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APPLICATINN FOR CONSTRUCTlON PERMIT � <br /> TO BE CUMPLETED IN BLACK INK—PLEASE PRIrv f `� ' ' <br /> BUILUING DEPARTMENT HEATING SYSTEM: I]GAS U ELECTRIC ❑ --� <br /> 259•8810 <br /> ❑ DEMOLITION ❑ COMBINATION �f BUILDING f�MECHANICAL ❑PLUMBING ❑ SIGN <br /> OWNER MAILADOAESS n GITY ZIP PN�NE <br /> rl�'6 QUE/N6 CU, /•O. (jGv� �707 /t'` S�Jf/�-/3 .5(.rR'TIL���/A• 9f'�i-�� <br /> iENANT MRI��D�HE S Cltt _ PNONE <br /> �oE/N6 - <br /> �R ITEGTORDESIGNEF M�IL�OONE55 CI7Y 21P PHONE <br /> �o���NG- <br /> /0�1 NER(AL GONTR�LTOR N�IL�DOPESS CITY IIP PNONE ST�TE LILENSE� <br /> ('t �7T��1 ' <br /> MECIUNICAL CONTR�CTOR M�IL�OORESS CITY ZIP PMONE ST�iE LICENSE I <br /> PLUMBM�GONTR�LTOR M�ILAD011E55 CITY ZIP PHONE STATELICENSEI . <br /> CONTPACT PRICE OF WORK <br /> � Or�U� UrJ(� <br /> OE�Cf1�E�l�.'Oj���QUI�E��� 'W�'�E9�/S��G CONTACTPENSON�NDPMONENO. <br /> l/ � �• 6 n J <br /> C.�"u.vatit� ��l��2s,� ZGc-3.r'C9 <br /> i HEREBV CERTIFV THAT I HAVE RE-AD AND E%AMINED THIS <br /> GROPOSED USE OF 6UILDIN6 AppLICATION AND KNOW THE SAME 70 BE TRUE AND CORRECT.ALL <br /> PROVIS�ONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br /> IEGAL0E5CNIPTIONOFPROPERTY�SNOWNBEIOWORATiACMTWOCOPIES� WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br /> NOT. 1"HE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br /> ' �or stocK oF AUTHORITY TO VIOLATE OR CANCLL THE PROVISIONS OF ANY <br /> OTHEfi STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br /> PERFOHMANCE OF CONSTRUCTION.THAT I AM AUTHORIZED�Y THE <br /> OWNER OF THIS PROPEFTY TO PERFORM THE WORK FOR WHICH � <br /> APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> PARCE�TAX 10 NlIM9ER CONTRACTORS LAW 18.27 RCW AND 296.200 WAC. <br /> CONSTRUCT 1 LONI�ENDER,AODRESS,TELEPHONF NIIM N G, —A,� _ q.� �/ " 6 /y <br /> a� SiNO !2•� �u--�j Y �/ ���r,�-.._. <br /> PROJECT ADDHESS 51p1""""�� °�16 <br /> cnrouswrssiKrNSEr�� <br /> PLUMBING MECHANICAL <br /> N0. TYPE OF FIXTURE OR ITEM FEE NO. TYPE OF EUUIPMENT FEE <br /> YJATER CLOSET(TOILET) /VC—NHNDLG UNITS—H.P. � <br /> BATHTUB FORCED AIR SYSTtMS—B.T.U. M E.A. <br /> LAVATORV(WASH BASIN) UNIT HEATERS—B.T.U. M � <br /> SHOWER ' CLOTHES DRYERS ' <br /> KITCHEN 51NK 6 D�SP � VENTILATION FAN � <br /> DISHWASHER � flANGE HOOD � <br /> LAUNDHY TRAV �VATER HEATER ' <br /> � <br /> CLOTHES WASHER � WOOD STOVE <br /> URINAL ' METAL FIREPLACE(WOOD BUHNING) ' <br /> DRINKING FOUNTAW � FIREPLACE INSEIiT �_ <br /> FLOOR DRAIN HEAT PUMP _ ' <br /> BACKFLOW PREVENTERS ; GAS PIPING ,_� <br /> ROOF DRAINS—RAINLEADERS E%HAUST FAN <br /> SINK�SERVICE—BAR,ETC.1 � <br /> � <br /> T <br /> I <br /> 1 � <br /> � T <br /> SUB TOTAL S SUB TOTAL S ' - <br /> PERMIT $ � PERMIT S � <br /> TOTALFEE S TOTALFEE S <br /> FOR OFFICE USE ONLY: <br /> FRONTSETB�CN REARSEiBACK SIDEGETOFCN PIANC f.KHUMOER FEE RECEIPTNO. <br /> 5"a�3 <br /> USE 20NE LOT�REA VACFNT SIIE FEES VALUATION FEE <br /> �� YES ( 1 NO eUILOING � �"' °'O �j���/ ; �4� <br /> IY�{�ILON51. , NOOFSTORiES 2:ur�x[r xoaUwuuxcutins � <br /> nj Wv pLUMBING �_ <br /> i <br /> SREOF9LOG. FIRESPf11NKlEB5RE0'D 6�SEMEVT MECHANICAL � <br /> lyu oo ,� n v�s �o <br /> OGc ru�qvLO�D Fi nununEOD MEIGHiLIMITAiION AD�ITIONALPLANCMECK � � O� <br /> � i <br /> ��IO� /L S OTHER i <br /> REASON � <br /> �XSrG • STATE OUILOING SURCNARGE � � `��� <br /> INiANGOY ruHsnrr oveoo• CITYOFEVERE7T PUBLIGWORRS I <br /> �An LOCAL SALES � <br /> n„TE y, , y 4 TAX CO�E IS 3105 TOTAL ; <br />