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APPLICATIQV FOR CONSTRUCT,LpN PERMIT � <br /> TO BE COMPLETED IN BLACK INK—PLEASE PRIN( <br /> BUILDING DEPARTMENT HEATING SYSTEM: ❑GAS Cl ELECTRIC ❑ <br /> 259-8810 / <br /> ❑ DEMOLITION U COMBINATION f I BUILDING C:I MECHANICAL IKPLUMBING O SIGN <br /> OWNER M�ILADURE55 CITY ZIP PHONE <br /> rMF &�InY � <br /> TEN�NT 1.UIl�UDRE53 CITY ZIV PNDNE <br /> ARCNITECTORDESIONER MAIL�OOPE55 CITY IIP PHONE <br /> OENEHALCd1iRAC70N MARADORESS CITY ZIP PNONE ST�TELICENSEI <br /> • <br /> MECHANIGILGONiPACTON MARADDPESS CI7V ZIP PIIOhE STAiELICENSE� <br /> W.p. P�-r,-p.l� P0. EnX 33� 5EhT11� `fB133 36'�-6'�ic� <br /> PWMBWOCONTMCTON AU0.ADOHESS CITY ZIP PIqNE 6T�TELICENSEI <br /> GONTHAGT PPILE OF WJNN <br /> OESGRIBE WORK ANO 6IXI�NE FOOT�GE INYOLVED CONi�CT PERSON ANO PIIONE NO. <br /> � ` <br /> 5 GM C BS °IO- - 3 <br /> `�� l`�'' I HEREBV CERTIFY THAT I HAVE READ AND EXAMINED THIS <br /> vnoroseousEOFeuxnwo qPPLICATION AND NNOW THE SAME TO BE TRUE AND COHRECT.ALL <br /> PROVISIONS OF LAWS AND ORDINANCES 60VERNIN6 THIS TYPE OF <br /> lEMl0E6CNIPIpNOFVROPEfltt�5110Y.'NBEI OIIATTACIITWOf.OPIE6� WOFiK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br /> NOT. THE aRANTINO OF A PERMIT DOES NOT PflESUME TO 61VE <br /> ��t �� � AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br /> OTHER STATE OH LOCAL UW HEGULATINO CONSTRUCTION OR THE <br /> PERFORMANCE OF CONSTRUCTION.THAT I AM AUTHORIZED BY THE <br /> OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br /> APPLICATION IS MADE AND I CQMPLV WITH THE STATE <br /> P�PCEL TAM I.D.NUAIBER CONTRACTORS LAW 18.27 RCW AND 296200 WAC. <br /> CONSiPUCT10N LOAN lENOER.MDIIESS.TELEPNONE NU4BEH <br /> .ili.� loll°I�94 <br /> PRQIECT ADDREBS s w�f <br /> — ' cnreuswcssiKcwscHo <br /> PLUMlMIO MECHANICAL <br /> NO. TYPE OF RXTURE OR REM FEE NO. TYPE OF EOUIPMENT FEE <br /> WATERCLOSET�TOILEn � A/�A/HNDL6UNITS—H.P. � <br /> BATHTUB ; FORCEDAIHSVSTEMS—B.LU. M E.A. ' <br /> LAVATORY(WASH BASIN) � UNIT HEATERS—B:CU. M �_ <br /> SHOWEF ' CLOTHES DHVERS � , <br /> KITCHEN SINK 6 DISP � VENTILATION FAN � <br /> DISHWASHER � RANGE H000 � <br /> LAUNDRYTRAV ; WATER HEATER ' <br /> CLOTHES WASHER WOOD STOVE � <br /> URINAL ' METAL PIREPLACE(WOOD BURNIN6) � <br /> ORINKIN�FOUNTAIN � FIREPLACE INSERT � <br /> FLOOR DMIN � HEAT PUMP � <br /> BACKFLOW PREVENTERS ; GAS PIPING ' <br /> ROOF DRAINS—RAINLEADERS � EXHAUST FAN � <br /> SINK(SERVICE—BAR,ETC.) � � <br /> Z r � <br /> � � <br /> � � <br /> � � <br /> � � <br /> � � <br /> SUB TOTAL S ' SUB TOTAL S ' <br /> PERMIT S ZU � PERMIT S � <br /> TOTALPEE S ' TOTALFEE i ' <br /> FOR OFFICE USE ONLY: <br /> FRONT6ETBACN REM6ETBACK SIDE6ETBACI( PLWCN CKNUMOEP FEE PECEIPTNO. <br /> usezor+e �ot�ae� VAC�NTSIiE FEES VALUATION fEE <br /> C1 VES fl NO BUILDIN6 � <br /> IYPEOfCONSi. NO.OFSi011IE5 ouui+M:r MaaV�t�iNuuMnn � <br /> �� PLUMBINO i <br /> 6QEOFBLDO. FIRESPPINNLF.RSREdD B65EMENT MECHANICAL � <br /> ❑ YES ❑ NO � <br /> OCCUPANCVLMD fIHEMARMREO'0 NEIONTtIMITQ10N A�DITIONRLPUNCHECN <br /> i <br /> OTHER i <br /> �T <br /> PEASON i <br /> STATE BUILDINO SURCHAROE `_ <br /> � <br /> INTANEOY f`LANS�PPROVEOOY CITY OF EYI:HEIT Pl1ULIC WORKS � <br /> LOf'�.ShLES � <br /> o�rE TAX' 'IS 3105 TOTAL ; <br />