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APPLICATIC-1 FOR CONSTRUCT' IN PERMIT <br />2 TO BE COMPLETED IN BLACK INK —PLEASE PRINT <br />HEATING SYSTEM: U GAS IJ ELECTRIC <br />BUILDING DEPARTMENT <br />259-8810 <br />❑ DEMOLITION ❑ COMBINATION I-i BUILDING MECHANICAL PLUMBING SIGN <br />OWNER `MAIL ADDRREE+SS /�I'�}� '^CITY' I ZIP PHONE ��-���0 <br />TEND (�O A IAI�ADO Jc 1.-VI..VC6 I 1 V�`-'� �l.��Zl� "PHONE It <br />� J <br />ESS <br />it It <br />ARCHITECT OR DESIGNER MAIL ADOflE55 CITY ZIP PHONE <br />GENERAL CONTRACTOR MAIL ADDRESS CITY ZIP PHONE STATE LICENSE <br />J Im- =N MIRK 6� 0% cjD <br />MECHANICAL CONTRACTOR MAIL ADDRESS CITY ZIP PHONE STATE LICENSE It <br />PLUMBING CONTRACTOR MAIL ADDRESS CITV ZIP PHONE STATE LICENSE s <br />� _1 <br />nill� n�9—/dl �. IICT .o. D/n092h <br />iS IT) <br />{ U <br />"I! <br />_n <br />GY <br />CON TRACT PRICE OF WORK Ito, <br />DESCRIBE WORK AND SQUARE FOOTAGE INVOLVED <br />CONTACT P S AND PHON I <br />U 5 <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br />APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />PROPOSED USE OF BUILDING <br />PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br />WORK L BE COMPLETWITH ENOT <br />LGRANTING <br />ATTACH TWO COPIES) <br />LEGAL DESCRIPTION OF PROPERTY (SHOWN BELOW OR <br />PRIESUME'TOFIED <br />NOT THE OF A PERMIT DOES GIVE <br />BLOCK OF <br />AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br />LOT— <br />OTHER STATE OR LOCAL LAIN 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 LAW 18.27 RCW AND 296.200 WAC, <br />PARCEL TAX I.O. NUMBER <br />n <br />CONSTRUCTION LOAN LENDER, ADDRESS, TELEPHONE NUMBER <br />PROJEC ADDRES <br />Cv <br />o oeiE <br />LIiY OOS W ESS LICENSE NO <br />PLUMBING <br />MECHANICAL <br />FEE <br />NO. TYPE OF FIXTURE OR ITEM <br />FEE <br />NO. TYPE OF EQUIPMENT <br />WATER CLOSET (TOILET) <br />AIC—A/HNDLG UNITS—H.P. <br />_ <br />FORCED AIR SYSTEMS—B.T.U. M E.A. <br />BATHTUB <br />/ <br />UNIT HEATERS—B.T.U. M <br />LAVATORY (WASH BASIN) <br />1 <br />SHOWER <br />CLOTHES DRYERS <br />KITCHEN SINK 8 DISP <br />VENTILATION FAN <br />DISHWASHER <br />_ <br />RANGE HOOD <br />LAUNDRY TRAY <br />; <br />WATER HEATER <br />CLOTHES WASHER <br />WOOD STOVE <br />' <br />' <br />METAL FIREPLACE (WOOD BURNING) <br />URINAL <br />FIREPLACE INSERT <br />DRINKING FOUNTAIN <br />FLOOR DRAIN <br />' <br />HEAT PUMP <br />BACKFLOW PREVENTERS <br />; <br />GAS PIPING <br />ROOF DRAINS—RAINLEADERS <br />' <br />EXHAUST FAN <br />_ <br />SINK (SERVICE —BAR, ETC.) <br />T <br />I <br />' <br />SUB TOTAL <br />$ <br />.0 <br />SUB TOTAL $ <br />PERMIT <br />$ <br />1 <br />PERMIT $ <br />TOTAL FEE <br />$ <br />TOTAL FEE S <br />FOR UhhlGt UbC <br />FRONT SETBACK <br />UI ILT: <br />REAR SETBACK <br />SIDE SETBACK <br />PLFN CH C{I NUMBER <br />/CC/YY� <br />FEE <br />RECEIPT NO. <br />USEZONE <br />LOTAREA <br />VACANT SITE <br />❑ YES ❑ NO <br />FEES <br />VALUATION <br />FEE <br />BUILDING <br />_ <br />TYPE OF CONST. <br />NO. OF STORIES <br />mwPANGY <br />GROUP <br />NO OF MUING UNITS <br />PLUMBING <br />SIZE OF BLDG. <br />FIRE SPRINKLERS <br />BASEMENT <br />❑ YES ❑ NO <br />MECHANICAL <br />ADDITIONAL PLAN CHECK <br />' <br />OCCUPANCY LOAD <br />FIRE ALARM RED <br />HEIGHT LIMITATION <br />OTHER <br />i-- <br />REASON <br />STATE BUILDING SURCHARGE <br />PUBLIC WORKS <br />INTAKE BY <br />LANS APPROVED By=TAXCODE <br />TDATE <br />EVER' <br />S <br />105 <br />TOTAL <br />i <br />