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APPLI�:ATIC^1 FOR CONSTRUCT�N PERMIT � <br />TO BE COMPLETED IN BLACK INK—PLEASE PRINT <br />BUILDING DEPARTMENT I HEATING SYSTEM: �GAS ❑ ELECTRIC ❑ � <br />259•8810 � � � <br />DEMOLITION f� COMBINAT1qN ✓ BUILDING r'1�IECHANICAL LUMBING SION <br />�OYMER / MAR��OHE55 CITY zIP PNpNE <br />�io� �Vr 3/8 So«'►�i! n.ae>.�- 61�TT 98.Zo3 ,��) 3s3 -s6'o3 <br />TENANT M�ILIIDDRE55 CITY <br />�� ��� _ �� 71P P1qNE <br />AqCHITECTORDE516NER M�ILADORE55 �ITY Zip pp� <br />CpITRACTOR <br />cuss oc wonK <br />!INEW y <br />MAR �DDRESS <br />OC✓dE� <br />M�IL AODNE55 <br />M�R ADDRES5 <br />� ALTERATION REPAIq <br />!�.�.Yve.v �GS� /L a — <br />CONiR11CT PRICE OF WORK <br />DESCRIBE WORK �ND SOU�RE FOOT�GE INVOLVE� <br />i��a� s,fr <br />PROPOSEOUSEOFBUIL INQ .� _ _ <br />LOT�� BLOCK �DaoeF <br />�DDRESS <br />SHOWER <br />� KITCHEN SINK 6 DISP <br />� DISHWASHER <br />� LAUNDRVTRAY <br />CLOTHES WASHER <br />URINAL <br />DRINKINO FOUNTAIN <br />� FLOOR DHAIN <br />FOR OFFlCE USE ONLY: <br />USE 20NE � <br />� <br />TYPE Oi CONib. A <br />^TY A� <br />✓ <br />✓ <br />21P P110NE ST�iE LICENSE � <br />CITY ZIP <br />CITY tIP <br />DEMOLITION WOODSTOVEiFRPL INSERT <br />CONTAGT PERSON �N� PIqNE NO <br />ST�TE LICENSE I <br />Si�iE LICENSE • <br />BUILDING RELOCATION <br />' I FIEREBV CERTIFV THAT I HAVE READ AND EXAMINED THIS <br />APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />iWRC0VIE5� PROVISIONS OF LAWS AND ORDINANCES 60VERNING THIS TYPE OF <br />� • WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br />� NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO �IVE <br />AUTHORITV TO VIOLATE OR CANCEL THE PROVISIONS OF ANV <br />� OTHER STATE OR LOCAL LAW REGULATING CONSTqUCTION OR THE <br />� PERFORMANCE OF CONSTpUCTION. THAT 1 AM AUTHORIZED BV THE <br />OWNER OF THIS PROPERTV TO PERFORM THE WORK FOR WHICH <br />APPLICATION IS MADE AND I COMPLV WITH THE STATE <br />C ' W 18. AN 296200 WAC. <br />� -�a,,� � -�- yz <br />s ..�� � o.�E <br />...,..._ / ......�.� <br />LOT�RE� V�L�NTSITE <br />fYM Of CON57 �CN�I <br />N0. Or STdiIE i <br />fIRE SPANSLEqS REO'0 <br />� <br />M p MLIiNGUN�if <br />LIMIi�TI <br />►d <br />TAX CODE IS 9105 <br />WATER HEATER �11s <br />WOOD STOVE <br />� METAL FIFEPLACE 6 CHIMNEV <br />� FIREPLACEINSERT <br />� HEAT PUMP <br />6AS PIPING <br />/ EXHAUST FAN <br />NUMBEP <br />BUILDINO <br />PLUMBINO <br />MECHANICAL <br />A�DITIONAL PLAN CHECK <br />SPRINKLER <br />STATE BUILDINa SURCHAH�E <br />PUBLIC WORKS <br />TOTIIL <br />M E.A. <br />FEE�/� a� 1 <br />i <br />T <br />I <br />71� <br />