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APPLICATICA FOR CONSTRUC7.ON PERMIT <br />TO BE COMPLETED IN BLACK INK —PLEASE PRINT 4= <br />HEATING SYSTEM: ❑ GAS <br />❑ ELECTRIC <br />❑ _ <br />BUILDING DEPARTMENT <br />259-8810 <br />J DEMOLITION LJ COMBINATION <br />l J BUILDING <br />MECHANICAL I-1 PLUMBING CI SIGN <br />OWNEfl MAIL ADDRESS <br />CITY <br />ZIP <br />a�aol <br />PHONE <br />a59-ato"1-7 <br />TENANT MAIL ADDRESS <br />CITY <br />ZIP <br />PHONE <br />i <br />ARCHITECT OR DESIGNER MAIL ADDRESS <br />CITY <br />ZIP <br />PHONE <br />GENERAL CONTRACTOR MAIL ADDRESS <br />CITY <br />ZIP <br />PHONE STATE LICENSE# <br />t <br />rt <br />is MECHANICAL CONTRACTOR MAIL ADDRESS <br />CITY <br />ZIP <br />PHONE STATE LICENSE a <br />r <br />Y PLUMBING CONTRACTOR MAIL ADDRESS <br />CITY <br />ZIP <br />PHONE STATE LICENSE <br />E�I <br />9 <br />CLASS OF WORK ,T,nNI I I wnnnRTnUFiFRPL INSERT I -! SUILDING RELOCATION <br />LI NtW I AIJUI IIUI4 .._...... <br />CONTACT PERSON AND PHONE NO. <br />`'.� <br />b <br />CONTRACT PRICE OF WORK L,J V <br />DESCRIBE WO KK��1��SQUARE FOOTAGE <br />. INVOLVED <br />o i c/ <br />. <br />no ci <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br />PROPOSED USE OF BUILDING <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 />LEGAL DESCRIPTION OF PROPERTY (SHOWN BELOW OR ATTACH FOUR COPIES) <br />BLOCK of <br />NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br />LOT <br />AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br />OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br />PERFORMANCE OF CONSTRUCTION. THAI 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 />X <br />GI -NA DATE <br />PROJECT ADCRESS <br />35OLk Lom ncc� �vere l� �t� ail <br />_ <br />TYBJY sG ucENGE NO <br />PLUMBING <br />FEE <br />MECHANICAL <br />NO. TYPE OF EQUIPMENT FEE <br />NO. TYPE OF FIXTURE OR ITEM <br />, <br />WATER CLOSET (TOILET) <br />I <br />AIC—A HNDLG UNITS--H.P. <br />' <br />FORCED AIR SYSTEMS—B.T.U. M E.A. <br />' <br />BATHTUB <br />UNIT HEATERS—B.T.U. M <br />' <br />LAVATORY (WASH BASIN) <br />I <br />SHOWER <br />CLOTHES DRYERS <br />KITCHEN SINK & DISP' <br />' <br />VENTILATION FAN <br />DISHWASHER <br />' <br />RANGE HOOD <br />' <br />' <br />LAUNDRYTRAY <br />WATER HEATER <br />) <br />CLOTHES WASHER <br />, — <br />WOOD STOVE <br />' <br />METAL FIREPLACE & CHIMNEYURINAL <br />' <br />FIREPLACE INSERT <br />DRINKING FOUNTAIN <br />FLOOR DRAIN <br />' <br />HEAT PUMP <br />BACKFLOW PREVENTERS <br />' <br />' <br />GAS PIPING <br />ROOF DRAINS—RAINLE.ADERS <br />' <br />EXHAUST FAN <br />' <br />SINK (SERVICE —BAR, ETC.) <br />, <br />I <br />, <br />SUBTOTAL $ <br />SUBTOTAL $ <br />' <br />PERMIT $ <br />I <br />PERMIT $ <br />TOTAL FEE $ <br />' <br />TOTAL FEE $ <br />' <br />SIDE SETBACK <br />N CHECK NU E f EF <br />PLAN <br />RECEIPT NO. <br />FRONT SETBACK <br />REAR SETBACK <br />353� <br />USE ZONE <br />LOT AREA <br />VACANT SITE <br />FEES VALUATION <br />FEE <br />1 <br />BUILDING <br />TYPE OF CONTS, ALLOWABLE <br />TYPE OF CONST ACTUAL <br />0(6UPAN61 <br />NO.Of MELLING UNITS <br />' <br />GNouP <br />- A <br />� <br />pLUlEBING <br />SIZE OF BLD�Ki57 <br />- <br />NO. OF STORIES <br />BASEMENT <br />MECHANICAL <br />_ <br />q , <br />✓ ' <br />fL AW <br />ADDITIONAL PLAN CHECK <br />OCCUPANCY LOAD FIRE SPRNKLERS RED'D HEIGHT LIMITATION <br />i <br />/f(D <br />SPRINKLER <br />STATE BUILDING SURCHARGE <br />' <br />REASO FOR SPRINKLERS <br />INTAKE BY <br />PLANS APPROVED BY <br />CITY OF E1IERM <br />PUBLIC WORKS <br />LOCAL SALES <br />J4 I/Zf/gz <br />TAX CODE IS 3105 <br />TOTAL <br />