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APPLIC�TI� N FOR CONSTRUCT DI� PERMIT � <br /> TO BE COMPLETED IN BLACK INK—PLEASE PRINT <br /> HFATING SYSTEM• ❑GAS Q ELECTRIC ❑ — <br /> BUILDING DEPARTMENT <br /> 259-8810 <br /> �( DEMOLITION ❑ COMBINATION ❑ BUILDING ❑ MECHANICAL ❑ PLUMBING ❑ SIGN <br /> WNER MAILADORE55 CITV Z�P PHONE � <br /> U� ,;�,;;.•��i //)210K�f�/,clr"S �`�'J �R��b '`��� ' -�7JIj <br /> / ENANT MAILAUDRE55 ��T� <br /> ARCMITECTORDESIGNEF MAILADDRESS CITY ZIP FHONE <br /> GENERAL CONTPACTOR MAIL AODRESS CITV Z�F PHONE STATE LICENSE N <br /> MECHANICALCONTflACTOR MAILAODRESS CIiV ZIP PHONE STATELICENSEM <br /> PLUMBINGCONTRACTOR NAILADDRESS CITY ZIP PHONE STATELICENSEI <br /> CONTRACT PPICE OF WORK <br /> DESCNI9E WORK AND SOUAFE FOOTAGE INVOLVED CONTACT PERSON NNC PHONE NO. <br /> �t�SS�LLL«�.�zYn fl��C�Gt� <br /> I HEREBY CERTIFY THAT I HAVE READ AND FXAMINED THIS <br /> PROPOSEDUSEOf BJILOING APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT.ALL <br /> PROVISIONS OF LAWS AND ORDINANCES GOVERN�NG THIS TVPE OF <br /> LEGAIDESCRIPTIONOFPflOPERTY�SHOWNBELOWOf7ATTFCMTVJOCOPIES) N�R THELGRA T�ING OF ADPERMITrDOES NOT PR'ESUME TO GIOVE <br /> X�pr-- e�ocK aF AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br /> ��q_��L/� ���� OTHER STATE OR LOCAL LAW FEGULATING CONSTRUCTION OR THE <br /> / /� Z � ��' PERFORMANCE OF CONSTRUCTION.THAT 1 AM AUTHORIZED BY THE <br /> 1 / / R�p/- /,,/)Q OWNER F THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br /> �/ /Z /�PSS S� ^�""`-'`u�rJ /��/ APPLIC TION S MADE AND I COMPLY WITH THE STATE <br /> PARCE �I.o;t+u�ea�/_ � CONTR TORS AW 1 .27 RCW AND 296.200 WAC. <br /> ��lU <br /> CONSTflUCTIONLOR�(�IDEP,AO/Q'F S.TELEPHONENU�MB1EO,/ �f� <br /> .J% 1'V����Z—V� 7 �� � <br /> SIGt URE DATE <br /> � ,PROJECT E S <br /> X CI Y USIN SLILENSENO <br /> PLUMBING C ICAL <br /> FEE O. TYPE OF E�UIPMENT FEE <br /> NO. TYPE OF FIXTURE OR ITEM � <br /> WATER CLOSET(TOILET) � A/�-NHNDLG UNITS—H.P. <br /> BATHTUB ; FORCED AIR SYSTEMS—B.T.U. M E.A. ' <br /> LAVATORY(WASH BASIN) � UNIT HEATERS—B.T.U. M � <br /> SHOWER � CLOTHES DRYERS � <br /> KITCHEN SII�K&DISP � VENTILATION FAN � <br /> DISHWASHER � RANGE HOOD � <br /> LAUNDRV TflAY ; WATER HEATER i— <br /> , WOOD STOVE ' <br /> CLOTHES WASHER � <br /> � METAL FIREPLACE(WOOD BURNING) <br /> URINAL <br /> DRINKING FOUNTAIN � FIREPLACE INSERT ' <br /> FLOOR ORA.IN HEAT PUMP � <br /> BACKFLOW PREVENTERS ', GAS PIPING ; <br /> ROOF DRAINS—RAINLEADERS � EXHAUST FAN _ � <br /> � <br /> SINK(SEflVICE—BAR,ETC.) � ; <br /> � � <br /> ' � <br /> — SUBTO''Al S ' SU6TOTAL $ � <br /> — PERMIT $ PERMIT $ ' <br /> TOTAL FEE $ ' TOTAL F�[ S ' <br /> � <br /> FOR OFFICE USE ONLY: Receiai ruo <br /> pLANCNECKNUMBER FEE <br /> FRONT SETBACK REAR SETBACK SIUE SETBACK , <br /> FEES VALUATION F� EE_� <br /> USE ZONE LOT AREA VACANT SITE � <br /> CI YES ❑ NO BUILDING � <br /> � <br /> IYPEOFCONSi. NO.OFSTORIES O[CUPu&v kOafOwElnkGUNnS <br /> GNOUP pLUMBING <br /> SIZE OF BLDG. FIRE SPRINNLERS REO'U BASEMENT MECHANICAL � <br /> f7 YES ❑ NO � <br /> ADDITIONAL PLAN CHECK ' — <br /> OC;UPANCY IOAU FIRE ALARM REO'0 HEIGHT LIMITATION i <br /> OTHER � <br /> __. <br /> REnSON STATE Bl9LDING SURCHARGE ' <br /> INTANE BY P�ANS APPROVEO BV CITY OF E�.iERE?T PUBUC W�RKS � � <br /> LUCAL SkLES — � <br /> DATE <br /> TAX CODEIS 3105 T0T4L � <br />