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t�l C+7 � <br />y <br />C�H <br />�Hm <br />y�H <br />K n <br />H �1 <br />'�J H kJ <br />(A H <br />H <br />z <br />�HC <br />OH <br />� n d <br />HC�70 <br />� V �] <br />YH� <br />r z <br />HH <br />g� <br />�ia�ir t7 �n <br />C9 � i�! <br />zy�n <br />H O Cn <br />APPLICATiC l FOIR �O(�15iRUC7 ��l PERfV11T �� <br />TO BE COMPLETEG IN aLACK IN.:—PLEASE PiiINT �=�T <br />BUILDING DEPARTMENT �EATING SYSTEM: J GAS _I ELECTRIC J I <br />259-8810 <br />DEMOLITION COMBINATION j�BUILDING MECHANICAL PLUMBING SIGI: <br />p'::r.ER 1.mILAD�RE55 Qrv 21P PHO�JE <br />LU��� k�d v✓ P/f�tuv; :-G^4 �'"''t SF ECJ�R�'% 9*.-x�'- ij5 -!T/l= � <br />lEtIANT IARILADDA.E55 CITY ZIP PHONE <br />)�:y �+GAr� �"NiT= /Oi w,�,�`�RciTy c�i&F�/% qs:'o.y 34� -.-'.��s 3 <br />n�CMIiEGtORDE5IGNER MFRAODRE55 CITY ZiP PNONE <br />MAtL A�DRE55 <br />ZIP PHDNE STATE LICENSE tl <br />A'iJ.�JE l <br />I.IECHANICALCONTRACiOP MAILApOPE55 CIiV 21P PNONE STATEL�GENSEe <br />PWMBINGCONTRACTOR M1IAILADDHE55 CITY ZIP PNONE STATELiCEYSEa <br />c�nss o= woaK <br />NEW � ADDITION A�TERATION <br />CCNIPACTPRiCEOFWORH � /� O/Q(7 <br />�ESCRiBE WORK ANO SOUARE FOOTAGE INVOLVE <br />NFw Roo��vG /a;:d =� �= r- <br />PROPOSED USE OF BUIL�ING <br />S�L� <br />LEGAl0E5GFIPTiON OF PAOPEPiV �SNOYM BELOW OR ATT/ <br />LUT BLOCK _ OF <br />vr�aec* noo�aess <br />//7/ /.c� ,Grt <br />NO. TYPE OF FI%TURI <br />WATER CLOSET (TOILET) <br />BATHTUB <br />SHOWER <br />KITCHEN SINK 8 <br />URINAL <br />DRINKING FOUNTAIN <br />FLOOR DRAIN <br />BACKFLOW PREVENTERS <br />SINK <br />FOR OFFICE USE ONLY: <br />�cC;ll 5[T�ACK R[AR SETBAQ( <br />I L L LCIlL <br />I'r�l �': fOHIS.AIIOMABIE <br />� c=o�oc- <br />-_.-� 3 mnNcv i c�no <br />PC,�.'=P'� FOfl SPRINHLERS <br />It[Z�LY <br />FIRE <br />riEPAIR DEMOLITION WODDSTOVEFRPL INSERT BUILDING RELOCATION <br />I CO4TACiPEP50NANDPHONENO. <br />I HEFEBY CERTIF'{ THAT I HAVE READ AND EXAMINED THIS <br />APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT ALL <br />FOIIR COPIE51 PROVISIOIJS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br />WORK WILL BE COM1IPLE'ED WITH WHETHER SPECiFIED HEREIN OR <br />KOT. 7HE GFANTING OF A F�RMIT DOES N0T PR =SUME TO GIVE <br />AUTHORITV TO VIOLATE L`R CANCEL THE PROVISIONS OF ANV <br />OTHER STATE OR LOCAL LAW REGL'LATING CONSTRUCTION OR THE <br />PERFORMANCE OF CONSTqUCTION. THAT I AM AUTHORIZED BY THE <br />OWNER OF THIS PROPERTY TO PEFlFORM THE WORK FOR WHICH <br />APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />CCNTRACTORS LAW 1827liCW AND 296.2G0 WAC. <br />% "7� '��_...._`"c=) ✓�7�I�/. _ �7— _ ; S - `! Z_ <br />ac,unwn= � o++e <br />FEE <br />TOTAL 5 <br />v117 5 <br />�L FEE S <br />SIDE SETBACK <br />VACANi SITE <br />acur�rvcr xaorown:��.�.�.;vs <br />cAom <br />6ASEM[Ni <br />�D HEIGNTLrtARATiON <br />ennkenv a�nHsnvanov�onv CITY�JfEUEflETT <br />LOCIIL SALES <br />TAX COOE IS 3105 <br />AC-A�HNDLG UNITS-H.P. <br />FORCED AIR SYSTEMS-B.T.U. <br />UNITHEATERS-B.T.U. M <br />CLO7HES DRYERS <br />VENTILATION FAN <br />RANGEHOOD <br />WATER HEATER <br />METAL FIRE <br />FIREPLACE <br />HEAT PUMP <br />GAS PIPING <br />BtIILDING <br />FLUlABING <br />MECHANICAL <br />ADDITIONAL PLAN CHECK <br />SPRINKLER <br />STATE B111l�ING Sl1RCHMGE <br />PUI3LIC 190RKS <br />TOTAL <br />b7Cllu1�1�1 <br />�EL <br />sue Torn� s <br />PERMIT S <br />TOTAL FEE S <br />.'ii�..��+_ � �'-c�.-� <br />v' <br />� <br />