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CITYOF <br />green C ON S Y YO `kJ C� � I' ! <br />v r ttPERMIT e e e <br />BUILDING DEPARTMENT <br />259-8745 TO BE COMPLETED IN INK- PLEASE PRINT <br />❑ DEMOLITION ❑ COMBINATION ❑ BUILDING ❑ MECHANICAL APLUMBING ❑ SIGN <br />OWNE(�R MAILADDRES`. CITY ZIP PHONE <br />MI fit h 1J4, c;Nfilt. WA 9810_� to ­�Ll-�L'l��n <br />ARCIUTECT OR DESIGNER <br />MAIL ADUHEs. <br />cu, GIY <br />rnuXc <br />GENERAL CONTRACTOR <br />MAIL ADDRESS <br />CITY ZIP <br />PHONE LICENSE• <br />MECHANICAL CONTRACTOR <br />S ,rrt „ a MC <br />MAIL ADDRESS <br />N,A,uA� I63S <br />1I I� <br />)a <br />CITY ZIP <br />Avg N�•, ��A�i�t,wn g8ru <br />PHONE LICENSE• <br />.3b4 3(Dab 1(oI a7 <br />PWMSWGC@ITRACTOR <br />MAIL ADDRESS <br />CITY ZIP <br />PHONE LICENSE• <br />SP/Dfe/Jla /(aqp <br />G�LjASS OF WDRK <br />i NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ DEMOLITION Cl WOODSTOVE/F'9PL.INSERT ❑, BUILDING RELOCATION <br />VALUATION OF WORK (COST OF MATERIALS PLUS LABOR) <br />La mA, Llj.r <br />USE OF BUILDING <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS AP- <br />PLICATION AND KNOWTHE SAMETO BE TRUE AND CORRECT. ALL <br />PROVISIONSOF LAWSANO ORDINANCES GOVERNING THISTYPE <br />OF WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HERE - <br />IN OR NOT. THE GRANTING OFAPERMITDOESNOT PRESLMETO <br />GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS Or <br />ANY OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION <br />OR THE PERFORMANCE OF CONSTRUCTION. <br />SIGNATURE OR OR AUTHORIZED AGENT DATE <br />X �I2(6'Co <br />LEGAL DESCRIPTION OF PROPERTYIDHOWN BELOW OR ATTACH FOUR COPIES) <br />LOT — BLOCK _0F _ <br />CI ar' <br />Fry J.'EC I ADJiLSo <br />- <br />I YOZ Sit�l 1'�nu IA31q -S 0(jI o <br />PLUMBING <br />APPLICANTS CITY BUSINESS LICENSE NO. <br />MECHANICAL <br />NO. <br />TYPE OF FIXTURE <br />Y,Q FEE <br />NO. <br />TYPE OF EOUIPMENT <br />FEE <br />WATER CLOSET (TOILETI <br />_ <br />AIR COND. UNITS—H.P. EA. <br />_ <br />BATHTUB <br />REFRIGERATION UNITS—H.P. EA <br />_ <br />LAVATORY (WASH BASIN) <br />BOILERS—H.P. EA. <br />SHOWER <br />GAS FIRED A.C. UNITS —TONNAGE EA <br />KI FCHEN SINK d DISP. <br />FORCED AIR SYSTEMS—B.T.U. MEA <br />DISHWASHER <br />WALL HEATERS—B.T.U. M <br />LAUNDRY TRAY <br />UNIT HEATERS—B.T.U. M <br />_ <br />CLOTHES WASHER <br />EVAPORATIVE COOLERS <br />--WATER <br />HEATER <br />CLOTHES DRYERS <br />_ <br />URINAL <br />VENTILATION FAN <br />DRINKING FOUNTAIN <br />RANGE HOOD <br />_ <br />FLOOR DRAIN <br />AIR HANDLING UNIT— C.F.M. <br />VACUUM BREAKERS <br />STOVE <br />ROOF DRAINS—RAINLEADERS <br />METAL FIREPLACE B CHIMNEY <br />SINK SERVICE —BAR. ETC.) <br />WOODSTOVE/FIREPLACE INSERT <br />SUBTOTAL <br />SUBTOTAL 5 <br />PERMIT 5 <br />PEflM1T S <br />TOTAL FEE S <br />vv <br />TOTAL FEE S <br />so <br />THIS PORTION TO BE COMPLETED BY BUILDING DEPT. PERSONNEL_ <br />FRONT SETBACK <br />REAR SETBACK <br />SIDE SETBACK <br />PLAN CHECK NUMBER <br />PLAN <br />CHECK FEE <br />FEE <br />RECEIPT NO. <br />USEZONE <br />LOT AREA <br />VACANT SITE <br />FEES <br />VALUATION <br />FEE <br />OYES ONO <br />TYPE OF CONST. <br />OCCUPANCYGROUP <br />I NO. OF DWELLING UNITS <br />_ <br />BUILDING S <br />SIZE OF OlOO <br />NO. OF STORIES <br />MAX OCC. LOAD <br />PLUMBING <br />FIRE SPRINKLERS REQUIRED ❑ YES ❑ NO <br />MECHANICAL <br />OTHER <br />PENALTY <br />APPLICATION ACC. BY <br />M-M ' <br />PLANS CHECKED BY <br />APPR. FOR ISSUANCE BY <br />_ <br />TOTAL <br />