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APPLICATI�._J FOR CON�TRUCT )N PERMIT � <br /> TO BE COMPLETED IN BLACK INK—PLEASE PRINT <br /> HEATING SYSTEM� �!GPS '�LECTRIC U � <br /> BUILDING DEPARTMENT <br /> 259-8810 <br /> '�. ! DEMOLITION L; COMBINATION I 1 BUILDING I 1 MECHANICAL ❑PLUMBING Ll SIGN <br /> QµryEp MRILA�OA[ti5 CIIY ZIP P��ONE <br /> %a�c�,�-�N Li��+��<<-K �foz •-,.rrr��"�� 9$�.�� z5L-4S�N <br /> IENFNi MALLApORE55 GiY ZIP PHONE <br /> 4iiCHrtECTOfl�ES�GH[N NAII�DNE55 LIr Z�� P�� <br /> GLN[MICONiP4Ci0P MAIL�O�AE55 CRY ZIP PNONE SUiEIICENSE! <br /> MCCr1ANILALLCNLPELTOF MMlAOCR[55 d� CRV bP PMOME STAtEII�ENSE� <br /> '/jh�.i.! /.x'it L%�'�T�c1UT �O �"✓-�c-7T 9�LC-�l if•3�i�/4 �7��'�Nnqyv_[. <br /> PLU1A0!NGCIXliFACiOP MAILACORE55 CIiY ZIP bE � E <br /> GCY1RACiPRICEOF WOPN <br /> iono <br /> i�c scnieE wonx nu:,sourAc Foo*nce wvoiveo cor+rncr vcnsorv nNo allovE rw <br /> 1 NEREBY CERTIFV THAT I HAVE REAO AND E%�MINED THIS <br /> rnorosenuse or emio:ec APPLICATION AND HNOW THE SAME TO BE TRUE AND CORRECT.ALL <br /> /� ).� ��� Fq�����.J PROVISIONS OF LAWS O.ND ORDINANCES GOVERNING THIS TYPE OF <br /> iccn�oescwrrwnorvaoPeettisNowrvoe�owoaarrecHrnocowes� NOT T ELGRAN NG OF ADPERMITJUOESENOT PRIESUTAEETO GNE <br /> io* e�xx aF pUTHORITV TO VICLATE OR CANCEL THE PROVISIONS OF ANV <br /> OTHEfl STATE Ofl LOCAL LAW REGULATING GONSTRUCTION OR TNE <br /> - PERFORMANC[OF CONSTRUCTION.THAT I Ald AUTHOR�ZE�BV THE <br /> OWNER OF THIS PROPEi7TV TO PERFOFM iHE WORK FOR WNICN <br /> APPLILATION IS h7ADE AND 1 COldPLV WITH THE STATE <br /> rn�rceunx i o r+uuoee CONTPACTORS LAIV 1827 PCW AN0:96200 WAC. <br /> COt41ROCilONIOANLENOEN.���flE55.1[LEFHONENIIMBER ' � � J� � <br /> � %�– <br /> - nn� <br /> PROJECT A�OflE55 '�"" --- <br /> P -L Le7///�AF�iJ cu.ous��nss.�a�+seuo <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE Ofl ITEM FEE NO. TVPE OF EDUIPMENT FEE <br /> WA7EP CLOSET�TOILET) A'C-A�HNDLG L1NIT5-M.P <br /> BATH7UB FORCEDAIRSVSTEIA$-B.LU. M E.A. <br /> LAVATORV IWASH BASIN) UNIT HEATERS-B.TL. Id <br /> SHOWER ClO1HE5DRYEFS _ <br /> KITCHEN 91NK 8 DISP VENTILATION FAN <br /> OISHWASMER RANGE HOOD <br /> LAUNDfiV TRAV 1YATER HEATER <br /> CIOTfi[S VlASHER WOOD STOVE <br /> URINAL MEtAI FIPEPLACE�WOOD BI/RNING� <br /> ORINNING FOIJNTAIN FIREPLACE INSERT <br /> FLOOR DRAIN HEAT PUMP <br /> BnCKFLOW PREVENTERS GAS PIPING <br /> ROOF DRAINS-flPINLEADERS EXHAUST FAN <br /> SINK(SERVICE-BAfl,ETC.) <br /> —T <br /> SUBTOTAL 5 SUBTOTAL S <br /> PERMIT 5 PERMIT 5 <br /> TOTALFEE S TOTALFEE 5 —T- <br /> FOR OFFICE USE ONLY: <br /> �RONLSElOACN Nt>RS(1PAC6 SIpESHBAGN VLANG�EIXNWI061 iEE RECEiGiNO <br /> J <br /> i;Ezm�E io.nAen vecne*sne FEES VALUATIDN FEE <br /> ❑ VES ' � NO BpILOING <br /> ivGFOILON51 NOOFSiOPiES nuunr�;v wwoMunr,ux�s <br /> cnao pWMBING <br /> 54EOFOlW RPESFRMKL[FSPEa'� 0�SE4ENi MECHANICAL <br /> ❑ VES ❑ NO <br /> CCCUGANLVLMO FIIIEI.LAPAIRWO NEIGNTLIMIiAIIINI AOOITIONRLPIANCHECK <br /> OTHEfl <br /> f1EAWN <br /> SiATE BUILDING SURCHARGE <br /> iN1pNCBY VUNSFPPFOVEDBV CITYOFEVEBETi PUOLICWORN$ <br /> LOCAL SALES <br /> �„�� TA%C�DE IS 3105 TOT^� <br />