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APPLICATIQ 1 FOR CONSTRUCT' 1N PERMIT <br /> .4_ (� I � TO BE COMPLETED IN BLACK INK—PLEASE PRINT � <br /> BUILDING DEPARTMENT HEATING SYS7EM: J GAS J ELECTRIC J J <br /> 759-8810 <br /> DEMOLITION COMBINATION X BUILDING MECHANICAL PLUMBING I SIGN <br /> OWNEP MRIL�ODCE55 � CIiY 21P PMONE <br /> nrE e,ti:�,.:, ,�.. ��� �,.�. s,��, , M1� ��,{-�� yF���«- c�� . 7`- ;. y �_�� �s � � <br /> 7EN�NT MAL�D�RE55 �RV IIP P��ONE <br /> /�vE,dc <br /> ARCN/I�LECtONPESiGNEN MAIL��DPE55 f.liV 2iP PHONE <br /> (.)(IF /f�(i, <br /> GENERRLCONiRRCTOR MMIAD�PE55 CRY 21P PHONE SiATELICENSE• <br /> �j/C.�,�[.�f: /. (!� . <br /> MECNANICAICONiMCTOR MAItADOHE55 CItY ZIP PNONE ST4TElICENSE� <br /> PIUMBING CONiR1CTON M�IL ADDRE55 dTv 21P PIIONE SiRE IICENSE� <br /> COflTNACT PPICE OF WORK <br /> ��ov <br /> DESCRIOE WONK RND SOUAPE FOOT�GE INVOlVEO CONTRC7 PERSON ANO PHONE NO <br /> L�'oN�hG �r�-r�E,,,�ski zc! :ss-1,3 <br /> E��CL.nSE� �a� hlc.�.�ii— %•.Z • I HEREBV CERTIFY THAT 1 HAVE READ AND E%AMINED THIS <br /> PROPOSEDUSEOFBUILo�c APPLICATION AND KPlOW THE SAME TO BE TRUE AND CORRECT.ALL <br /> O F/%[r�C PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br /> IEG�IDESLRIPiIONOFPqOPERTYISHOWNOELOWONATTACNTWOCOPIE51 WORK WILL BE COMPLETED WITH WHETHER SPEGFIED HEREIN OR <br /> ior BIOCK aF NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br /> AUTHORITV TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br /> OTHER STATE OR LOCAL LAW FEGULATING CONSTRUCTION OR THE <br /> PERFORA7ANCE OF CONSTRUCTION.THAT I AM AUTHORIZED BV THE <br /> OWNER OF THIS PROPERTY TO PEHFORM THE WORK FOR WHICH <br /> P�RCEl7ANID NUMBER APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> CONTRACTORS LAW 10.27 RCW AND 29ti200 WAC. <br /> CONSTRUCTION IO�N IEN�ER.��DRESS.TElEP1lONE NUMOER / 1 <br /> PN_Q,IECTADDRESS s� �uN—F���-�D/ ���� /�/�,/� <br /> SOG'i �•� . C�9 s.,.., _�7. �� -R L o��c <br /> c�rr ous�r�css i�c�r�s�r�o <br /> PLUMBINO MECHANICAL <br /> N0. TYPE OF FDITURE OR ITEM FEE NO. TYPE OF EOUIPMENT FEE <br /> WATER CIOSET(TOILET) � NC—luHNDLG UNITS—H.P. <br /> BATHTUB FORCED AIR SVSTEMS—B.T.U. M E.A. <br /> _ LAVATOFiY(WASH BASIN) � UNIT HEATERS—B.T.U. M <br /> SHOWER � CLOTHFS DRYERS � <br /> _ KITCHEN SINK d DISP VENTIIATION FAN � <br /> DISH'NASHER RANGE HOUD <br /> IAUNDRVTRAV ; WqTER HEATER � <br /> CLOTHES WASHER WOOD STOVE <br /> U!iINAL ' METAL FIREPUICE(WOOD BURNING) � <br /> DRINKING FOUNTAIN � F�REPLACE INSEHT <br /> FLOOR�RAIN HEAT PUMP � <br /> BACKFLOW PREVENTERS GAS PIPING <br /> ROOF DRAINS—HAINLEADERS � EXHAUST FAN , <br /> SINK(SERVICE—BAR,ETC.) <br /> � <br /> — i_ <br /> � <br /> SUB TOTAL $ SUO TOTAL S <br /> PERMIT $ PEFMIT $ <br /> TOTAL FEE $ TOTAL FEE $ <br /> FOR OFFICE USE ONLY: <br /> FRONTSETBRCN REFRSETBRGR Si�ESETB�CR PLANGIIECR UMB H FEE RECEIViNO <br /> ��3� <br /> USEIfklE LOiRREA VACANiSrtE FEES VALUATION FEE <br /> : � YES � � NO BUILOING � �O U �i <br /> IVPE9fGONSt NOOFSTORIES occu>�xa �morowu�mcuxrts <br /> � / — N� �. PIUMBINO � <br /> S2E OF BIDG FIqE SPRINKLERS REO'0 B�SEMENT i <br /> iS�o Sf.�r, .�. �/FS - vEs �o MECHANICAL , <br /> � <br /> OC UPRNCYlOAD FlRE�L�RMP.EQO NEIGNTIIMIU110N <br /> ADDITIONAL PLAN CHECK � <br /> Nn OTHER � <br /> REASON <br /> STATE BUIL�ING SURCHARGE / '' C� <br /> INGNEOv PLANSA I�VEOBV CITYOFEVEREIT PUBLICWORKS i <br /> ��� LOCALSALES <br /> o�re � 2 _� _ TAX CODE IS 3105 To*A� I�O <br />