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APPLICATiQ"' FQR CONSTRU�TI''�N PERMIi �� <br />TO BE COMPLETED IN BLACK INK—PLEASE ?RINT T <br />BUILDING DEPARTMENT L- <br />259•8810 <br />! 1 DEMOUTION I I COMBtNeTION <br />HEATING SYSTEM <br />iX BUILDING <br />/ RUIL FOpRE55 CITY <br />�qurcrit ��irnrCi 5�Z.7 /�/�/T�'S't S� <br />TENAI" MRILAOD�E55 CIT'! <br />r1NCMITECTORDE5IGNER MRILADDPE55 CIiV <br />GEN�I�RLCONiRACTOh MFI�AO�FE55 CIiV <br />f�ELECTaI� f] <br />❑ MECHANICAL ❑ PLUMBING <br />�IP FHONE <br />C(a�v� 337-�/_�E�.:Z <br />21P <br />ZIP <br />ZIP <br />m=......�.i...wvninn�ivm m�i�no�neoo CIIY 21P <br />PLOMBINGCONTRACTOF AIAIIADDRESS dTY ZIP <br />0 )Gr.��.:� �t <br />UESCRIBE WORK AND SGUARE FOOTAGE <br />„1��% $t� Y'Y �w$C <br />� �tIZ L <br />PROP � f���I BUILU� S� <br />LEGAL �ESCRIPTION OF PROPESTY �SHOWN BEIOW OR r1iTRCN TWO CJPIES� <br />1���.] t e'f� n <br />LOT BLIX'R OF <br />L' �-z�a �� ��/ �J � � Lf �/T/� , <br />G— Lo-(-f-�� ;�. ��-�r; �,_ �rro <br />PANCELTAxID.NUMBER <br />3� Z 0.. (�po ..00 2' O l o$ <br />LONSTPUCTIONLOFNAIEN�ER,RDORE55,TELEPHONE NUMDER <br />�V 1-� <br />13cJ, �.n n � <br />NO. I TYPE OF <br />LAVATORY (WASH BASIN) <br />SHOWER <br />KITCHEN SINK 8 DISP <br />DISHWASHER <br />LAUNDRYTRAY <br />CLOTHES VJ.4SHER <br />URINAL <br />DRINKING FOUNTAIN <br />FLOOR DRAIN <br />BACKFLOW PREVENTERS <br />ROOF DRAINS--RAINLEADEFS <br />SINK ISERVICE—BAR, ETC.1 <br />SUB TOTAL 5 <br />PERMIT $ <br />TOTAL FEE 5 <br />FOR OFFICE USE ONLY: <br />FRONTSETBpCK pERRSET9ACN <br />�� � <br />USE 20NE — � lOT AREA <br />% <br />iYPEOfLONSi NO OFS10RiE� <br />�$I � ��yyD� FlRE S � INNLERS FEOD <br />7.(i rs`.. ,VU <br />OCCUPANLYIOA� FIHEAIARMFEO� <br />FEASON <br />iNTAKE OV � PLANS <br />CONiACT PE{ISON AN� PMONE NO. <br />PNONE <br />PHONF <br />PMONE <br />PHONE <br />STATE LICENSE � <br />STRTE LICENSE • <br />� <br />SIGN <br />i HEREBY CERTIFY THAT I HAVE READ AND EXAMINFD THIS <br />APPLICATION AND KNOW THE SAME TO BE TRUE AND CORHECT. ALL <br />PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br />WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br />NOT. THE GFANTING OF A PEqM1T DOES NOT PRESUME TO GIVE <br />AUTHORITY TO VIOLATE OF CANCEL THE PROVISIONS OF ANY <br />OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br />PERFOHMANCE OF CONSTRUCTION. THAT I AM AUTHORI2ED BY TH� <br />OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WFIICH <br />APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />CONTRACTORS LAW 18.27 RCW AND 296.200 WAC. <br />Y �flK�/I I . �w�`�l � Z' ���' / i <br />TYPE OF <br />UNITHEATERS—B.T.U. M <br />CLOTHESDRYERS <br />VENTILATIUN FAN <br />RANGEHOOD <br />WATER HEATER <br />WOOD STOVE <br />METAL FIREPLACE (WOOD <br />FIF'PLACE INSERT <br />HEAT PUMP <br />GAS PIPING <br />SIDESEIBRC / PLANCHECNNOM9LN <br />� �/(o� S'% <br />VACANTSRE FEES <br />- - YES .� NO BUILDING <br />oc�c�rx��.Jr, �n orow[u�xauxrts — <br />p�/M� 2 PLUMBINC <br />1 <br />BnS �dEUT MECHANICAL <br />YES �'NO <br />NEiG�rt u5�ii�py/ , D�ITIONAL PLAN CHECK <br />oaTe �� /.� 7/� � TAX COUE IS 3705 <br />OTHEF {� ������ <br />S7ATE BUILDING SURCHARGE <br />PUBLIC WORHS <br />TOTAL <br />E.A. <br />/ � � O I RE ///O <br />—��—:-.L.� <br />�n� — <br />