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APPLICATIC"'1 FOR CONSTRUCT`1N PERMIT � <br />TO BE COMPLETED IN BLACK INK—PLEASE PRINT <br />� — <br />BUILDING DEPARTMENT HEATING SYSTEM: J GAS ❑ ELECTRIC i] __ <br />259-8810 <br />' DEMOLITION I I COMBINATION BUILDING I! MECHANICAL i; PLUMBING k'SIGN <br />OWNER MAILADDRE55 GiY ZIP PHONE <br />�o�'L.rf �J Qv�lo�vS..r�2��� 11�kr'i�ttc, v�Ur{ �U_ 0►2ff ;�A% �tJJ3 �'J�?S3 <br />TENANT MAi. �DRE55 CITY ZIP PHONE <br />�. _ � �r �_, _-'_ , c��. u�roM1, i�.., c:.� �.'/..._ i. !�h 9stiv� '�u2 _ �a 2r <br />C[NEFAL <br />MAIL <br />MAIL <br />MAI� AODRESS <br />CITY <br />CITY ZIP <br />i # z EuE�t <br />QiY ZIP <br />PNONE <br />PNOrvL Sin�t.UCtrvJt• <br />STATE LICENSE a <br />PI.UTABING CONTRACTOR MAIL 4�ORESS CITY ZIP PHONE STATE LICENSE 4 <br />CONTRACT PRICE OF WOFK <br />i�OD <br />nFSf.RIBE WORK AND SOUAPE FOOTAGE INVOLVED , <br />OF PROPERTv (SNOWN BELOW OR ATTACN l Y!0 COP�ES� <br />— BLOCK OF <br />i.o.NUMeEa <br />CCNSTRUG.IONLOAi2N0Eq ADDR�SS.TELEPHONE <br />PLUMBING <br />WATEP.CLOSET <br />SHOWER <br />KITCHEN SINK & DISP <br />DISHWASHER <br />LAUNDRY TRAV <br />URINAL <br />DRINKING FOUNTAIN <br />FLOOR DRAIN <br />BACKFLOW PREVENTERS <br />SINK <br />$ <br />5 <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br />APPLP�ATION AND KNOW THE SAME TO BE TRUi: AND CORRECT, AlL <br />PRO��ISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br />WOF(K WILL BE COMPI ETED WITH WHETHER SPECIFIED I �EREIN OR <br />NO-i. THE GRANT�NG OF A PERMIT DOES NOT PqESUME TO GIVE <br />AL'THORITV TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br />O'fHFR STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br />FEy�ORA1ANCE OF CONSTRUCTION. THAT I AM AUTHORIZED B'f THE <br />JWNER GF THIS PROPERTY TO PERFORM THE WORK FOR WHICM <br />APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />CONTflACTORS L W 18.27 RCW AND 296200 WAC. <br />x���l_L�ti�cta�'� io- r�2 -G; i <br />sicrvn. onie <br />MECHANICAL _ <br />N0. TVPE OF EOUIPMENT FEE <br />� AiC—AIHNDLG UNITS—H.P. <br />� FORCED AIR SYSTEMS—B.T.U. M E.P. <br />� U'VIT HEATERS—E3.T.11. M � <br />C�.OTHES DRYERS <br />L Vf_NTILATION FAN <br />T <br />R 4NGE HOOD <br />WATER HEATER <br />� WOODSTOVE <br />� METAL FIREPLACE (WOOD BURNING) <br />FIREPLACE INSERT i <br />FOR OFFICE USE ONLY: <br />FRONTSETBA(CK FEAPSETBPCK SIOESETBACN <br />I �l ' � U <br />USE 20NE LOT AREA VACANT SITE <br />� � � - '- YES � � NO <br />ivPE�FCON57 NOAFSTORIES oc[uP�xc ':ao�OwEuihGwuts <br />ceouv <br />SRE OF 9LDG. <br />OCCUP�NCVLOAO <br />FEFSON <br />iNTAH[ PV <br />FIqE SPR� JNLERS REOD <br />0-�i'l <br />BASEMENT <br />' : YES ' -�� NO <br />NLIGHT IIAfITATION <br />LOCAL SALES <br />TAX CODE IS 3105 <br />GAS PIPWG <br />EXHAUST FAN <br />TOTAL 3 <br />NIT $ <br />1L FEE $ <br />PLPN CI� ��� I FEE //. C� <br />BUILDING ' <br />— i <br />PLUMBING <br />MECHANICAL ' <br />� <br />ADDRIOtJAL PLAN CHECK <br />OTHER <br />i <br />SiATE BUILDING SURCHARGE � ji <br />� <br />PUBLIG WORKS <br />TOTAL �j I i 5 <br />