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APPLICATIC'1 FOR CONISTRUCT^1N PERMIT � <br /> � TO BE COMPLETED IN BLACK INK-PLEASE PRINT <br /> RPHEATING SYSTEM: ❑GAS ❑ELECTRIC ❑ <br /> BUILOING DEPARTMENT <br /> 259-8810 / <br /> ❑ DEMOLITION �( COMBINATION ❑ BUILDING ❑MECHANICAL ❑PLUMBING ❑ SKiN <br /> R WR/�DDRE55 CITV ZIP PNpNE <br /> ,�J�f/� 5,('o�,G �D �sz6� �vEr� Y��z o/ <br /> Gr��� �-� a��s�rF� �b�8' ��,,.�Y c�Ec�.�� Z9S�a� P a s9=9��s <br /> h MTECTOROESIGNER RAWRESS CITY 21P PIIONE <br /> GlJI���iM 1�/�f�v/� /�/A �lv/l� �/�l�IE ��o/ a S�' -�.2o S <br /> r.u��oo�ss cirv xir p�ane si�reuc��e <br /> v�o �p�qi,a �9 Fvl'� �.�a�irf/� C[.�l. 9'6.�0 5�3f9ss� ,�� 7�66Cw <br /> ICKGOMTRAC M�R 55 CITV 21P PlIONE T�IELICEN9E1 <br /> VLU11BRqCON1iUCiOR W1llIDqiESS CITV 21P PHONE ST�TEIICENSE� <br /> CCNTMCT PRICE OF M/ORK , <br /> �� <br /> .. DEBCR�lE W�71F(AND 90lMRE PoOTIIOE MVOLVEO CANTACT PERSON AND PHONE NO. r • <br /> s- <br /> I HEREBV CERTIFY THAT 1 HAVE READ AND E%AMINED TNIS <br /> o y�o�w'�R , APPUCATION AND KNOW THE SAME TO BE TRUE MID CORRECT.ALL <br /> � � PROVISIONS OF UWS AND ORDINANCE3(30VERNIN01HI3 7YPE OF <br /> oescawtaNt�r ��u�a2wNeKowa+�n.�cHTwqcac�s��� WORK WILL BE COMPLETED WITH NRiETHER SPECIFIED HEREIN OR � <br /> �or 3 e�ocK�L oF � �� NOT. THE GHANTINO OF A PERMIT DOES NOT PpESUME TO OIYE <br /> AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br /> � OTHER STATE OR LOCAL LAW RE(iULATIN(i CONS7AUCTION OR THE <br /> PERFORMANCE OF CONSTRUCtIOfd.THAT I AM AUTHORI2ED BV THE ' <br /> ONMER OF THIS PROPERTV TO PERFORM THE WORK FOR WHICH <br /> � APPLICATION IS MADE AND I COMPLV WITH TME STATE <br /> ... .� PMICEI T/0(I.D.qUAlEX CONTRACTORS LAW 7827 RCW AND 296200 WAC. <br /> - -vA�6 n <br /> . ' COMBTIN1CilON LWN lENOER.l1DDRESS.tELEPHONE NIMBEN �� /� / / � / �� .� � . . <br /> Y .le,uJ ;.'a, a r� <br /> . ; � �� EqIMT E � ��� ! M1E . <br /> W[� +, <br /> � • qTY MIlIE!!LICENSE 1q. �• <br /> ' i KINM10 1AEqMINCAL `�ni <br /> i N0. TtrE OR RXTlN1E OII REM FEE N0. TYPE OF EGIIIPMENT fEE <br /> �. ' WATER CLOSET(TOILET) � IV�AMNDLO UNITS—M.P. � '. :� <br /> BATHTUB ' FORCED AIR SYSTEMS--B.T.U. M E.A. ' <br /> LAVATORV(WASH BASIN) i UNIT HEATERS—B.T.U. M � i <br /> , SHOWER � CLOTMES DRVERS � ;, l <br /> � � KITCHEN SINK 8 DISP � ; VENTILATION FAN ; � C:'Y, <br /> � DISlIWASNER � RANOE HOOD � i �� ���,� <br /> LAUNORYTRAY ` ; WATERMEATER ' ' ,�_� <br /> CLOTHES WASHER � WOOD STOVE � ' � <br /> � URMIAL ' METAL FIqEPLACE(WOOD BURNINO) � I ��� <br /> DRINKINO FWNTAIN � FIREPLACE INSERT � � <br /> FLOOR DRAIN � HEAT PUMP � ' ,;,� <br /> I BACKFIOW PREVENTERS ; GAS PIPINO ' � ;,a <br /> ! ROOF DRAINS--RAINLEADERS � EXHAUST FAN � " <br /> i SINK(SERVICE—BAR,ETC.) ; ' <br /> i � ; <br /> � � � <br /> � � � <br /> SUBTOTAL S ; SUBTOTAL S ' <br /> i PERMIT S � PERMIT S � <br /> ' TOTAL FEE S ' TOTAL FEE S ' <br /> wn o�ce use oN�r: <br /> ', FIIONTSEI&�CI( REMSE7HIICK SIDESET&1CN PLANCNE KNUMBER FEE � FIECEIPTNO. <br /> 5� a�. �5 3 <br /> �, use -� LOTMEA v�NrsitE FEES VALUMION FEE <br /> ❑ VES O NO BUILDING � <br /> ttPEo�coxsr. Pa.aFSTon1Es acuwhcr xa.aowninpux�n i <br /> ��v pLUMBIN(3 i <br /> SQEOFBlDO. FIRESPRM�tLERSREOD BASEMENT MECHANICAL ' <br /> ❑ YES ❑ NO � <br /> OCCUM11qvLW10 FIREAUflMREOD XEKiHTLIMITATION ADDITIONALPLANCHECK i � <br /> i <br /> OTHER � <br /> NE�SON � <br /> STATE BUILCING SURCHARGE � ^ ! <br /> INTN(EBY PIANSAPPROVEDBY CITYOFEYERE7T PUBLICWORKS � <br /> JM LOCAL 8ALE8 <br /> �r� � . TAI(CODE IS 5105 roTµ � � <br />