS CITV 21P PNONE STATELICENSE� <br /> �� <br /> u[CHFNICAI CONIGACTOF MMl RDDRESS GITY ZIP PNONE STRT°LICEFSE t <br /> _j�g�p�lp�ur. H-�. �(o��q 5 IRD �f+ Y.E�JT 98o3a ysi-o�5� i'L=1'-FGNAIS��T <br /> PLUMB�NOGONTRnGTOF MAILADDRESS GITY ZIP PMONE STATELICENSE� <br /> CLA55 OF WOAK <br /> NEW ADDITION X AITEflATION REPAIR DEMO'_ITION WOODSTOVE/FRPL INSERT BUILDING RELOCATION <br /> �--= CONiAGT FEHSON AN�PIIONE IIO <br /> �onrr,nc,rFl�ceo.woaK � �,�GC' • ���T TW�L-DU Z5�-C73��G� <br /> DESGRI9E WOIiN AND 5]UARE FDOTAGE INVOLVED <br /> �£DULT�S\y-y,�_ hp��lo�Y-�E�R.j��� (2� T�57�iI5, Suprbr[t WGT��j¢ vauTS <br /> PROPOSEG'.10� �IliL01NG ���T� i HEREBV CERTIFV THAT I HAVE READ AND EXAMINED THIS <br /> APPLIC/1710N AND KNOW THE SAME TO BE TRUE AND CORRECT.ALL <br /> �cca�oescai rior+oF a enEaiv�sHowr+eetOwoa anncN FouRwviEs, PROVISIONS OF LAWS AND ORDINANCES GOVEFNING THIS NPE OF <br /> WORK WILL BE GOMPLEfED WITH WHETHER SPECIFIED HEREIN OR <br /> �o, e�ocK oF NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br /> AUTHORITY TO VIOLATE OR CANCEL TFIE PROVISIONS OF ANY <br /> OTHER STATE OR LOCAL LAW REGULATING CCNSTRUCTION OR THE <br /> PERFORMANCE OF CONSTRUCTION.THAT I AM AUTHORIZED BY THE <br /> OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHIGH <br /> APPLICATION IS MADE AND I COMPLY WITH THE STAT� <br /> CONTRACTORS LAW 1827 RCW AND 296.200 WAC. <br /> X D� � �L �/s-ty - <br /> °�PJOQIEGT�AjODRE55 / e�r,r��n���'� �*E <br /> �J�O ��I� V bivpUSME551�6015FNO <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FI%TURE OR ITEM FEF. NO. TYPE OF EOUIPMENT FEE <br /> WATER CLOSET(TOILET) A�C—A/HNDI.G UNITS—H.P. i <br /> 9ATHTUB � FORCED AIR SVSTEMS—B.T.U. M E.A. i_ <br /> I.AVATORY(WASH BASIN) � UNIT HEATF_RS—B.T.U. M � <br /> SHOWER ' CLOTf1E5 DRY[RS ' <br /> KITCHEN SINK R DISP VENTILATION FAN <br /> DISHN'ASHER AANGE HOOD � <br /> LAUiJDRY TRAV � WATER HEATER ' <br /> CLOTHES WASHER WODD STOVE � <br /> —r— <br /> URINAL ' METAL'rIREPLACE 8 CHIMNEY ; <br /> DRINKINv FOUNTAIN i FIREPLaCE INSERT i <br /> FLOOR DRAIN � HEAT PUMP �— <br /> BSCKFLOW PREVENTERS i GAS PIPING _ i <br /> HOOF DRAINS—RAWLEADERS EXHAUST fAN <br /> SINK(SERVICE—BAR.ETC.! ' � <br /> i � <br /> � � <br /> — � <br /> �—. <br /> SU8 TOTAL 5 SUB TOTAL $ �� ' <br /> PERMIT $ PERMIT $ � � <br /> TOTAL F[E $ TOTAL FEE $ ' <br /> FOR OFFICE USE ONLY: <br /> rqOi�T SETBALK REAF SETBAGK SIUE SETBACN PV�N GNECK NUM9ER FEE RECEIPT NO. <br /> usezor+e iornaen �ACANTSITE FEES VALUATION FEE <br /> B:1ILDING <br /> iYCE Of CONTS.ALLOWFBIC fYPE 0�LON57.RCTUAL ofcuvqMcv rW dGnwMGUx�.rs i <br /> ��WP PLUMBING <br /> —�— <br /> � 1 <br /> S2E OF BLDO. NO.OF STOBIES BASEM[NT �,�ECHANICAL � <br /> OCCUPANCYLOAD FiREsrRrvniERsaeo'D Hei�ei�IMrtanON ADDITIONALPLANCHECK <br /> � <br /> SPRINKLEP i <br /> — —— T— <br /> REnSJN FOR SPRINHLERS <br /> STATE BUILDING SURCHARGE <br /> i <br /> 14TANEBV PLANSRPPROVEDBY CITYGFEVEflETT PUBLICWORKS <br /> i LOCAL SALES � <br /> I TAX CODE IS 31G5 TOTAL <br />