Laserfiche WebLink
`�EU�� - � CT)NSTRU�TION � - - /� <br /> eve.rett pE�MI'r PERMIT N(Z._.� ��`�" <br /> 259 -8745 <br /> ❑ DEMOLI710N ❑ COMBINATION ❑ BUILDING L�I MECHANICAL ❑ PLUMBING ❑ SIGN <br /> OWNEP MAlLA00RE5S CITY ZIP PHpNE <br /> Vance I. Crumpler P.O. Box 531 Goldbar WA 98257 793-2440 <br /> ARCHITECT OR DESiGNEiI MAIL ADORE55 CITY ZIP PMONE <br /> GENERAL CONTRACTOR MAIL AppRESS CITY ZIP PNONE LILENSE� <br /> NECHANICRLCONTRACTOR MAIL/D�RE55 CITY ZIP PNOkE LICENSEM <br /> PLUMBINGLONTRACTOR MAILqDDRESS CITY ZIP PMONE LICENSE+ <br /> C1A550F WORN <br /> ❑ NEW ❑ ADDITION ❑ ALTERATION O REPAIR ❑ DEMOLITION ❑ BUILDIN3 RELOCATION <br /> VALUATION OF WORK <br /> S <br /> �ESCRIBE WORN <br /> Woodstove installation <br /> IIEAT SOURLE <br /> O ELECTRICITY ❑ GAS O WOODSTOVE ❑ OTHER <br /> PROPOSEO USE OF BUILDING <br /> Single family residence I HEAEBY CERTIFY THAI' I HAVE READ AND EXAMINED THIS <br /> APPLICA?ION AND KNOW THE SAME TO BE TRUE AND <br /> LEGAlDESCRIPT10NOFPFOPEfiTY�5HOW6ELOWORATTACHFOUPCOPIES) CORRECT. ALL PROVISIONS QF LAVJS AND ORDINANCES <br /> �OT_BLOCK _ OF GOVERNING THIS TYPE OF WORK WILL BE COMPLIED WITH <br /> WHETHEfl SPECIFIED HEREIN OR NUT. THE GRA�TING OF A <br /> 4379-438-031-0000 PERMIT DOES NOT PRESUME TO GIVE AUTHORITY TO <br /> VIOLATE OR CANCEL THE PROVISIONS OF ANY OTHER <br /> STATE QR LOCAL LAW REGULATING CONSTRUCTION OR <br /> THE P RFOFMANCE OF CONSTRUCTION. <br /> JOB A RE55 � SIGNA RE O CONTRACTOR.AUTHO FO AGENT,OR OV/ F DATE <br /> �Lombard �I(�� X , + 2/5/87 <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM FEE NO. ?YPE OF EOUIPMENT FEE <br /> WATER CLOSET(TOILET) A/C—A/HNDLG UNITS—HP. <br /> BATHTUB REFRIGERATION UNITS—H.P.EA. <br /> LAVATORV(WASH BASIN) BOILERS—B.T.U.iH.P. <br /> SHOWER GAS FIFEU A�C.UNITS—B.TL. <br /> KITCHEN SINK 8 DiSP. FORCED AIR SVSTEMS—BS.0 1A EA. <br /> DISHWASHER WALLHEATERS—B.T.U. M <br /> LAUN�RYTRAY UNITHEATERS—B.T.U. M <br /> CLOTHES WASHER EVAPORATIVECOOLERS <br /> URINAL CLOTHESDRYERS <br /> DFINKING FOUNTAIN VENTII ATION FAN <br /> FLOOR DRAIN RANGE HOOD <br /> BACKFLOW PREVENTERS W�TER NEATER • <br /> ROOFDRAWS—RAMLEADERS 1 WOODSTOVE 3O O <br /> SINK�SERVICE—BPR.ETC.) METAL FIREPLACE 8 CHIMNEY <br /> FIREPLACEINSEHT <br /> HEAT PUMP <br /> GAS PIPING <br /> EXHAUSTFAN <br /> SUB TOTAL 5 SUB 7'OTAL 3� 0 <br /> PERMIT S PERMIT <br /> TOTAL FEE 5 TOTAL FEE 3O O <br /> FRor+i SETBnCN aEnR SETBaCrc SInE SEiBnCK P�AN CHECK NUMOEP. FEF RECEIPi NO. <br /> USE ZONE LOT AREA VACFNT SITL <br /> ❑ves ❑No fEES VALUATION FEE <br /> TYPEOFCONST. OCCUPANCYGFOUP NOOFOWELLINGUNITS BUILDING :^ <br /> PLUMBING <br /> SIZE OF BLOG NO OF STORIES MA% OLG LOAD <br /> MECHANICAL 3O OO <br /> INVESTIGATION FEE `b'CL���d(e�" F'M OOOiiH.?9J.? �f-F:I:.i: <br /> FIPE SPRINKLERS REOl11RED ❑VES ❑NO <br /> STATE BUILDING SURCHARGE HOOO1774S <br /> S7ATE[NERGY SURCI IARGE y` � � <br /> nPPLICAT10NACC BY PLANSCMECKED9Y APPR FORISSU4NCEBV <br /> �r�"" <br /> DRIVEWAV PERMIT <br /> M.M. TOTAL 30 00 <br /> PF.flMIT VALIDATION <br /> WHEN PROPERLY VALi�ATED(W THIS SPACE)THIS IS YOUR PERMIT <br /> Q� <br /> �r <br /> ti <br /> ti <br /> � <br /> ;�:;��;;.c: :; ; �; E <br />