Laserfiche WebLink
APPLICATIQ� FOR CONSTRUCT�"1N PERMIT � <br /> /� � TO BE COMPLETED IN BLACK INK—PLEASE PRINT <br /> ��{� <br /> BUILDING DEPARTMENT HEATING SYSTEFl: ❑GAS ❑ELECTRIC CI <br /> 259-8810 <br /> ❑ DEMOLITION ❑ COMBINATION ❑ BUILDING ❑MECHANICAL ❑ PLUMBING ❑ S1GN <br /> OWNER MAILADDRESS dTY IP PHOIJE <br /> CN�N PA �< �3R�R�'L� //� ��. �127" �G��-/ 231� <br /> TENANT MAILADORESS � CITV 21P PHONE <br /> �R-6eL IUo����-r Slof� �vCQ�2� �� Su,-rr- 3 �'v�ctT �.1 �, 48Zo� 2sh-iz63 <br /> ARCHITECTORDESIGNER MAILAD�RESS CIN ZIP PHONE <br /> GENERALCON?RACTOR MAILADDFE55 CITY ZIP PHONE STATELICENSEa <br /> IAECHANICALCONTRACTOR MAILAD�RESS CITV 21P PHONE STATELICENSEN <br /> 1.� + L P��rn3r•v � <br /> Uld81NG CONTRACTOfl h1A1L ADDRESS CIN ZIP PNONE STATE LICENSE a <br /> y. CONTRACT PPICE rOF\VORK \ <br /> 7� J ��� �V <br /> OESCRIBE WORK AND SOUARE FOOTAGE INVOLVED CONTAC�PERSON AND PHONE NO. <br /> � � i piN6 NO u <br /> -vG o v =vJ GC�'- �-orevl� 258 - 1Z63 <br /> �O S F'j � I HEREBY CERTIFY THAT I HAVE flEA6 AND EXAMINED THIS <br /> PPOPOSED USE OF BUILDING APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT.AI.L <br /> ''r� f (, PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br /> LEGALdESCRIPTIONOFPROPERTV�SHOWNBEIOWORAiTACHTWOCOPIES) WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br /> NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br /> �or e�ocK aF AUTHORITY TO VIOLATE Ofl CANCEL THE PROVISIONS OF ANY � <br /> OTHER STATE OR LOCAL LAW REGULATING 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 COMPLY WITH THE STATE <br /> PARCEL TAX I.D.N1IMBER CONTRACTORS LAW 7827 RCW AND 296.200 WAC. <br /> CONSTRUCTIONLOANLENDER.A�URESS,TELEPHONENUMBEF I <br /> x ,h. �7�-y-d- I`d `1 �/ <br /> PROJECT ADDRESS (=V FR ET 1 WA .�SiGNniURE �—� oA*E_ <br /> IOg ��1C�-GREt� W a cnrausir+essucenseHa � <br /> PLUMBING MECHANICAL <br /> - NO. TYPE OF FIXTURE OR ITEM FEE NO. TYPE OF E�UIPMENT FEE <br /> . WATER CLOSET(TOILET) � A/C—AIHNDLCo UNITS—H.P. � <br /> BATHTUB ' FORCED AIR SYSTEMS—B.T.U. M E.A. ' <br /> LAVATORY(WASH�ASIN) UNIT HEATERS—B.T.U. M � <br /> SHOWER ' CLOTHES DRYERS ' <br /> KITCHEN SINK&DISP � VENTILATION FAN � <br /> DISHWASHER � J RANGE HOOD � <br /> UtUNDRY TRAY ; WATER HEATER ' <br /> CLOTHES WASHER � WOOD STOVE � <br /> URINAL ; METAL FIREPLACE(WOOD BURNING) ' <br /> � DRINKING FOUNTAIN I FIREPLACE INSERT - � <br /> FLOOR DRAIN � HEAT PUMP ' <br /> BACKFLOW PREVENTERS ; GAS PIPING � <br /> ROOF DRAINS—RAINLEADERS � EXHAUST FAN � <br /> SINK(SERVICE—BAR,ETC.) ; � <br /> i � <br /> � � <br /> � � ' <br /> � , � <br /> T <br /> I � i <br /> SUB TOTAL $ ' SUB TOTAL $ S� <br /> PERMIT 5 � PERMIT $ .`J� <br /> TOTAL FEE 5 ; TOTAL FEE $ �� ' <br /> � FOR OFFICE USE ONLY: <br /> i <br /> FflONT SETBACN FEAR SETBACK SIDE SETBN�R PLAN CHECK NUMOER FEE RECEIPi N0. <br /> USEZONE LOTAREA VACANTSITE FEES VALUATION FEE <br /> ❑ YES ❑ NO BUILDING ' <br /> iVPEOFtONST NO.OFSTORIES ataveNGr noovoWEumGmuis � <br /> tnour PLUMBING i <br /> SIZE OF BIDG. FIFE SPRINKLERS REO'D BASEMENT MECHANICAL � <br /> ❑ YES ❑ NO � <br /> OCCUPANCYLOAD FIREALARIAREO'D NEIGHTLIMITATION ADDITIONALPLANCHECK � <br /> � <br /> OTHER � <br /> . REASON i <br /> STATE BUILDING SURCHARGE <br /> INTAKEB'/ PLANSAPPROVEDBY CITYUFEUERETT PUBLIC�JJORKS i <br /> LOCAL SALES � <br /> onre TAX COUE IS 3105 70TAL <br />