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� APPLICATIOK �=0R CONSTRIJC�'1�` 1 PERMIT ���� <br /> TO BE COMPLETED IN BLACK INK—PLEASE PRINT <br /> H o HEATING SYSTEYI: ❑GAS �ELECTRIC ❑ —� <br /> [� �j� BUILDING DEPARTMENT <br /> p� x 259-8810 <br /> 9 y ,� DEMOLITION COMBINATION �' BUILDING MECHANICAL PLUMBING SIGN <br /> t�� OWNEfI IAAILADOFE55 CitY 2�P PHONE <br /> r <br /> i �/ _ nn� i� �,�ln o "_ 7.R- "i <br /> y � / �l,(„��� �19�•r�iQl,- - C/,,;.-�l �',. , -�C. -Y� - <br /> K n TEN�.Nj IAAIIhDDBE55 Ci1V 1I�P PHONE <br /> H;v / <br /> �yH rt <br /> ARCNRECTOHDESIGHER M�ILA[1DFE55 CITV ZIP PNONE <br /> � 7' �' f�I�� CITY 21P PHOME STATEUCENSE� <br /> O . GENERALCONTiIALTOF MAIL1100NE55 <br /> o i� d �1�vd Nra,dl�Cna�k H7o5' C'a��n .�c� l'-vrre� GJ.� �'8�''3 �z'l�)�-�X� �?/lE/��t'_IO//�`_ <br /> / MECHAN�G�LGd�iRAdOF MAR���PESS Gli\' � ZIP PNOHE BT�tEUCENSEI <br /> H�g <br /> n• o <br /> �y � PLl1MBMGCONiNAC10F /MhAIIDRESS CIP 21P PH01JE StATEIILENSE� <br /> z <br /> H H cuss oc wonK <br /> gy -. � NEW '�. I ADDITION J( ALTERATION . REPAIH DEMOLITION � WOODSTOVE/FRPL MSERT , ��. BU�LDING RELOCATION <br /> H <br /> n rJ(/J CONTALTPERSONANpPHONENO <br /> �� L CONiRACiPRiCEOFWOFN � Q ��JCY� .�L /I/✓ /� �c�OC^ �oZSn LS7O <br /> �� �+� DESGPiBE/W/ NKANOSOWpEF AGEINVCLYE� Ane�nK 7S � � <br /> H O fyi� / �'1'0 <br /> � R1 !'jC�: O....r Nrr'!�A-cl .SfiT/is �a Q .� <br /> PROPOSEOUS �OFBUILDMO � I HEREBY CERTIFY THAT I HAVE READ ANO E%AIdINE� THIS <br /> �jr��}�- C'�fU 2. APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT.ALL <br />' tEc,uoescn IONOfPROPERTVIBNOWNBEIOWOflATiAGNFd1HCOPIES� PROVISIONSOFLAWSANDORDINANCESGOVERNINGTHISTYPEOF <br /> WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br /> ipT g�ocK or NOT. THE GfiANTING CF A PERMIT DOES NOT PRESUME TO GIVE <br /> � .I AUTHORITY TO VIOLATE Ofi CANCEL THE PROVI810NS OF ANY <br />. � � � OTHEF SiATE OR LOCAL LAW REGULATING CONSTFUCTION OR THE <br /> _� ,y <br /> . ' PERFOflMANGE OP CONSiRUCTION.THAT I AM AUTHORIZE�BY THE <br /> � OWNER OF THIS PROPERTV TO PERFORM THE WORK FOR WHICH <br /> - � - q?PLICATION IS MADE AND I COIdPLV WITH TNE STATE <br /> I'�+`:-�`�' ' CONTRACTORS LAW 1827 RC W AND 296.200 WAC. <br /> Y..H <br /> ' " /, <br />' � C'�, G� = ..�«r-r _x.l�.,�, /.� � ��'�t.. S-aa-9� <br /> �„E <br /> vao�ec+noor+Ess sr��-ri/ �3'S-` 5z/5 <br /> ��� <�..n����.,.«��-�����,,, <br /> PLUMBING MECHANICAL <br /> I�' NO. TYPE OF FI7(TURE OR ITEM FEE NO. TYPE OF E�UIPMENT FEE <br /> WATER CLOSET ITOILET) � H'C—A:HNDLG UNITS—HP. <br /> '�' BATHTUB � _ FORCED AIR SYSTEMS–B.T.U. M [.A. <br /> ' ' LAVATORV IWASH BASIN) i UNIT HEATERS–B.T.U. M ; <br /> � <br /> SHOWEfi ' CLOTHES DRYERS <br /> KITCHEN SINK 8 DISP VENTILATION FAN � <br /> ' ' DISHWASHER � RAtJGEli00D _ <br /> LAUNDRVTRAV � WATER HEATER � <br /> 1�I CLOTHES W�SHER � WOOD SiOVE � <br /> T <br /> URINAL ' METAL FIREPLACE 8 CHIMNEV <br /> '-1 ORINKING FOUNTAIN I FIFEPLACE INSERT �_ <br /> FLOOR DRAIN � HEAT PUMP ' <br /> � BACKFLOW PREVE '�ERS � <br /> GAS PIPING � <br /> �1 ROOF DRAINi–FAINLEADERS E%HAUST FAN <br /> SINK(SERVICE–BAF.ETC.) <br /> ' i <br /> � 1 SUB TOTAL 5 SUBTOTAL $ ' <br /> ' PER!JMIT S � <br /> �- - TOTALFEE $ TOTALFEE $ �— <br /> FOR OFFICE USE ONLY: <br /> .�RONTSETBACK FEAFSEiOACN S�DESETB�LK PUNLHECKNU�Q�ERS FC�O•� ,/ AE�E��'TJ�i� <br /> ?j0 «y6 <br /> usezor+e �ornFcn VACANTSCE FEES /VALUATION FEE <br /> BUILDING TJ 'OD�J lDu 'L� <br /> iYFfOfGONiS.hILOWRBIE TYPFOfLONSi.�Lt11At ttW�� NOO�M.:wYutins ' <br /> PLUMBIN4 � <br /> � '�'�i�� � <br /> �SrzJE�OcnLOG. NO.OFSTOR�ES �ASEMENi MECHANICAL � <br /> N1t7L9�L— � <br /> I ADDITIONAL PLAN CRECK � <br /> OGCUPANCYLOAO Fl SPPNKLENSREO'0 HEIGHTLIIAITATION <br /> SPRINKLER <br /> - T <br /> REASONFONSPRINNLEPS � '�'� <br /> STATE BUILDING SURCNARGE <br /> ��,rn�,eer PLRIS�PPROVE�AY CITYOF[VERfTT pueucwonrs � <br /> LOCAL SALCS <br /> ,/��� JM TAXCOOEIS;t105 TOTAL J j I �I;1C <br /> �� <br />