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APPLICATIC`1 FOR CONSTRUCT'IN PERMIT <br />TO BE COMKETED IN BLACK INK —PLEASE PRINT <br />BUILDING DEPARTMENT HEATING SYSTEM: )4 GAS ❑ ELECTRIC ❑ <br />259-8810 <br />I-1 DEMOLITION ❑ COMBINATION ❑ BUILDING XMECHANICAL 1-1 PLUMBING ❑ SIGN <br />OWNER MAIL ADDRESS CITY ZIP PHONE <br />J�o.LJ 6q&& gr Il 7.?oS 2 7G w MlQ .J*,y wvso M2 9 Z 6 2 51 S 2 6 / <br />TENANTM,4,t!K MAIL'ADDRESS CITY ZIP PHONE <br />5ff�- ,niac 3111/7 -IsEm4 _�/JFA E✓7-, tgAA. -788 0/2% <br />I ARCHITECT OR DESIGNER MAIL ADDRESS CITY ZIP PHONE <br />GENERAL CONTRACTOR <br />MAIL ADDRESS <br />CITY ZIP <br />PHONE STATE LICENSE# <br />MECHANICAL CONTRACTOR <br />MAIL ADDRESS <br />CITY ZIP <br />PHONE STATE LICENSE <br />�Ol3i�lE� <br />Gfl-Zf S' P�//GF <br />c''Z$ fii.4oL� 9 i t✓T !t <br />✓a ZS5-8199Z (: 6q - <br />PLUMBING CONTRACTOR <br />MAIL ADDRESS <br />CITY ZIP <br />PHONE STATE LICENSE 0 <br />CONTRACT PRICE OF WORK <br />lomwQ O� <br />DESCRIBE WORK AND SQUARE FOOTAGE INVOLVED <br />CONTACT PER AND PHONE NO. _A 187 <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br />APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br />WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br />NOT. THE GRANTING 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 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 fLAW <br />1818.27 R7R/C`W AND 296.200 WAC. <br />Y <br />PROPOSED USE OF BUI'.DING <br />LEGAL DESCRIPTION OF PROPERTY (SHOWN BELOW OR ATTACH TWO COPIES) <br />LOT BLOCK OF <br />PARCEL TAX I.D. NUMBER <br />CONSTRUCTION LOAN LENDER, ADDRESS. TELEPHONE NUMBER <br />PROJECT ADORERS <br />AW-6W4- Qu£. tyr. [y.�t. <br />aKAMTwE r DATE <br />G BU#MEEBI CENSE NO <br />,TV17 <br />PLUMBING <br />MECHANICAL <br />NO. <br />TYPE OF FI"E OR ITEM <br />FEE <br />NO. <br />TYPE OF EQUIPMENT <br />FEE <br />WATER CLOSET (TOILET) <br />' <br />AIC—A(HNDLG UNITS—H.P. <br />I <br />BATHTUB <br />FORCED AIR SYSTEMS --- B.TU M E.A. <br />' <br />LAVATORY (WASH BASIN) <br />I <br />UNIT HEATERS—B.T.U. M <br />SHOWER <br />' <br />CLOTHES DRYERS <br />' <br />KITCHEN SINK d DISP <br />VENTILATION FAN <br />DISHWASHER <br />RA14GE HOOD <br />' <br />LAUNDRY TRAY <br />WATER HEATER <br />CLOTHES WASHER <br />WOOD STOVE <br />URINAL <br />METAL FIREPLACE (WOOD BURNING) <br />' <br />DRINKING FOUNTAIN <br />FIREPLACE INSERT <br />FLOOR DRAIN <br />HEAT PUMP <br />' <br />BACKFLOW PREVENTERS <br />GAS PIPING <br />ROOF DRAINS—RAINLEADERS <br />EXHAUST FAN <br />' <br />SINK (SERVICE —BAR, ETC.) <br />, <br />SUB TOTAL $ <br />SUB TOTAL $ <br />PERMIT $ <br />PERMIT <br />TOTAL FEE $ <br />TOTAL FEE $ <br />' <br />w w ^11T I ICC nul V. <br />FRONT SETBACK <br />REAR SETBACK <br />SIDE SETBACK <br />PLAN CHECK NUMBER <br />FEE <br />RECEIPT NO. <br />USE ZONE <br />LOT AREA <br />VACANT SITE <br />FEES <br />VALUATION <br />FEE <br />BUILDING <br />' <br />I <br />El YES ❑ NO <br />TYPE OF CONST. <br />NO. OF STORIES <br />cauMNcr <br />NO Of pMEILINGUNITS <br />GRWP <br />PLUMBING <br />MECHANICAL <br />' <br />SIZE OF BLDG. <br />FIRE SPRINKLERS RED D <br />BASEMENT <br />❑ YES ❑ NO <br />ADDITIONAL PLAN CHECK <br />I <br />OCCUPANCY LOAD <br />FIRE ALARM RED D <br />HEIGHT LIMITATION <br />i <br />OTHER <br />I <br />REASON <br />STATE BUILDING SURCHARGE <br />PUBLIC WORKS <br />i <br />INTAKE BY <br />PLANS APPROVED By=CODE <br />TOTAL <br />DATE <br />i <br />