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APPLICATIC�] FOR CONSTRUCT'�)N PERMIT � <br /> TO BE COMPLETED IN BLACK INK—PLEASE PRINT <br /> HEATING SYSTEM: �O GAS �.1 ELECTRIC U --I <br /> BUILDING DEPARTMENT <br /> 259-8810 <br /> i DEMOLITION ' I COMBINATION I BUILDING ' MECHANICAL f !PLUMBING SIGN <br /> OWNER MAiI�ODfiE55 CITY DP PNONE <br /> A.t ` ��� -f�'��'1 /'�'� 1 �C�-F�Son �Qr19r1.�rv -Ih�.L.(.'i� �i:'JS>- �Yc 'lo�� �553 <br /> iENRNT M�IL�(1DRE55 CITV 2iP PNpNE <br /> i1r r� <br /> pI1CMITELTOPDE5IGNER IAMLRDDRE55 CITY IIP PHONE <br /> �� R�! �r�� r <br /> G[NEF�L CONTR� OR MMl�DORESS QTY ZIP PHONE SiQE IICF.NSE I <br /> 61CLN�NIC�I GONiR�C10R M�IL�UORE55 CITY 21P PNON[ SUiE LICENSE• <br /> PWMB�NGCONTR�CTOF Id�IL�DORE55 CITY ZIP PMONE SUTELICENSE• <br /> CONTRAC7 PRICE OF WORK <br /> �ESCNIBE WORN AND SOU�RE FOOT�OE I/VOIVED GONT�Ci BSONRND PI j E NO t� 53 <br /> Q .- <br /> �rn� . .. .J � � i � <br /> '(' i HEREBY CERTIfY THAT I HAVE READ AND E%AMINED THIS <br /> PROPOSEO USE OF B ioir+a APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECi.ALL <br /> _����n(�,,q r,Q PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br /> LEfi�LDESCRIP710NOFPROPERIYISHO'MIBELOWORATTACHTWOCOPIE51 WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br /> NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br /> ioT mocK oF AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANV <br /> OTHER STATE OR LOCAL lAW REGULATING CONSiRUCTION OR THE <br /> PF.RFORMANCE OF CONSTRUCTION.THAT I AM AUTHORIZED BV THE <br /> OWNER OF THIS PFOPERTV TO PERFORM ?HE WORK FOR WHICH <br /> APPLICATION IS MADE AND I COMPLV WITH THE STATE <br /> r�ncEi T�z i o r+uMe�n CONTFACTORS LAW 18.27 RCW AIlD 296.200 WAC. <br /> LONSTRUCTION LO�N LENDEN.�DDRE55.TELEPHONE NUMBER �P�'`K��Ij n����F«Q� <br /> i <br /> ��,j,��,� LS/ ��.J r�_ <br /> PRlOJECT ADDRESS ti��.��,,,��r ��•+� � _ <br /> /SO� I CIIYPIISIN�CCIi�I11511N1 <br /> PLUMBINC MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM FEE NO. TYPE O.'•EOUIPMENT FEE <br /> WATER CLOSET(TOILET) A�C—AiHNDLG JNITS—H.P. <br /> BATHTUB FORCEDAIRSVSTEMS—B.T.U. M E.A. <br /> LAVATORV(WASH BASIN) UNIT HEATEFS—B.T.U. M _ <br /> SHOWER ' CLOTHES DPVERS _ <br /> KI7CHEN SINK 8 DISP VENTILATION FAN <br /> DISHWASHER RANGE HOOD _ _ <br /> LAUNDRYTFAY WATEH HEATER <br /> CLOTHES WASHER WOOD STOVE <br /> URINAL METAL FIREPLACE(WWD BURNING� <br /> DRINKING FOUNTA�N I FIREPLACE INSERT I <br /> FLOOR ORAIN HEAT PUMP ii <br /> BACKFLOW PREVENTERS GAS PIPING � <br /> ROOF DRAINS—RAINLEADERS E%HAUST FAN <br /> SINK(SERVICE—BAR,ETC.) <br /> —�— <br /> SUB TOTAL S SUB TOTAL $ <br /> PEHMIT E PERMIT $ � <br /> TOTAL FEE E TOTALFEE 5 � <br /> FOR OFFICE USE ONLY: <br /> fqONT6E1fl�CK RE�RSETB�CN SIDESEIB�CN PLRNCNE NNUMPER FEE AECEIPTNO <br /> use zar+e �or nnEe ��C�Ni SiTE FEES VALUATION FEE <br /> ' � VES '.-�' NO BUiL�ING <br /> 1YFEOfCONST NOOFSTOR�ES navr�w� Non;wuu4,un�ts <br /> ''""''° PLUMBING <br /> 52E W BIOG flqE SPRINNLEHS REOD B�SEMENT MECHANICAL <br /> "--� VES �.��. NO — <br /> 0^.CIIP�NCY IO�D LIRE�UPM REOD NEIGN7lIMIT�TION ADDITIONAL PUN CHECK <br /> OTHE(i i <br /> r,E�SON --T <br /> STATE BUILDING SURCNARGE <br /> iNtnneer Vl�NS�PPRO\'EOBY CITYOFEVEflETT PUBLICWORNS <br /> LOCAL SALES <br /> o�tE TAK COUE IS 3105 TOT�� <br />