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APPLICATIO FnR CONSTRUCT��`N PERMIT � <br /> TO BE COMPLETED IN BLACK INK—PLEASE PRINT <br /> BUILDING DEPARTMENT HEATiNG SYSTEM: ❑GAS ❑ELECTRIC CI —� <br /> 259-8810 <br /> ❑ DEMOLITION C3�COMBINATION I-1 BUILDING :7 MECHANICAL ❑PLUMBING ❑ SIGN <br /> OWNER I.IAILA�DRE55 CITY ZIF PHONE ZJ�, (�,+.�'l(�-l/ <br /> �,�,ufr M.F A4�sfaklFrS c�0 �..^�Doulr��►5G, �InP�M �uAn#F.��s5'�L-,r✓EI2 d�ll I��"��10 (��uE,�UE�.�'� <br /> TENANT MRILADDPE55 CITV ZIP PHONE <br /> hlellov� yYlotii�a� .mM�r,+n^M_. <br /> ARCHITECTOHDESIGNEH MRILADDHESS GT'/ ZIP PHONE <br /> 1�.1� t��c�,r.� »� �ia.�- �icvs ��`'sr �t��� ,��"'` u� �2�� C�3�aRs -r�i� <br /> �iENERALCONTRACTOR MAILAODRESS n CITY ZIP PHONF $TATELICENSE� <br /> �j�A���K�I/fti��CU_ �W��J1A� �''�K IIlDl1A./(�l'�� 1��7 �1.�.��' <br /> MECHANICAL CONTRACTON MAIL ADDRESS CITY 21P PHOITE STATE UCENSE� <br /> PLUMBING CONTRACTOR AIAIL ADDRESS GTY ZIP �'HONE S7ATE IICFNSE� <br /> CONiRACT PRICE OF WO K <br /> � ��'lUO, / <br /> D�,CRIBE WOP R D S�URRE FOOTPGE INVOWED , � CONTAGT PERSON AND PHONE NO. <br /> �� , s�p{Yni,n�,4� C�3� 2�S- I"71� <br /> '�'fi�^`' <br /> t HEREBI' CERTIFY THAT I HAVE READ AND E%AMINED THIS <br /> PROPOrSEDtiSE OF BWLDING APPLICATION AND KNOW THE SAME TO BE TRUE ANC CORRECL ALL <br /> ,(�XI LD IA. PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TVPE OF <br /> LEGALDESCRIPTIONOFPROPERN�SHOWNBELO'NOf7ATTACHTWJCOPIES) WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br /> NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br /> ��T B�°CN oF AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br /> �� ��.t I OTHER STATE OR LOCAL lAW REGULATING CONgTRUCTION OR THE <br /> � PERFORMANCE OF CONSTRUCTION.THAT I AM AUTHORIZED BY THE <br /> OWNER OF THIS PROPERTY TO PEFFORM THE WORK FOR WHICH <br /> APPLICATION IS MADE AND I COMPLY WITH THE �TATE <br /> P�RCEL TAX I.D.NUMBER C'�NTRACTORS LAW 18.27 RCW AND 296200 WAC. <br /> 2- 0 3 - 005 -000� i� <br /> CONSTRUCTRJK LOAN LEN�ER.ADDRE55.TELEPMONE NUNBER � <br /> i <br /> I I I�E DDRESS _TC YY1Pf� �lly� A� s�cruiunE o�re <br /> W� ,1{� �IY� LIiVBU5ME55L�LEN NO <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF flIITURE OR ITEM FEE N0. TYPE OF EOUIPMENT FEE <br /> WATER CLOS�T(TOILET) � FUC—A/fINDLG UNITS—H.P. � <br /> BATHTUB ; FORCED AIR SYSTEMS—B.T.U. M E.A. ' <br /> LAVATORY�WASH BASIN) � UNIT HEATERS—B.T.U. M � <br /> SHOWER CLOTHES DflYERS ' <br /> KITCHEN SIPIK 8'�ISP � VENTILATION FAN �_ <br /> � DISHWASHER � RA4GE HOOD ' <br /> LAUNDRYTRAY ; WATERHEATER _ ` <br /> CLOTHES N'ASHER � WOOD STOVE � <br /> URINAL ; METAI FIREPLACE(WOOD BURNING) ' <br /> DRINKING fOUNTAIN � FIREPfACE INSERT �_ <br /> FLOOR DR.11N � HEAT PUMP ' <br /> BACKFLOW PREVENTERS � GAS PIPING � <br /> ROOF DRAINS—RAINLEADERS EXHAUST FAN � <br /> � <br /> SINK(SEFVICE—BAR,ETC.) � <br /> � <br /> , ' — <br /> i <br /> � <br /> � <br /> SUB TOTAL 5 ' SUB TOTAL S ' <br /> PERMIT S PERMIT S � <br /> TOTAL FEE $ ; TOTAL FEE 5 ' <br /> F1'IR OFFICE USE ONLY: <br /> FRONT SETBACK FEAR SETBACK SIDE SETBACH PLA�ECH NUMBER FEc RECEIPT NJ. <br /> ! <br /> use zot+e LOT AREA VFCANT SITE FEES VALUATION FEE <br /> ❑ YES !7 NO BUILDING ?j � �)� � � <br /> ttPEOFCON57 NO.OFSTORIES ottursqtr x00iVMluxtuxn5 i <br /> �"Wv pLUM91NG • � <br /> T.l. <br /> SIZEOFBLD+. FIRESPRMKLERSREO'D BASEMENT MECHANICAL � <br /> IZZD T.i• `(t� ❑ ves � No � <br /> OCCUPANCVIOAD FIREALARMREUO MEIGHTLIMITATION ADDITIONALPLANCHECK � <br /> Y�� ' <br /> �f T�. OTHER i <br /> REASON ��� <br /> l�jl/ris'l l/G i1Jb'77'fn STATE BUILDING SURCHAAGE <br /> f/!`t�71 �nro `^J-i r•-.' 1 i <br /> WTANE�Y PLANSAPPROVEDBV CITYOFEUEAETT PUBUCWORKS � <br /> JM LOCAL SALES -T- <br /> DAiE -� ;J TAX CODE IS 3105 TOTAL / /�' :�G� <br />