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� APPLICQ,TIC 7 FOR CONSTRUC'p"��N PERMIT � <br /> �1� , TO BE COMPLETED IN BLACK INK—PLEASE PRINT <br /> BUILDING DEPARTMENT HEATING SYSTEM: '. AS J ELECTRIC J___ —� <br /> 259-8810 <br /> _ DEMOLITION COMBINATION BUILDING MECHANICAL PLUMBING I SIGN <br /> g�N�A IAAILADDRE55 PHONE <br /> l��tcC� �n/.,G SAn/ 30��/ �,eOmf�_f4-rJ 21�(.�'�C�-� �S�'" 077� <br /> tENANT ldAILAD'JRESS Gt� ZIP VHONE <br /> �FCNITEGTOR�ESIGNER MAIL�D�FE55 CITY ZIP PMONE <br /> GENERALGONTPACTOR IA/.ILADDRE55 CRY ZIP P4pNE STATELICENSEe <br /> M HANICPLCOIITqACTOR MNIhDOAE55 QTY ZIP PMONE STATELICENSEa <br /> !�%[�� �/��nlr Q Cca�1�r..C. /�C� it/�- �'1.S S± �. �/� . `l��oS� I�c '� -�I C�Q� <br /> FLt1�dBINGCONTRACTOR M41Lq��FESS CiTV Z�p PHONE STATELICENSEb <br /> CGIJjNACT PRICE OF WDqK <br /> w/3 So (lCJ <br /> CE IBE VlOPK����1'D/SOU!E FOO�fjG'E�(�.� �5 COIJTACT PERSON AND PHONE NO.� / . � � <br /> I ��T!/� S <br /> GY+S ,��Pv 9 �R/S77`t2i. � <br /> —��/ � Iy `��—• I HEREBV CERTIFY THAT I HAVE READ AND EXAMINED THIS <br /> PROPOSED U E OF 6WLDWG APpLICATION AND KNOW THE SAME TO BE TFUE AND CORRECL ALL <br /> S PROVISIONS OF LAINS AND OR�INA�CES GO`JERNING THIS TYPE OF <br /> iE�nioescaivnor+oFaaoPearr� HOVlNBELOWOFAiTACHTWOCOPIES� WORK WILI. BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br /> �or — e�ocK oF ��OT. THE GrIANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br /> AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br /> OTHER STATE OR LOCAL LAW REGULATING CONSTFUCTION OR THE <br /> PERFORM1IANCE OF CONSTRUCTION.THAT I AM AUTHORIZED BY THE <br /> OWNER OF THIS PROP�RTY TO PERFORM THE WORK FOR WHICH <br /> PARCELiA%ID.NOMBER APPLICATION IS MA E AND I COMPLY WITH THE STATE <br /> CONTR RS L 18. RCW AND 296.200 WAC, <br /> CONSTRUCTIONLOANLENOcR.ADDdG55.TELEPHONE NUId6ER � �� <br /> r v/L <br /> PROJECTADDRESS s�ciur a� o�rF — <br /> cuv ausir+ess i�umst rva - <br /> 'LUMBING MECHANICAL <br /> NO. TYPE OF FIX7URE OR ITEM FEE NO. TYPE OF EOUIPMENT PEE <br /> WATER CLOSET(TOILcT) i A/C—NHNDLG UNITS—H.P. <br /> BA7HTU8 FORCED AIR SYSTEMS—B.T.U. M E.A. <br /> LAVATORV(WASH BASIN) UNIT HEATERS—B.T.U. M <br /> SHOWER CLOTHESDRYERS �— <br /> KITCHEN SINK& DISP ; VENTILATION FAN <br /> DISHWASHER RANGE HOOD <br /> LAUNDRYTRAY WATER HEATER <br /> CLOTHES WASHER WOOD STOVE <br /> URINAL ; METAL FIREPLACE(WOOD BURNING) <br /> DflINKING FOUNTAIN i FIREPLACE INSERT ' <br /> FLOOR DRAIN � HEAT PUMP �— <br /> BACKFLOW PREVENTEriS GAS PIPING � <br /> ROOF DRAINS—RAINLE.4DERS EXHAUST FAN <br /> SINK�SERVICE—BAR,ETC.) <br /> i <br /> _ SUB TOTAL $ � SUB TOTAL $ �j� ',� <br /> PERMIT g PEFMIT 5 <br /> TOTAL FEF S TOTAL FEE S <br /> F�JR OFFICE USE ONLY: <br /> Fq�NTSET9ACK qEARSETBICH SIDESETBACK P�ANCHEGKNUMBER PEE FECEIPTNO <br /> usezoNe �otr,nen vncnNrsire FEES VAWATION FEE <br /> .- YES :'7 NO eui�oiNn <br /> iYPEOF�ONSi. NO.OFSTORIES o(tuoarip r;permv¢uvsuriiis - <br /> caouv pLUM91NG ' <br /> SREOFBLOG. FIRESPRINKLEPSREO'D BASEMENT MECNANICAL <br /> '^! Y'cS � . NO <br /> OCCIIPANCVLOAD FIREr1LARMREO'D NEIGHTLIMITpTION ADDITIONALPLANCHECN <br /> OTH[R i <br /> qEA50N <br /> _� <br /> STA7E 6UILDING SURCHARGE <br /> INTAKEBY PIANSAPPROVEDBV CITYOFEVEREIT PUBLICWORNS � <br /> LOCAL SALES <br /> on.e TAX CODE IS 3105 70TAL <br /> a <br />