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APPLICATIC"t FOR CONS�'RUC:T rN PERMIT � <br /> , 1 TO BE COMPLETED IN BLACK INK—PLEASE PRINT <br /> ,;pJ <br /> BUILDING DEPARTMENT �ATING SYSTEM: ❑GAS [�ELECTRIC J 1 <br /> 259-8810 <br /> DEMOLITION � I COMBINATION I i BUILDING I !MECHANICAL PLUMBING �SIGN <br /> 01Yt�ER , • , IAILADDPC55 CI Y___�� FDI�� .___9��s /`-�.� <br /> T[NANT h",Il qDDRE55 71TV 21P PHONE � <br /> f+OQtN�WES7S�.l�/o CG I SE. EU td �ii Fv _ G�A.9P2s� 3SS-a8na <br /> dFLXITECTOR0E51GNER M�ILAOORESS C'TY ZIP PHONE � <br /> GENER4LGONTR4CiGfi MAILFDDRESS GI7V ZIP PHONE STAT[IiCENSE� • <br /> �ir___�_Ncvr� lr�c• Po,gd�S1�g �5x��we.g G✓r� 9$a�!` 7�6•8�3s Ize2�.v�co����., <br /> MECHni::^nLCON!RACTOR AINLADDRE55 CRY ZIP P110NE ST�TELICENSE• <br /> PLUMOINGGONTflACTOR AIFILADDRESS CITY ZIP PHONE STATELICENSEY <br /> C�TRACT PRICE OF WORK <br /> /yyo,Do <br /> D�CR16E WONN FND UQR[FOOTA�/INVOLVE3�i" �� CONTFCT PERSON ANO PHONE NO <br /> S � 2) �s x 3•9 A�N ga��N6�/ <br /> /lWA, �a nrL �6 � — <br /> i HEREBY CERTIFY ?HAT I HAVE READ AND EXAMINED THIS <br /> PROPOSEDU'iEOFDUIL�ING APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT.ALL <br /> � GL/A//G PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br /> LEG�LDESGRIPTIONOFPROPERTV�SHOWNOELOWORATTACHiWOCOPIES� WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br /> �f?C.I�j7 NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br /> �ot n�otk`� oF AUTHORITY TO VIOLATE OR CANCEL THE PiiOVISIONS OF ANY <br /> GTHcR STATF OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br /> - PEHFORMANCE 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 CON,PLY WITH THE STATE <br /> PPRCEL iAX I D NUM�EN c CONTRACTORS LAW 18.27 R AND 296200 WAC. <br /> �2 � �� �) ��0�� <br /> CONSTRUGTIONLOANIENDFR,ADDRESS TELEPNONCNUMBEA <br /> � ' � -- <br /> PROJECTADDRESS s�cr+.nm�r � � o+� <br /> u CIivPU51N65UCtN5CN� <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM FEE N0. TYPE OF E�UIPMENT FEE <br /> WATEH CLOSET(TOILET) � NC—A�HNDLG UNITS—H.P. � <br /> BATH7UB ' FORCED AIR SYSTEMS—B.T.U. M E.A. ; <br /> LAVATORY(WASH BASIN) � UNIT HEATERS—B.T.U. M � <br /> --�— <br /> SHOWER ' C�OTHES DRYERS ' <br /> KITCHEN SINK 8 DISP � VENTILATION FAN � <br /> _�— <br /> DISHWASHER � RANGE HOOD <br /> LAUNDRV TRAY ; WATER HEATER <br /> CLOTHES WASHEF WOOD STOVE <br /> URINAL ' METAL�IREPLACE(WOOD BURNING) ' <br /> DRINKING FOUNTAIN FIREPLACE INSERT __T <br /> FLOOR DRAIN I1EAT PUMP ' <br /> BACKFLOW PREVENTERS ; GAS PIPING <br /> ROOF DRAINS—RAINLEADERS � EXHAUST FAN <br /> SINK(SERVICE—BAR,ETC.) � <br /> � ' <br /> — � � <br /> � <br /> SUBTOTAL S SUB?OTAL 5 <br /> PERMIT S PERMIT $ � <br /> 70TAL FEE $ TOTAL FEE S ' <br /> FOR OFFICE USE ONLY: <br /> FRONTSETB�CK AEARSETBACN SIDESETBACN PLANCMECNNOIdBER FEE � RECEIPT�NO�� <br /> 7 ��� <br /> use mNE,� wT naEn VACANT SITE FEES VALUATION FEE <br /> �� � 'l YES '�� NO — � , <br /> BUILGING <br /> TYPEOFCONSf NO.OFSTOR�ES aturA,tv non�CmRUNaUNrtS � <br /> r.nouv PLUMBING i <br /> SIZE Of�LDG. FIRE SPRINHLEflS AEO'D BASEMENT MECHANICAL � <br /> I� YES "�� NO - <br /> OCCUPANCV LOA� FIRE ALARIA REOD HEIGHT LIIAITAiION ADDITIONAL PLAN CHECK i <br /> O7H8R i <br /> REASON � r <br /> STATE BUILOING SURCNARGE <br /> INTAKEAV PLAt�S�PPiiOVEDBV CIT�"�Ij EVE9ETT PUCLICWORKS <br /> JM LOCi:I SALES <br /> p�,� ��,�� � TAX CODE IS 3105 rorn� <br /> T <br />