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_ •��••r.�. ■ ��aov s o.�e� PGI'fM1 1 `YY%°v�rr <br />TO BE COMPLETED IR BLACK If��K—NI.E:�SE PRINT <br />BUILDING DEPARTMENT � HEATING SYSTEM: fjQ'GAS ❑ ELECTRIC 'J � <br />259-8810 <br />DEMOLITION COMBINATION BUILDING �MECHANICAL PLUMBING SIGN <br />�������A MAILAODRESS <br />� _ CITV ZI` aunuc –'��---- <br />ZIP <br />4RCHITEGTORUES�GNEF IdqILpDDqESS qry <br />Z�P PMCNE <br />GWERALCONTEACTOR IAAILADppF55 CRV �IP NNONE <br />IdECMANICALCONTRqCTOR MAILA�DRE55 CItV — <br />21P PHONE <br />%/LnmASZf-td rus2z,v�.a/ u�snt>n/✓�[cfw u,�i���cldar� 1d�p 9�i, pa <br />PLUUBINGCONIRACTOR 1AAllqDORE55 CIT`.' Z!p PHONE <br />C� ASS OF WORN — _ <br />NEW A <br />�. � DDITION xALTERATION .. FEPAIR ' �EMOLITION . WOODSTOVE/FqPLINSERT <br />I CONTACTPERSONAN�PHONENO. <br />�-orcnqqpqlCEOFWORK �� -7�� <br />C�ESCFIBE WORK AND SOUA3E FOOTAGE INVOLVE� <br />4/� TD/A S �(,p,�/ACf CD,fJ!/, <br />PpPO�PO-SED USE OF B' iILDING <br />`i"l <br />t CGAL OESCRIPTION OF PROPERTY iSHOWN BELOW OR qTi�CH FOUR CC` 1 <br />:Oi BLOCN ___ pp _ <br />i-9�JJECTA�DRESS <br />Lp0 <br />PLUMBING <br />NO. TYPEC <br />WATEfl C� OSE <br />BATHTUB <br />KI IGHEN SINK & DII <br />DISHWASHER <br />LAUNDRY?RAY <br />CLOThcS WqSHER <br />URINAL <br />DRINKIN6 FOUNTAI <br />FLOOR DRAIN <br />BACKFLOW PREVEI <br />ROOF DRAINS—RAI <br />SINK (SERVICE—AA <br />FOfi OFFICE USE ONLY: <br />I°iv.^.HTSEiBACK qEpq; <br />USLZCNE LOTAR <br />I�+i�[OfCON�S.ALLOWAOIE ttPEOF <br />. z[ OF 6LDG. NQ OF <br />GC: UPANLY L0�0 FIRE SP <br />SUB TOTAL 5 <br />PERMIT 3 <br />TOTAL FEE $ <br />SIDESETBACK <br />VACANT S11E <br />STATE LICE.VSE • <br />STATE LICENY�E k <br />d <br />BUILDII�G RELOCATION <br />I HEREBY �:ERTIFY THAT I HAVE READ AND EXAMINED THIS <br />APPLICATIOIv AYD KNOW THE SAME TO BE TRUE AND CORR[CT. ALL <br />PROVISIONS C)F LAWS AND ORDINANCES GOVERMING THIS TYPE OF <br />WORK WILL 3E COMPLETED WITH WHETHER SPECIFIED HEREIiV OR <br />NOT. THE GRA°!TING OF A PERMIT COSA NOT PRESUME TO GIVE <br />AUTHORITY TC VIOLATE OR CANCEL THE PROVISIONS OF ANY <br />OThIER ST��fE OR LOCAL LAVJ fiEGULATING CONSTRUCTION OFi THE <br />PERFORMhM10E OF CONSTRUCTION. THAT I AM AUThIORIZED BY THE <br />OWNEfi OF 1"HIS PROPERTY TO PERFOR�d THE WORK FOR WHICH <br />APPLICAI-ION IS MADE AND I COMPLY WITIi THE STATF <br />CONTRACTORS LAW 1N.27 RCYV AND 296200 WAC. <br />.,o-::n�-��_� ������ <br />nmt <br />FEE '— N0. TYPE OF EOUIPME�i <br />A-C—h�HNDLG UN TS-�H.P. <br />� PORCEUAIRSYS�E`AS—B.LU. <br />UNIT HEATERS—B.T.U. M <br />CLOTHES DRYEF�S <br />VENTILATION FAN <br />RANGEHOOD <br />WA�iER HEATEf7 <br />T <br />� WOO�STOVE <br />METAL FIREP�ACE 8 CHIMNEY <br />i <br />� FIREPLACEINSERT <br />HEAT PUNP <br />GAS PIPING 7� <br />,. EXHAUST FAN <br />BUILpING <br />acauaavcr r:o aroxu;n..c:rc= <br />eaouv <br />PLUIdBING <br />BASEMENi 1/ECHANICAL <br />HEIGMi uMiTATION ADUITIONAL PIqN CHECK <br />-- _I .`,PflINKLER <br />STATE 9UILDING SURCHARG[ <br />iin,:Heev Pi�Nsnovaoveoov CITYOFEVEffETT <br />LOCAL SALES P�'3lIC WORKS _ <br />I I TAX CODE IS 31G5 TOTAL <br />FEE <br />TOTAL S 3Q � � <br />N:r s <br />iL FEE $ � ��i i <br />0 <br />