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���APPLICA'i1C-f FOR CONSTRUCT'�3�1 PERMI'9' <br />TO BE COMPLETED IN BLACK INK-PLEASE PRINT �����r <br />BUILDING DEPARTMENT �EATiNG SYSTEM: f] GAS U ELECTRIC U <br />259-8810 _� <br />❑ Df:MOLITION ❑ COMBINATION ❑ BUILDING L MECHANICAL ❑PLUMBING IVSlGN <br />OWNER IA�ILA�DRE55 CITY ZIP PHONE 6R3�-�,�08 <br />�� ��so.� �oao ,��ss�a✓ ��.f� M�ySVIGc�qBz�o " <br />TEN�NT /�f{L(L FjRQ§�I}���LADOHESS CITV 21P PHONE <br />A-� LoCKSh[/TH (�710 �t/F1ZGi2c�i�/ f�/4y �I/�t-�T 9�'2��3 3�{7-y733 <br />AflCHITECTOR0E51GNER MAILADDAESS CITV ZIP PHONE <br />GENERALCONTRACTOP <br />MECNANICAL <br />AND <br />PROPOSED USE OF BUILDING <br />MFIL A��PE55 CITV 21P PHONE STATE LICENSE u <br />C�r�l.-.�\-u.-� y2>aol3 <br />r.. r p GV\O • ve c�v n� 1i o� ��� �. � <br />�n�__, a�-- � <br />MF L ADDRE55 GITY � ZIP� �`��PMON �� -� STATE UCE SE p <br />` � � Ca�r\�.� FOr � <br />MAI�' NY�\ r �4�1.\U w � � �� nSti \ �� . �\r <br />CITV 21P � PNO L _ SiATEUCE SEA <br />C <br />/D� i3AtKL iT <br />LEGAL DESCRIFTION OF PFOPERTY �SHOWN BELOW OR ATTACH iW0 COPIES) <br />LOT-- BLOCK OF <br />GV�E�- <br />PAFCELTA%I.D.NUTA�ER <br />CONSTRUCTION LOAN LENDER, <br />NO. TYPE OF FIXTI <br />WATER CLOSET (TOIL <br />BATHTUB <br />LAVATORY(WASH BA: <br />SHOWER <br />KITCHEN SINK & DISP <br />TELEPHONE NUMBEfl <br />LAUNDRYTRAY <br />CLOTHES WASHER <br />URINAL <br />DRINKING FOUNTAIN <br />FLOOR DRAIN <br />BACKFLOW PREVENTERS <br />SINK <br />FEE <br />� <br />PERMIT $ � <br />TOTAL FEE S ' <br />FOR OFFICE USE ONLY: <br />FfiONTSET9ACN � fl RSLTB K ,/ 5�S�TBACK <br />USEZONE'� LOTAREA VACANTSITE <br />❑ YES ❑ no <br />NPEOFCONSi. NO.OFSTORIES OC[UPNKr uoAFmVEWYGUNns <br />GPOJP <br />SRE OF BLDG. <br />OCCUPANCY <br />REASON <br />FIflE SPRINKLERS REO'D <br />FIRE ALARM REO'D <br />PlANS APPROVED BV <br />DFT� �"/II i IQ Z <br />❑ YES ❑ NO <br />CITY OF ! <br />LOCAL <br />TAX CODI <br />ANOPHOt�E_��^ L�,�.�_'���'/ <br />� ;. Y <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br />APPIICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />PROVISIONS OF LAWS AND ORDINANCtS GOVERNING THIS TYPE OF <br />WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br />NOT. THE �iRAtJTING OF A PERMIT DOES NOT PRESUME TO GIVE <br />AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br />OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br />PERFORMANCE OF CODISTRUCTION. THAT I AM AUTHORIZED BY THE <br />OWNER OF 1'HIS PROPERTY TO PERFORM THE WORK FOR WHICH <br />APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />C ACTORS L W 1827 RCW AND 296.200 W . <br />��u �- �+� -�3" 97 <br />�}—y-93 <br />SIGNAi �ZL�`°r �I �AIE <br />LIiY OlI51NE55 LICENSE NO. <br />N0. I TYPE OF EDUIPMENT � FEE <br />NC-NHNDLG UNITS-H.P. <br />FORCED AIR SYSTEMS-B.T.U. M E.A. <br />UNIT HEATERS-B.T.U. M <br />CIOTHES ORYERS <br />RANGEHOOD <br />WATER HEATER <br />WOOD STOVE <br />METAL FIREPLACt <br />FIREPLACE INSERI <br />HEAT PUMP <br />EXHAUSTFAN <br />SUB TOTAL $ <br />PERMIT 5 <br />TOTAL FEE 5 <br />27 <br />BUILDING � - <br />i <br />PLUMBING i <br />I <br />MECHANICAL ' <br />i <br />� <br />ADDITIONAL PLAN CHECK i <br />i <br />OTHER � <br />STATE BUILDING SUFCHAR�E � �` <br />i <br />PUBLIC WORKS i <br />�T <br />TOTAL i /% ! •S <br />