Laserfiche WebLink
APPLICATIQ"! FOR CONSTRUCT'+1N PEaMIT � <br />TO BE COMPLETED IN BLACK INK—PLEASE PRINT <br />BUILDING DEPARTMENT HEA7ING SYSTEM: � GAS '� ELECTRIC ❑ � <br />259-8810 <br />pZ DEMOLITION Qi COMBINATION p9 BUILDIN(i ❑ MECHANICAL ❑ PLUMBING I' SI(iN <br />OWNER M�ILIIDORE55 CITY ZIP PNd1E <br />L3e5T PlQcoucj's G. wc_ P.o.Box 2�3c� R���MeKo. va_ 232co•��o� (Ao�) 2ct-23�1 <br />TEN�NT M�IIADDRE55 CITY 21P PH(WE <br />Bdsr Rzoo�oTs c�. �uc. Po. p,�„r uao; ¢�cuuou� va 2azce-�o; fp�,l2�1-2zGi <br />ARCMITEC Op D�NER M�IL �DDRESS GITY 21P� PHONE � <br />6�QL_ F: lu�� ki� lCY AG� C'e2Pu¢�'('6 DQ_ Stl� /05 La�(1�1C��i�KY 1o50a •2749 t�o�1223 -�/23 <br />OENEFAL COYTq�CTOR MAIL DDRESS CITv 21P NONE STA E LICE SE � <br />MECMANICQ CONTR�CTOR M�IL �DDNESS CITV 21P PHONE SUTE LILENSE � <br />PIUYBINOCONTRACTOR M�Il�0URE53 CITV 21P PNONE ST�TELICENSEI <br />CONTN�CT PPICE OF VIORI(� <br />� <br />INVOIVEU <br />LEO�LbE5CR1ItpN OF PROPERTY�ISIIOWN BELOW OR �tt�CM TWO COPIES� <br />L(1T BLOCN OF <br />S�r e'�j�C41 TWa COPfaS _ <br />PARCEL TAxJ,Q�y�IMBER�. �� y � ^/ ��^ � <br />/ /-�y ��, �,1��� <br />CONSTRUC710N LO�N LENOER. ADDRES9, TELEPNONE NUMBEfi- <br />PROJECT ADDRESS �CC�G—p��T�Atj,-C <br />�ae� ueeru Dee��wwv <br />P�urenro <br />N0. TYPE OF FOITURE OII ITEM <br />WATER CLOSET <br />BATHTUB <br />LAUNDRVTRAV <br />CLOTHES WASHER <br />UiINAL <br />DRINKIN4 FOUNTAIN <br />FLOOR DRAIN <br />BACKFLOW PREVENTERS <br />FOR OFFICE USE ONLV: <br />FRONiSETB�CN RE�NSETB�CN <br />USE 20NE l0T �REA <br />tYM Of CONSi � � Sid1IE5 <br />lii- / <br />SIIE OF 0LIX3 FINE SPRINNLEHS AEO'� <br />0 04.3 `�ES <br />OCCUP GY LO�D �iRE AI�RM REOD <br />l,Zn�'J yE5 <br />RE�,� £"�s r� <br />INT�NEBv PLANSA�ROVEOBY <br />A �1 <br />oerE �l l — 7 i - <br />SI[IE <br />CONUCT PERSON �ND P1qNE NO <br />i HEREBV CERTIFY THAT I HAVE READ AND EXAMINED THIS <br />APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />PROVISIONS OF LAWS AND ORDINANCES 60VERNINO THIS NPE OF <br />WOflK WILL BE COMPLETED WITH WHETHEH SPECIFIED HEREIN OR <br />NOT. THE GHANTINO OF A PEHMIT DOES NOT PRESUME TO GIVE <br />AUiHORITV TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br />OTHER STATE OR LOCAL LAW REOULATING CONSTRUCTION OR THE <br />PEHFORMANCE OF CONSTfiUCTION. THAT I AM AUTHORI2ED BY THE <br />OWNER OF THIS PROPERTV TO PERFORM THE WORK FOR WHICH <br />APPLICATION IS MADE AND 1 COMPLY WITH THE STATE <br />CONTRACTORS LAW 18.27 RCW AND 296200 WAC. <br />y �� C1 �'��t��" � � � <br />, <br />s���unE o�r <br />� <br />EMS—B.T.U. M E.A. <br />S.U. M <br />RANGEHOOD <br />WATER HEATER <br />WOODSTOVE <br />METALFIREPLACEi <br />FIREPLACE INSERT <br />HEAT PUMP <br />GAS PIPING <br />EXHAUSTFAN <br />� A J <br />�� l <br />NUMBER <br />WCANT SIiE Fina <br />-�: VES (-�. NO BUaDINa <br />OCfI1MNCY NOIXOWfl11NGUN��S <br />nnouo p�UMBINO <br />3-z <br />8�5EUENi MECHANICAL <br />�� VES !�"NO <br />NEIOHi LIMIT�TION ADDITIONAL PUN CHECN <br />OiNER <br />�T�tE BWLDIN4 SURCHARGE <br />FUBLIL WOHNS <br />CODE IS 3105 I T�TAL <br />Fee <br />xtiT 4 <br />U <br />11 <br />Ma�V <br />S <br />S <br />TOTAL FEE S IJO�,.I <br />i <br />N7ndd�- �r,A _ <br />'E RECEIPTNO. <br />�C/%�0 /4% <br />—�l �� � nv <br />� <br />� <br />a <br />