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APPLICATIO'-�• FOR COiVSTRUCT��N PEFiMIT <br /> TO BE COMPLETED IN �LACK INK—PLEASE PRINT • ���ir <br /> BUILDING DEPARTMENT HEATING SYSTEM: ❑GnS ❑ELECTRIC ❑ <br /> 259-8010 � <br /> ❑ DEMOLITION ❑ COMOINATION O BUILDING lJ MECHANICAL . ❑PLUMBING T�SIGN <br /> ��.��,��< A�,�k��R �,o, ,�`o`X a�9 Z��o�sPii�"E9�oyi ���r�9 <br /> 7EIMNf . YAILAUpl1E7�5 GfY ZIP %IpNE <br />� L�.��%m� 02 J a,�Co��y�..�-ve�zY 9�a oi a�-�-aao&� <br /> ARGIIIECT0110EWW/ER wu��oonew�— cm l zw pwr+e � <br /> �ya z�c•.�c1�6A �.s.v - O-L,i`c �3�3/6� ��.�rze�`t 9�' �i �Sa-yQ// . <br /> OENEMLCONTMCTOR MI1lAD PE55 � GIfY � ZY� � ryp� � STATELICGNSE� <br /> � �si�,.�.v���: tio�SPL <br /> i MECINNICALCOI/fMCTpi WLADIN1Eb5 CIfY ZIP iM10NE STATELIGENSEI. . • <br />� VLUMBNOCONTPACTpI IMLAppI1E5g GTY ZW PIqNE STATELICENSEI . <br /> 1 <br /> TMCTP1110E OVyIYf <br /> �/DUO � / 09� - �s'�-y9// <br />� ce�s �rro Foorro�►rv vco • eor�uerrensor�nr� i+onEea. � ' � . . . � • ': <br /> �4�� � N ON /C� . <br /> �� ��j �� <br /> . ��� � H[R[:DY CERTIFY THAT'1 HAVE pEAD AND E%AMINEJ THIS � <br /> . ��D�°F�O� APpLICATiON AND KNOW THE SAME TO 9E TRUE AND CORRI:CT.ALL <br /> PRCVISIONS OF LAWS AND ORDINANCC-S GOVEflNING THIS 7YPE OF <br /> �eKOEscnwtaqamopeqrv�aawrieEtowoap�nncNrwocor�s� � WORK WILL DE COMPLETED WITH WHETHEH SPECIFIED HEf�EIN OR <br /> � wr ��� e�opc-�� oF ..c/U���� � NOL THE GRANTING OF A PERMIT DOES NOT PRESUME '�J GIVE <br /> � ,�/ -J /' AUTHORIT% TO VIOLATE OR CANCEL THE PROVISIONS OF ANY ' <br /> - ��yy� "RCCORdCGi /N �/d�o�� �O .o�_ PC FORMANCG OF ONSTRU T ON.`TH TCI AM Al1TFiORIZHD JY HE <br /> � �j(�Q ��j��� �� , • OWNER OF THIS PROPERTY TO PERFORM TNE WORK FOF WHICH ' <br /> APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> v��t�to r�n ' CONTRACTORS I.hW 10.27 RCW AND 29G.200 WAC. <br /> �s - - i9 - <br /> 1:ON6THUCTqN LONI LEHDER,ADIMESS,TElEP110NE NUMOkR <br /> PHOJEC�DDRES�/ aXw�.�une r ��D,F 6� wr¢ ���6�s' , <br /> fAt�M&NFF{I YFMii NI. , <br /> PLUMBIN6 � • MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM � FEE NO. TYPE OF EOUIPMENT FL•I: <br /> WATEH CLOSET(TOILET] � AIG-/VHNDIG UNITS-H.P. � <br /> �-- <br /> BATHTUO � FOFiCED AIR SYSTEMS-B.T.U. M E.A. � <br /> LAVATORY(WASH BASIN) � ' � UNIT HEATEHS-B.T.U. M i . <br /> SHOWER � CLOTHES DHYERS �_ <br /> � KITCHEN SINK 8 DISP � VENTILA710N FAN ; <br /> DISHWASHER ' � RANGE HOOD ' -��T- <br /> LAUNDHV TFiAY ; WATEH HEATER ' <br /> CLOTHES WASHER � WOOO STOVE � <br /> -•— <br /> URINAL � METAL FIREPLACE(WOOD DURNING) i_ <br /> ORINKING FOUNTAIN i FIHEPLACE INSEHT . i <br /> FIOOR DRAIN HLAT PUMP � <br /> DACKFLOW PREVENTHRS • � GAS PIPING ; <br /> ROOF ORAINS-HAINLEADERS —� E%HAUST FAN • � <br /> SINK(SERVICE-OAR,ETC.) ' ; � <br /> � <br /> � -- -- ' <br /> � � <br /> --�—— _�_ <br /> — � � <br /> � <br /> -- -r— <br /> ' ' i � ' <br /> ' SUD TOTAL S � ; �" SUO TbTAL S _L� <br /> PERMIT S � � PERMIi 5 <br /> TOTAlFE6 E ' , 1�T0 IFEB S i_ <br /> FOR OFFICE USE ONLY: ' �j� � q�' <br /> FAONfSETBnCK PEMISETOACK SIDESEIWGK PUNGiE NU � FjE 1iFCEIPTNO. <br /> . / ��. /� ! <br /> USFmdE ^ Z nnEn y1� vnc�wTSiTE � FEES VALUATION FEE <br /> Z� I � YES �-' "" OUILDING <br /> �rrc a wxs�. <br /> KK).oF&ron�Es orr�r.ncr xaaoxu�wcunu —� <br /> � � PlUM01NG . <br /> S�ZEOFBLD0. FIRESPRWNL@M^11E0D MSEIIENf MEGHANICAL ' <br /> ❑ YES ❑ NO <br /> � OCGUPANCYlOAD FIIIE MAOM IIEOV HEIOHiLIMITAiIOH ADDITIONAl PLAM CHGCK \ � ' i <br /> I 1 � � <br /> , ��-1�l�/ OTHER � L ' <br /> , n�son — <br /> STATE OUIl01NG SURCHARGE � , , <br /> �+t�n¢ev vuH�rr@oveuov � �-,— <br /> fV� C LO AL SALE3� PUOLIG WOHKS �� <br /> oniE (���Z Gj` TAX COOE IS�31OS TOUL _ <br />