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APPLICATIC ] FQR CONSTRUCTi )N PERMIT � <br />�n/1 i TO BE COMPLETED IN BLACK INK—PLEASE PRINT <br />� V <br />BUILDING DEPARTMENT �EATING SYSTEM: U GAS U ELECTRIC ❑ —� <br />259-8870 <br />�. � DEMOLITION I I COMBINATION I-�. BUILDING I_i MECHANICAL I; PLUMBING , i SIGN <br />r�1�1'//'�-[�II MAILP�OPESS LitV $IP �IqNE <br />J/YONM � hJ� r'/C-2T P"�SCy� �,/�,['�fi 7J'//S ✓fZY'GFG/ <br />1LNRNI MRILAD�PE55 CILY ZIP PNOM1E <br />�IlfllllE{:IOflU(SIfNE{I MAILAUDPE55 Cltt 21P PMONE <br />GL':tHALCINiIOhCt011 MAILPO�PE55 CILY IIP P��E SLPtELICENSE• <br />A•EUiqNiULCONfP�CTOfl Y�IIWUNt55 <br />PLUMp�,NGCONn1fl/I.LiON NAIIA�DPE$$ <br />��/'1UFl� h9.74C �ys <br />CON1R4Ci VfiICEO� WOIiN <br />I1FsrnwF NOIIN RNO SOIUIIE f WiAGE INYOLVED <br />tOi BLOLK OF <br />i�nno« rn� m. rvuMeen <br />CO'.SIIiVLOIXlLOANLENDE� ��[19ESS.TEIEPMi <br />DRINKING <br />FOR OFFICE USE ONLY: <br />Tft ol cONSi. <br />s�.[ ov Btoc. <br />PLANSdI'VIIOVF�OY <br />I�O <br />cm zm .mx+e <br />CRY IIP 1`MGNE <br />OU � YPS <br />CONIRLT PERSON ANO PIIONE NO <br />❑ VES ❑ NO <br />❑ YES ❑ NO <br />MEIGNilIM1i�11W1 <br />LOCAL SALFS <br />TAX COOE IS 3105 <br />SiAIE I�CENSE � <br />a <br />I MEREBY CERTIFV THAT I HAVE REA� AND E%AMINED THIS <br />APPLICAiION AP:D'(NJW THE SAME TO BE TRUE AND CORREGT. ALL <br />PROVISIONS OF LAWS AND ORDINANCES GOVERNIN6 THIS TYPE OF <br />WORK WILL �E COMPLETED WITM WHETHER SPECIFIED HEflEIN OR <br />NOT. THE GFANTING OF q PERIAIT DOES NOT PRESUME TO GIVE <br />AUTHORITY TO VIOLATE OF CANCEL THE PROVISIONS OF ANV <br />OiHER STATE OR LOCAL LAW REGULATING CONSTRIIGTION np THE <br />PEF �ORMANCE OF CONSTFUCTION. TNAT t AM AUTHORIZED BY THE <br />(� VNEfl OF THIS PHOPERTV TO PERFORh1 THE \40RK FOR WHICH <br />AP?LICATION IS 1dA�E AND I COM17PLY WITH THE STATE <br />CONTRACTORS LA'.Y 1027 RCW AND 296200 W�C <br />0 .P��� � r�� S 2z4� <br />�.crvnlunt I[ <br />PUMP <br />OUIlOiNG <br />PLUAIOING <br />MEGHANICAL <br />AOOITIONFL PIAN CHECN <br />OLHEfi <br />SiAIE �OILOING SURCHARGE <br />PO�LIC WOPKS <br />TOTAL <br />re� <br />