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, `Z°6,�,�°50 :ICATION FO���? <br />everen <br />, �,�a�„9D�N�WDIani NST�tUCT10f� � � � <br />PLStMIT <br />PLETEDnIN INK- PLEASE PRINT <br />THE GLAD CONSTRUCTION GROUP, INC. � BUILDING O MECHANICAL ❑ PLUM8ING ❑ SIGN <br />701 DEXTEH AVE. N., SUITE I212 SEATfIE, bypSHINGTON 98109 ��TM z'P PHONE <br />[ca-✓'4- -- • � ,. . 5.�.. �c��W�2. �l.�b�� 77� " Z2'7 Z <br />�P HIT{;CL RO'SIGNER M�ILAOUHGaa GIfY 21P PMONE <br />��.,� �,MF�, � (�,S;ti� .rro �r�-�I� �t.,�s,� x�i(��� spd�,� �..r-s- �s-�1 <br />GONiR�CTOR <br />cnv _ zin <br />,{'l0 �j 2§'i —,('aJ''0 <br />ziv rr�or+e <br />ZIP PIIONE <br />or wuNn <br />NEW � NDDITION ❑ ALTERATIUN ❑ REPAIR ❑ �EMOLITION ❑ WOODSTOVE/FRPL.INSERT ❑ BUILDING RELOCATION <br />BELOW OR <br />ROJECTA�ORE55 <br />,�aZ s.� -r����- <br />PLUM8ING <br />NO. TYPE OF FIXTUHE C <br />WATER CLOSET �TOILET) <br />BATNTUB <br />UVATORY 1WASH BASIN� <br />SHOwER + <br />KITCHEN SINK 6 OISP. <br />DISHW�SHER <br />' LAUNDHVTRAY <br />CLOTHES WASMER <br />URINAL <br />SINK <br />OFCONST. <br />1� N <br />DF BLOQ <br />:zo st� <br />� <br />� <br />SUSTOTAI <br />PERMIT <br />TOTAL PEE <br />RSETO�CN <br />AR[A <br />OCGUPANCYGFOUP <br />fj• Z <br />� <br />FEE <br />awc ac � on�n <br />NO.OF OWELLING UNITS <br />� <br />Ut�� ln L!'C'C) C�b `1' /d �J G� � <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINcD THIS AP- <br />PLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />PROVISIONS OF LAWSAND ORDINANCES GOVERNINGTHISTYPE <br />OF WORK WILL BECOMPLETED WITH WHETHERSPECIFIED HERE- <br />IN OR NOT. THE GRANTING OFA PERMIT DOES NOT PRESUME TO <br />GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF <br />ANY OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION <br />OR THE PERFORMANCE OF CONSTRUCTION. �1� - <br />SIGNATUflE OF CONiRACTOR OP AUiNpR12E0 AGENT �AiE�V %��8� <br />X I <br />fQ � �,c�—c�� <br />MECHANICAL <br />NO.� TYPE <br />A/C — A/FINOLG UNITS — H.P. <br />REFRIGERATION UNITS — M.P. I <br />BOILERS — B.T.U./H.P. <br />GAS FIRED A.C. UNITS — B.T.U. <br />FOPCED AIR SYSTEMS — B.T.U. <br />WALL HEATERS — B.T.U. <br />UNIT HEATERS — B.T.U. <br />EVAPOHATIVECOOlERS <br />VENTILATION FAN <br />RANGEHOO� <br />WATER HEA7ER <br />wOODSTOVE � <br />METAL FIREPLACE 8 CHIMNEV <br />FIPEPLACEINSERT <br />HEATPUMP <br />GAS PIPING <br />E%HAUSTFAN <br />SUBTOTAL <br />VEPMIT <br />PLAN CHE K NUMBER <br />�" �lRq��{ <br />FEES <br />BUILDING <br />PLUMBING <br />MECHANICAL <br />OTHER P� C� <br />I <br />STATE BUILDIM1G SURCHAFGE <br />STATEENERGYSURCHARGE <br />PUBLIC WORKS <br />TOTAL <br />FEE <br />.`� <br />M EA. <br />M <br />M <br />RECEIPT NO. <br />/ �� <br />FEE <br />PROPERTY OWNERS APE RESPONSIBLE FOR DETERMININ6 ALL <br />PROPERTY LItJE LOCATIONSAND RELATED EASEtAENTS <br />