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1 <br />APPLICATION FOR CONSTRUCTION PERMIT <br />TO BE COMPLETED IN BLACK INK —PLEASE PRINT <br />HEATING SYSTEM: ❑ GAS <br />ClELECTRIC <br />BUILDING DEPARTPAENT <br />259-8810 <br />/ <br />1 1 DEMOLITION I I COMBINATION <br />I I BUILDING <br />IV MECHANICAL <br />I I PLUMBING I I SIGN <br />OWNER MAIL ADDRESS <br />CITY <br />ZIP <br />PHONE <br />SIC,D e// S.c EYC72t7T /✓/ijcL <br />/J/� GYGzc 77- <br />TENANT MAIL ADDRESS <br />CITY <br />ZIP <br />PHONE <br />SA.rL 6- <br />ARCHITECT OR DESIGNER MAIL ADDRESS <br />CITY G( �/ut ZIP <br />O <br />2 en N Ph��• �-, <br />PHONE <br />1970(,, 'Z15�- y"2Z -(,13c <br />GENEMLCONTRACTOB <br />MAIL ADDRESS <br />CITY ZIP <br />PHONE STATE LICENSE) <br />�A�\a � • <br />t�•v.�n 4"LZ"T ti�LL�l�l,i__tvJc; <br />So,033 <br />sZ&-OSOD <br />,NFJ:MANICAL CONTRACTOR <br />MAIL ADDRESS <br />CITY ZIP <br />PHONE STAI E LICENSE <br />.E — <br />- /71�G, Sy�i` �✓C L <br />�Aco ��^ 95424 <br />2ca; 522 ro(v44 G2fA/A//-I0i3-It c <br />PLUMBING CONTRACTOR <br />MAIL ADDRESS <br />CITY ZIP <br />PRUNE STATE LICENSE <br />CLASS OF WORK <br />I I I I♦ Inl.l N AITCDATInM I I REPAIR I I nFMOLITION I I WOODSTOVE/FRPL INSERT 1 1 BUILDING RELOCATION <br />CONTACT PERSON AND PHONE NO. <br />CONTRACT PRICE OF WORK �0 /J� % <br />DESCRIBE WORK AND SQUARE FOOTAGE INVOLVED 'TL%T/U L zo <br />,40-0/. /,/7 79 sP�i�k/E2s - PtLIXhT/. /r5 /Zz <br />PROPOSED USE OF BUILDING <br />I HEREBY CERTIFY THAT I HAVE HEAD 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 />.L DESCRIPTION OF PROPERTY (SHOWN BELOW OR ATTACH FOUR COPIES) <br />LOT_ BLOCK OF <br />NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br />AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br />' <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 LAW 18.27 RCW AND 296.200 WAC. <br />Xd - L Z&, // -),// 1"Iel-, 3 — <br />mNATURE / (I pA <br />O <br />PNOJECTA DRESS <br />ES CIIYBUSINSHCENSE NO <br />� <br />�7/ 'C L k. Ll <br />PLUMBING of <br />MECHANICAL <br />NO. <br />TYPE OF FIXTURE OR ITEM <br />FEE <br />NO. <br />TYPE OF EQUIPMENT <br />FEE <br />WATER CLOSET (TOILET) <br />I <br />A/C—A/HNDLG UNITS—H.P._ <br />BATHTUB <br />; <br />FORCED AIR SYSTEMS—B.T.U. M E.A. <br />' <br />LAVATORY (WASH BASIN) <br />I <br />UNIT HEATERS—B.T.U. M <br />i <br />SHOWER <br />' <br />CLOTHES DRYERS <br />! _ <br />KITCHEN SINK & DISP <br />VENTILATION FAN <br />DISHWASHER <br />— <br />RANGE HOOD _ <br />�— <br />LAUNDRY TRAY <br />;_ <br />_ <br />_ <br />WATER HEATER <br />_ <br />CLOTHES WASHER <br />WOOD STOVE <br />i <br />URINAL <br />' <br />METAL FIREPLACE 8 CHIMNEY <br />! <br />DRINKING FOUNTAIN <br />i <br />FIREPLACE INSERT <br />i <br />FLOOR DRAIN <br />' <br />HEAT PUMP <br />' <br />BACKFLOW PREVENTERS <br />i <br />GAS PIPING <br />ROOF DRAINS—RAINLEADERS <br />�— <br />EXHAUST FAN <br />SINE( (SERVICE —BAR, ETC.) <br />' <br />! <br />I <br />I <br />' <br />I <br />I <br />' <br />T <br />I <br />SUB TOTAL $ <br />; <br />—�_ <br />SUB TOTAL $ <br />' <br />PERMIT $ <br />PERMIT _ $ <br />i <br />TOTALFEE $ <br />TOTAL FEE $ <br />' <br />0 / <br />FOR OFFICE USE ONLY: <br />' <br />FRONTSETBACK <br />NEAR SETBACK <br />SIDE SETBACK <br />_� <br />PLAN CHECK NUMBER FEE- i <br />-7/-7-1 &0. as <br />RECEIPT NO. <br />ayo - <br />uSEZONE <br />LOTAREA <br />VACANT SITE <br />FEES <br />VALUATION <br />FEE <br />BUILDING <br />I <br />OF CONTS. ALLOWABLE <br />TYPE OF CONSL ACTUAL <br />0,cupmc <br />NB of DWITINGUNITS <br />Gnnuv <br />PLUMBING <br />' <br />—�_ <br />SIZE OF BLDG. <br />NO. OF SI0RIE5 <br />BASEMENT <br />MECHANICAL <br />' <br />ADDITIONAL PLAN CHECK <br />I <br />OCCUPANCY LOAD <br />FIRE SPRNKLERS NEOD <br />HEIGHT LIMITATION <br />SPRINKLER <br />I <br />REASON FOR SPRINKLERS <br />—� <br />STATE BUILDING SURCHARGE <br />I <br />INTAKE B�IADSAPPnQVFnHY I PITVIIFFIIFnfTT <br />minn.`•nnrc <br />I <br />JM S/7q%1J <br />