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APPLICATIG J FOR �ONSTRUCT �N PERMIT � <br /> TO BE COS+IPLETED IN BLACK INK—PLEASE PRINT <br /> I HEAiING SYSTEM: U GAS ❑ELECTRIC O <br /> BUILDING DEf ARTMENT <br /> 259-8810 <br /> I ', DEMOLITION I I COMBINATION I I BUILDING i i MECHANICAL 1 PLUMBING �C SIGN <br /> OWNER MAILADURE55 GITV ZIP PMONE <br /> c...a.•.r� �o�s .f,�,nn.srL�y iWI� ru�cwi«9 t1�F� �-.r7s,�v9a <br /> TENANT _ MAIIADDR $S���D � �/' CIIL�I�� ��'` �j6 �Q/E G�� r /��G — <br /> /1 v <br /> ARCHITEGTORDESIGNER MAllAUOR 55 CIN 21P PHONE <br /> GEN�AL CONTRACTOR MRIL AODRE55 CITV ZIP PHONE STATE LICENSE I <br /> n„a�`e 3r.ry �mr �u�S SE.�cE 9r/.�w u���-�S a.rr6r.va.o��w <br /> MEGHANICALGOHTR� OR MAILAODRESS qiV 21P PNONE STATELICENSE� <br /> PLU INGCGJTFACTOR MAILADORE55 GITY ZIP PHONE STAiELILEN5El1 <br /> ��� <br /> cuss oF woaK <br /> i I NEW I 1 ADDITION '�, I ALTERATION � I REPAIR �. ! DEMOLITION i . WOODSTOVE/FRPL INSERT �. '� BUILDING RELOCATION <br /> CONTACT PENSON AND PIIONE 1 A. <br /> CONTRACTPRILEOFWORK � G � �1�NI� O '�F�� ,�-�-93'$�S �. <br /> CESCRIBE WORK ANO SOUAPE FOOTRGE INVOLVE� <br /> r�rer,u� �7 IL1.YW. wNLL <br /> PROPOSEOUSEOFBUILDING I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br /> APPLICATION AND KNOW THE SAME TO BE TRUE AND COARECT.ALL <br /> LEGAL DESCRIPTION OF PPOPERTY(SMOWN BELOW OR ATf�GH FOUR COPIES) PROVISIONS OF LAWS AND ORDINANCES GOVERNING THlS TYPE OF <br /> WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEPEIN OR <br /> tor BLOGN oF NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br /> AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONfi OF ANV <br /> OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br /> PERFORMANCE OF CONSTRUCTION.THAT I AM AUTHORIZED BY THE <br /> OWNER OF THIS PR�)PERTV TO PERFORM THE WORK FOR WHICH <br /> - APPLICATION IS �SADE AND I COMPIY WITH THE StATE <br /> CO4TRACTOHS LAW 1d.27 RCW AND 296.200 WAC. <br /> ��GP.auc/ G-�-q3 <br /> S ATURE DATE <br /> PR0.IECT ADDRESS <br /> 's�/� �dM�� GIliBUSW[54l�CEN5EN0 <br /> �7 (�lt/ <br /> PLUMBIN� MECMANIrpL <br /> NO. TYPE OF FIXTURE OR ITEM FEE NO. TYPE OF EOUIPMENT FEE <br /> WATER CLOSET(TOILET) � AIC--A/HNDLG UNIT!i—H.P. <br /> BATHTUB ; FORGED AIR SYSTEMS—B.T.U. M E.A. <br /> ._AVATORY(WASH BASW) � UNIT HEA7ERS—P,.T.U. M <br /> SHOVIER ' CLOTHES DRYERS _ <br /> F'IT(;HEN SINK 8 DISP VENTILATION FAN �, <br /> CISHWASHER � RANGEHOOD <br /> L\UNDRY TRA'f ; WATER HEATER <br /> C'_OTHES WASHER � WOOD STOVE _ ' <br /> URINAL METAL FIREPLACE&CHIh�NEY � ' <br /> DFIINKING FOUNTAIN � FIflEPLACf INSERT � <br /> FLJOR DRAIN � HEAT PUMP <br /> BA�KFLOW PREVENTERS ; GAF,PIPING � <br /> ROJF DPAINS—RAINLEADERS � EXHAUST FAN ' <br /> — ' <br /> SINK(SERVICE—BAR,ETC.) � � <br /> � <br /> � <br /> � <br /> SUB TOTA! $ ' SUB TOTAL $ 1 <br /> — PERMIT $ � PERMIT $ <br /> TOTAL FEE 5 ' TOTAL FEE $ <br /> FOR OFFICE USE ONLY: <br /> RECEIPT N0. <br /> FRONTSETBACK REANSETBACK SI�ESETBACK PLANCH�Kt�U�R FE�//„ �_ ,7� � <br /> ����—t ___'_ Q <br /> VACANTSITE FEES VALUhT10N FEE <br /> USEZONE 1` I� LOTAREA -7 � <br /> —�C(.}T J� _--- �UILDING / ' <br /> TYPFOftONTS.IdLOW4PLE TYPEOFLONSI.AC7UAL M[uwxcv NOo�VAfluhGuxrts � <br /> i <br /> �^e1" � PWMBING ' <br /> SIZEOFBIDG. NO.OFSTORIES BASEMENT MECHANIChL � <br /> ADOITIONFL PLAN CMECK ' <br /> OCCUPANCYLORD FIRESPRNKlER5RE0'D HEIGHTLIMITpTION � <br /> i <br /> SFRINKLER � <br /> REASON FOfl SPRINMlERS <br /> STATE BUILDING SURCHARGE � � <br /> i <br /> INTANEBY PLANSAPPROYEOBY CITYUFEYERETT PUBLICWORK$ � <br /> LOCAL SpLES ' <br /> � >r J� TAX COOE IS 3105 TOTAL ?`J �.�Z� <br />