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APPLICATIC-1 FOR CONSTRUCT'�"fN PERMIT � <br /> TO BE COMPLETED IN BLACK INK—PLEASE PRINT <br /> BUILDING DEPARTMENT I HEATING SYSTEM: IJ GAS U ELECTRIC J ___� <br /> 259-8810 <br /> I I DEMOLITION COMBINATION �4 BUILDING � MECHANICAL PLUMBING ' ', SIGN <br /> OWNER M�R�ODnE55 CtiV pIP PNONE <br /> /.v�_SGLGd'.fca/ le__/O��(���(f�� fvti'i.»' �075 <br /> TEN�N M�IL�DpHE55 � ��iy 71P PNONE <br /> �RCHITECiOF�f51GNEA M�IL ADpRE55 CRY ZIP P110NE <br /> ��� <br /> GENERMGONTRRCTOR M�I��DL^RF�55 CItY 21P PNON[ SUIELICENSE� <br /> �Wc��/!'.f' �do�i' Y[3Q)/ �/I fsr.tlN1 �S3.�L�1[J <br /> MFCN�NIG0.CONI�RGTOR M�IL�OpRE55 f,IlV IiP PIIpNE STRE LICENSE• <br /> O� R �o.vs�e�ef�o./ s� �/�3suPi..v�:�;NE y8z�i �S3 B7Y9 /zBco.r.�so2)��' <br /> PLU BINGCONiRACiOR M�IL�OUNE55 CIiI ZIi' PNONF SiA1E LICENSE t <br /> CONTRACT PRICE OF WORN <br /> �� � <br /> ,� J �t3'/ ����..(� ��. ,. ; �EH�r.✓�,3�-6>99 <br /> OESCRIBE WOPN�ND SOU�RE FOpTAOE INVOLVE� CONL�f,T PERSON�NO PMONE NO <br /> �rGJf�/•i� G CL�f f A <br /> /t/v �/PG7f^���2 S b <br /> � i HEREBV CERTIFV THAT 1 HAVE READ AND EXAMINED THIS <br /> PPOPOS DUSE OFyBUILOING APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT.ALL <br /> ���n ��� PROVISIONS OF LAN/S AND ORDINANCES GOVERNING THIS TVPE OF <br /> ieoeioeSC�iIFT10Noar PEPTV�SHOWNBELOWON�TTAf.HiW000VIE5� WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREINOR <br /> LOT / eiocK oF NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br /> AUTHORITV TO VIOLATE OR CANCEL THE PROVISIONS OF ANV <br /> l�U� ' �� '� _ /�- y� OTHER STATE OR LOCAL LAW REGULATING CONSTFUCTION OR THE <br /> // — PERFORMANCE OF CONSiRUCTION. THAT I AM AUTHORIZED BV THE <br /> _��," /� � .� �.� , � OWNER OF THIS PROPERTY TO PERFORM THE 7JORK FOR WHICH <br /> P�RCELT�MID 11M8ER <br /> A^PLICATION IS MADE AND I COMPLY WITH THE STATE <br /> O� CUNTRACTORS LAW 18.27 RCW AND 296.200 WAC. • <br /> CONSTRUCtION LU�N LENOER.ADD SS EIEPNONE NIIMBE <br /> PROJECT ADDRESS vr,ve�om �70�,1`-/f 2�`�--- <br /> Ci1vPVSNF991�1IH51 NO - <br /> PLUMBINO MECHANICAL <br /> N0. TVPE OF FI%TURE OR ITEM FEE NO. TVPE OF EOUIPMENT FEE <br /> WATER CLOSET(TOILET) A�C—AMNDL�UNITS—H.P. <br /> BATHTUB ; FORCED AIR SYSTEMS—B.T.U. M E.A. <br /> LAVATORV(WASH BASIN) UNIT HEATERS—B.T.U. M <br /> SHOWER � CLOTHES DRVERS <br /> KITCHEN SINN 8 DISP VENTILATION FAN <br /> DISHWASHER RANG�HOOD , <br /> LAUNDRY TFlAY ; WATER HEATEF <br />� CLOTHES WASHER WOODSTOVE <br /> URINAL METAL FIREPLACE�WOOD BURNING) <br /> DRINKING FOUNTAIN FIREPLACE INSERT ; <br /> FLOOR DRAIN HEAT PUMP , <br /> BACKPLOW PREVENTERS GAS PIPING � <br /> ROOF DRAINS—RAINLEADERS EXHAUST FAN <br /> SINK(SERVICE—BAR.ETC.� � , <br /> � <br /> SUB TOTAL S SUB TOTAL E <br /> PEFMIT $ PERMIT y " <br /> TOTAL FEE $ TOTAL FEE $ <br /> FOR OFFICE USE ONLY: <br /> FRONiSETflACK NEARSEiBAGN � SiDES[iBRGN Pl<NCHECNNUMBFR !E[ � RECEiPTNO �� <br /> / <br /> / <br /> a �p �l; ��, � ��,- �� o��.,'�� <br /> use zor+e -7 �or nee� wceNT srte FEES VALUATION FEE <br /> �Li ' ' YES � NO BUILDING G <br /> 7Vtt0iCON51 NOOFSiORIEB arur�xn Naa�mniureuM��S - --l��` �/� ��-�� <br /> � � `'��"�� PWMBINO <br /> SREOFBLDO FIRESPNMNLERSREOD BASEMENL � � MECHANICAL <br /> S S D ' � VES ;✓NO <br /> OCCOPANCY O�D FllIE ALAPM REOD HEIGHT LIM17F510N A�DITIONAL PLAN CHECK <br /> � zf ' -- <br /> OTHER <br />, RF.�SON <br /> STATE BUIIDING SURCHARGE ._�: — . <br /> —�C y�.� <br /> INT�REBY Pl�NSA['�OVE�PY CITYOFEVERE7T PUBUCWORNS ��, i -� �� <br /> LOCAL SALES <br /> onre8 3J .�3 TAX CODE IS 3105 roui � <br /> / <br />