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[7e�.�n Oroup <br />;�,�.., <br />ICATION FO�;��� <br />BILL NERISON � S T R U C T 1 O N <br />�._-- �°a�PTA�N pE R11�l.IT <br />'2�gp%64thAVynuaW..SuiCEf200 ETED IN INK- PLEASE PRINT <br />Moundake Terr: ca. WA 98043 [206] 778-65�0 <br />_____,,,_ UILDING ❑ MECHANICAL <br />MAII / <br />MAIL AOORE55 <br />nouv�ess <br />CI1Y <br />� .. . � <br />���,�� <br />e <br />❑ PLUMBING ' ❑ SIGN <br />P�IONE <br />7�5 - z5 �5 <br />PHONE <br />71�p <br />P��ONE uccusF. <br />ynT `Itri �f3.GLTfri7 � . <br />IAECIUH�LnLCONiH4CTOq MAILA�ORE55 Cltt ZIP PIIONE IILENSC• <br />7yLii�= F�b��I '.�.1AP1.TG F�P2li l �' <br />VWMBINGLONiRACtOP MMLP�OR[55 Clrv 21P � PIIONE IICENSE� <br />u � <br />YY NEW ❑ ADDITION ❑ AL7ERATION ❑ REPAIR ❑ DEMOLITION ❑ WOODSTOVE/FRPL.INSERT ❑ BUILD�NG RELOCATION <br />V� W�TION OF WOfiF �COST qF MAIENUL$ PW $ LP�ORI <br />�3 �; nnP1 <br />OESCR�BE WO � <br />4ROPE.liY�SMOWN OEl01YOR <br />LGI_ BLOGI(—_ <br />PLUMBING <br />NO. TYPE OF F�1(TURE OR ITEM <br />WATEP CLOSET �TOILF.T) <br />BATFITUB <br />LAVATOHYIWASHBASIN� <br />NITCMEN SINK 6 OISP. <br />GISHW�SHER <br />LFUNORYTRAV <br />CLOTHES WASHER <br />URINAL <br />ROOF ORAINS — RAINLEAOERS <br />SINK �SERVICE — BAR. ETC.� <br />SUBTOTAL <br />PERMIT <br />TOTAL FEE <br />iPONISEIDRCK _ REAR=ETBACK <br />USF20NE LOTA(1E� <br />C-� 213 � <br />ttPEOFGON T OCCUP NLYGNCI <br />�,� y, z <br />512E Oi BLOG NO OF SIORIES <br />9gPo s� / <br />SI-E SEIBACK <br />VAC�NI :iliE <br />�S'ES OVO <br />N0. OF DIYELLING <br />-s�- <br />ennz occ �ono <br />la3 <br />M V'� I ��.. `"%-2i <br />� <br />I HERE6Y CERTIFY THAT I HAVE HEAD AND EXAMINED THIS AP• <br />PLICATION AN� KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />PROVISIONS OF LAWSAND ORDINANCES GOVERNING THISTYPE <br />OF WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HERE• <br />IN OR NOT. THE GRANTING OF A PEHMIT DOES NOi PRESUME TO <br />GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS UF <br />ANY OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION <br />OR THE PERFORMANCE OF CONSTRUCTION. .. <br />SIGNAIURE OF LONiRACTOR OP AUTHORI2ED AGENT OAtE <br />X <br />MECHANICAL <br />A/C — A/MNOLG UNITS — MP. <br />FEFRIGERATION UNI7S — H.P. EA. <br />BOILERS — B.T.U.MP. <br />GAS fIRED A.C. UNITS — B.T.U. <br />FOiiCED AIR SYSTEMS — B.T.U. <br />WALL MEATERS — B.T.U. ^ <br />UNIT t1EATERS — B.T.U. <br />EVAPORATIVECOOLERS <br />CLOTHESORYERS <br />VENTILATION FAN <br />RANGEHOOD <br />WATER MEATER <br />WOODSTOVE <br />METAL FIRFPLACE 8 CHIMNEV <br />FIREPUICEINSEHT <br />MEAT PUMP <br />GAS PIPING <br />E%HAUSTFAN <br />SI1B TO7AL <br />PERMIT <br />M EA. <br />M <br />M <br />FEE <br />PLANCHECNNUMBER �. �FEE 3 FECEIPTNO. <br />�a��ig ��3 I 7a9� 9�s��o <br />BUIL�ING S <br />PLUMBING <br />MECHANICAL <br />OTHER <br />STATE BUILDING SURCHARG <br />STATEENERGYSURCHARGE <br />PUBLIC WOFKS <br />TOTAL <br />PROPERTY OWNcRS ARE RESPONSIBLE FOR DETERMINING ALL <br />PROPERTY LINE LOCATIONS AND RELATED EASEMENTS. <br />