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APPLICATIO� FOR CONSTRUCTI`N PERMlT � <br /> TO BE COMPLETE�IN BLAf:K INK—PLEASE PRINT <br /> BUILDING OEPARTMGNT HEATING SYSTEM:�AS ❑ELECTRIC ❑ —� <br /> 259 BB10 <br /> DEMOLITION '� ! COMBINATION /BUILDING i i MECHANICAL I I PLUMBING I I SIGN <br /> OKNEfI MMLADDfiE55 LItY IIP pNpNE <br /> �VE.RE7T DUSiiI� lJUTs/oCir� /40� On�islR EYE,e�T GvA S�w/ �O(o 040o'�SS�LLL <br /> iFNnNi AUM1A�DPE55 CILY ZIP PNONE <br /> If1G�liECiOR�[SiGNEfl MLIIApDFF55 LIfY ZiV PHONE <br /> �Y�-r�izJ �,�ii�rEus i�o� �1�,�rr �9ce ErE,��- u�n �'aaoi ao� a�s��i <br /> G[N(iiPLCONIPACiOR MAI��pp11E5$ CILY ZIP PIIONE $iAiELiCENSE� <br /> Y�'� <br /> 1.4C�U�iiGlCpllp�ClOfl IMR�OpflE55 CIiV 21P pIqNE SiREIICENSE• <br /> i'WUBINGLpRFACiDf1 MAILL0�11E55 CIiY ZiC pHONE SiREIICEN56• <br /> LUSSOI WOIIN <br /> I NEW i I AODITION �TEFiATION REPAIR � I �EMOUTION I ! WOOCSTOVbPRPLIN59RT I I BUILDINGRELOCATION <br /> WNPQVFNSONhN NONENO <br /> M <br /> roiim�c*Pn¢eo�vroAK -�f �OO � l0lv�. SSC QY/'-�LCH/PN /��/�/7YGi <br /> Cf:CNIBEWOPRMlO50UAFEFp]G EINVOlVCO <br /> as�- 3��� <br /> rnoros[owec�ewmmc i HEPEBV CERTIFY TMAT I HAVE READ pND E%AMINED TMIS <br /> APPLICATION AN�KNOW'iHE SAME TOOE TRUE PND COqRECT ALL <br /> i[w�oEscwp�weoFraovcnn�SNowpoeiowonnnewwuetovicsi PROVISIDNSOFLAWSANDOR�INANCESGOVEFlNINGTMISNPEOF <br /> WORK WILL BE COMPLETED WITH WHETHEF SPEGFIED HEFEIN OR <br /> �or e�ax_ or _ NOT.TNE GRANTIMG OF A PERMIT DOES NOT PRESUME TO GIVE <br /> AL'TliORITV TO VIOLATE OF CANCEL TNE PROVISIONS OF ANV <br /> OTHEB STATE OR!.00AL LAYJ flEGULATING CONSTRUCTION OR THE <br /> PERFORM�NCE OF CONSTRUCTION.THAi I AM AUTHORIZEO BV THE <br /> 01YNER OF S P PtRTY TO PERFORM THE VJORK FOR WHICH <br /> — — APPLICA ON IS 1AOE AND I COh1PLV WITH THE STATE <br /> CONTR TORS LA\ 18.9�N�296200 WAC. <br /> x �- ��- <br /> rnmecreooaess smw.�u�r <br /> �;� [�"j L /J�rr� ��c:. _vr-��-��/ t�rc — <br /> FLUMBING MECNANICAL`r^ <br /> N0. TYPEOFFIXTUREOFITEM FEE N0. TYPEOFEOUIPMENT FEE <br /> WATER CLOSET(TOILET) NC—AMWDLG UNIT$—H.P. <br /> BATHTUB _ FORCECIAIRSYSTEMS--B.T.U. M E.A. <br /> LAVATORV�WASHBASIN) UNITHEATEFS—B.T.LL M <br /> SHOWER C�OTHESDRYERS <br /> HITCHEN SINK 8 OISP JENTILAiION FAN <br /> DISHWASHER RANGE NOOD <br /> LAUN�RV TRAV WATEH N[ATER <br /> CLOTNES WASHER WO00 STOVE <br /> URINAL METAI FlPEPUICE&CHIMNFV <br /> DHINKINu FOUNTAIN FIqEPLHCE INSERT <br /> FLOOfi DFAIN HEAT PUTAP <br /> BNCNFLOW PREVENTERS GAS PIPING <br /> ROOF�RAWS—RAMLEAOERS EXHAUSTFAN <br /> SItJK�SERVICE—BAR.ETC.) <br /> SUB70TAL $ SUBTOTAL b <br /> PERM17 $ PERMIT E <br /> TOTALFEE 8 TOTALFEE E <br /> FOR OFFICE USE ONLY: <br /> I(IUNt$E104[N (ifPP$EiNACK $IpESEiBI.CY. PLANCNECKNtIMBER iEE M1:GEIPiNO. <br /> ,�7.� .� -- 7� ;'SS" <br /> uscmrve iorenen vnc.wisrte FEES \�ALUATION FEE <br /> �OILOING �C �OC .� �'�I ' G'.2_. <br /> I��iOtCOx1'1LLOwIBI[ i':vEOi(OMSIA[N0. p3vour xunMtmrvcun'�s —F------1- <br /> Nn��� �"�� (/ PLUlABiNG _ <br /> T.VEOF�`LD"J . OflIES B\A^£MExI MECHANICAL <br /> % — <br /> OGCVi'NlLYIJ�� FIPE51'RNFLEflSflEOD NEIGV"IIMIiA1lON AD�RIONALPLANGHECK <br /> SPflINNIEli <br /> It[qSpN�OII SPOi11xLE115 �— <br /> STATE9UROiNu5Uf1GHARGE [� iS� <br /> ir�u.ro. tteusnannweoev CITYOPEVEflETi PUBLICWORKS <br /> LOCALSALES ' <br /> J,�''���_' ',��✓1 TIIX COOE IS 3105 *oTa� ,�� f' � a 1 <br /> �rWl�li� -- — <br />