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APPLiCAiIC�I FOR CONSTRUCT"lN PERMIi � <br />�� 1` TA BE COMPLETED IN BLACK INK—PLEASE PRINT <br />�J <br />BUILDING DEPAFlTMEfST f�EATING SYSTEM: ❑ GAS ❑ ELECTRIC ❑ <br />2�9-8810 / <br />❑ DEMOLITION ❑ COMBINATION ❑ BUILDING ❑ MECHANICAL �LUMBING ❑ SIGN <br />OW1�ER � , l�1P,ILAODRESS _ , , �Iry ZIP , HONE . <br />rrnnni mni4yWHt5J ' GITY �*L.I� ZIP PHONE -" <br />��"is�tibai,�i J�(. S+1C 1EJ�- thY� i�✓�¢i[n" _ <br />AFCHRECTORDESIGNER MAILADDflE55 GTY 21P PHONE <br />GEIJEflFL CONTRALTOR MAIL ADDflE55 CITY ZIF PHONE STATE LICENSE P <br />% 1 c o,.� � FZ -�/3 00 <br />MECHANICALCONTRACTOR MAILFDDflE55 QTV ZIP PHONE STATELICENSEa <br />PLUMOING CONiPPCTOR <br />CONTHPCT PRICE OF WORK <br />750'= <br />DESCflIBE WORN AN� Sq(�$ <br />PROPOSED USE OF BUILOING <br />iNvo�veo <br />LEGAI DESCfiIPTION OF PROPERTY (SHOWN BELOW OF FTTACH TWO COPIES� <br />LOT BLOCK OF <br />PARLELTAXLD.NUMBER <br />CONSTRUGTION LOAN LENDER, ADDRESS, TE�EPHONE Nl1MBER <br />NO. � TYPE OF FIXTURE OR ITEM <br />WATER CLOSET (TOILETI <br />LAVATORY <br />KITCHEN SINK & DISP <br />DISHWASHER <br />LAUNDRYTRAY <br />CLOTHES WASHER <br />URINAL <br />DRINKING FOUNTAIN <br />FLOOR DRAIN <br />EACKFLOW PREVENTERS <br />SINK <br />FOR OFFICE USE ONLY: <br />FRONT SET9ACK REPR SETBACI: <br />USE ZONE <br />TVPE Oi WNSi <br />SIZE OF BLDG. <br />OC W PAYC! LOAD <br />REASJN <br />INT�NE BY <br />PERMIT $ <br />TOTAL FEE $ <br />LOT AREA <br />NO. OF STORIES <br />FIqE SPRNKLERS RE�'D <br />FIRE AIARlA REO'0 <br />PLANSAPPFOVP:BV <br />OATE <br />SIOE SETBACN <br />VACANT SITE <br />❑ YES ❑ NO <br />a:uvnrvc+ i:a ovownuxr,uxns <br />cna o <br />BASEMENT <br />❑ YES � NO <br />HEI3MT UMITATION <br />IS 3105 <br />ZIP PHONE STATELICENSEs <br />CONTACT PERSON AND PHONE NO. <br />I HEREBY CERTIFY THAT I HAV� FEAD AND EXAMINED THIS <br />APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />PROVISIONS OF LAWS AND ORD�NANCES GOVERNING THIS TYPE OF <br />WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br />NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br />AUTHORITY TG VIOLATE OR CANCEL THE PROVISIONS OF ANY <br />OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br />PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br />OWNER OF THIS PflOPERTY TO PERFORM THE WORK FOR WHICH <br />APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />CONTRACTORS LAW 1827 RCW AND 296200 WAC. <br />,� --� � le. ��t /�o �4y <br />SIGNATpPED�LL� ♦ � O�iE <br />T roi,. <br />CITV BUSMESS LiCENSE NO. <br />A/�AIHNDLG UNITS—H.P. � <br />FORCED AIR SYSTEMS—B.T.U. M E.A. � <br />UNIT HEATERS—B.T.U. M ; <br />CLOTHES DRYERS � <br />VENTILATION FAN ' <br />RANGEHOOD � <br />WATER HEATER ' <br />WOOD STOVE � <br />METAL FIREPLACc jW00D BURNING) � <br />FIREPLACE INSERT . ; <br />HEAT PUMP � <br />GAS PIPING ' <br />EXFIAUST FAN � <br />BUI! DING <br />PLUMBING <br />MECHANICAL <br />ADOITIONAL PLAN CHECK <br />OTHER <br />STATE BUILDING SURCHARGE <br />PUBLIC WORKS <br />TO7AL <br />FEE <br />PERMIT $ <br />TOTAL FEE $ <br />N <br />i <br />i <br />i <br />