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TENANT MnIL ADDRESS CITY <br />ZIP PHONE <br />Cam ��DsIGNE�veFe�t fI ttD l 3 ti �- 5 Z35 <br />ARCHITECT OR ESR MAIL ADDRESS ITY <br />ZIP PHONF <br />GENERAL CONTRACTOR MAIL ADDRESS CITY ZIP <br />PHONE STATE LICENSE <br />uT I T' CIE; 1 -1 <br />MECHANICAL ONTRACTOR MAIL ADDRESS <br />'Ty EveF<' 7 <br />ZIP PHONE STATE LICENSE <br />MAIL ADDRESS <br />DESCRIBE WORK AND SQUARE FOOTAGE INVOLVED <br />Inert, \\ <br />CITY ZIP PHONE <br />HEATING SYSTEM: N.GAS );1ZLECTRIC Fl <br />CONTACT PERSON AND PHONE NO. <br />— —•\\ <br />f' \L F— L—'uh <br />,�.' -7.5 u.j I s Ttr <br />n-4-N -ock- G'--) Z, `�u <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br />PROPOSED USE OF BUILDING _Z <br />APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT ALL <br />. <br />PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br />WORK WILL BE COMPLIED WITH WHETHER APECIFIED HEREIN OR <br />LEGAL DESCRIPTION OF PROPERTY (SHOWN BELOW OR ATTACH TWC'COPIES) <br />NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME <br />LOT BLOCK OF <br />TO GIVE <br />AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY <br />' <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 />CONTRACTORS LAW 18.27 RCW AND 296.200 WAC. <br />/ (O <br />PARCEL TAX I.D. NUMBER <br />CONSTRUCTION LOAN LENDER. ADDRESS. TELEPHONE NUMBER <br />SIGNATURE DATE <br />CITY BUSINESS LICENSE NO, <br />PLUMBING <br />MECHANICAL <br />NO. TYPE OF E IPMENT FEE <br />NO. <br />TYPE OF FIXTURE OR ITEM <br />FEE <br />WATER CLOSET(TOILET) <br />' <br />BATHTUB <br />LAVATORY (WASH BASIN) <br />; <br />A/C —AMNDLG UNITS —H.P. , <br />FORCED AIR SYSTEMS — B.T.U. M E.A. ' <br />' <br />HEAT PUMP <br />SHOWER <br />' <br />UNIT HEATERS—B.T.U. M <br />CLOTHES DRYERS <br />, <br />KITCHEN SINK & DISP <br />DISHWASHEI; <br />I <br />VENTILATION FAN <br />, <br />LAUNDRY TRAY <br />; <br />RANGE HOOD <br />, <br />CLOTHES WASHER <br />' <br />WATER HEATER <br />' <br />URINAL <br />' <br />WOOD STOVE <br />, <br />, <br />DRINKING FOUNTAIN <br />; <br />METAL FIREPLACE (WOOD BURNING) <br />' <br />FLOOR DRAIN <br />' <br />FIREPLACE INSERT (WOOD BURNING) <br />' <br />BACKFLOW PREVENTERS <br />GAS FIREPLACE <br />' <br />SINK (SERVICE —BAR, ETC.) <br />GAS RANGE <br />, <br />GAS PIPING <br />, <br />EXHAUSTFAN <br />' <br />SUB TOTAL $ <br />SUB TOTAL $ <br />PERMIT $ <br />, <br />PERMIT $ <br />, <br />TOTALFEE $ <br />' <br />TOTAL FEE $— <br />rvn vrrl�C UaC UIYLT: <br />FRONT SETBACK <br />REAR SETBACK <br />SIDE SETBACK <br />PLAN CIIECN NUMBER <br />FEE <br />RECEIPT NO. <br />S-0795 <br />USEZONE <br />LOTAREA VACANT SITE <br />FEES <br />VALUATION <br />FEE <br />T <br />f7VE5 fl NO <br />BUILDING <br />' <br />HEIGHT LIMITATION <br />NO. OF DWELLING SIZE OF BIDGRI <br />' <br />UNITS <br />PLUMBING <br />OCCUPANCY <br />NO or STORIES <br />OCCUPANT LOAD <br />BASEMENT <br />MECHANICAL <br />fIYEB II NO <br />FIRE ALARM REOD <br />REASON <br />ADDITIONAL PLAN CHECK <br />i <br />, <br />, <br />OTHER <br />, <br />, <br />FIRE SPRINKLER RED[)REASON <br />STATE BUILDING SURCHARGE <br />TYPE OF f,ONST <br />PLANS PAR,,OVED BY <br />EVER ETT <br />PUBLIC WORKS <br />I <br />'„ <br />�TAD= <br />7o7A1 <br />I <br />DATE 2 7 S <br />