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APPLICATIO^ FOR CONSTRUCTt"N PERMIT � <br /> TO BE COMPLETED IN BLACK INK—PLEASE PRINT <br /> BUILDING DEPARTMENT HEATING SYSTEM: ❑GAS D ELECTRIC ❑ <br /> 259-8810 <br /> �DEMOLITION ❑ COMBINATION ❑ BUILDING I�MECNANICAL ❑PLUMBIN(i ❑ SIaN <br /> OMMER MAILIWDpESS CITY iP PHONE <br /> �AGt.E }IAa.Dwi►,�� �13z� 3d� R�c u- pe,�{ `�$�Y <br /> TENANT MAIIADDRE55 G^' 21P PHONE <br /> �HCHIiECTORDESqNER MAILADDRESS CITV 21P PMONE <br /> � 6ENEMLCONTR�GTOR MAItADORESS CITY ZIP PIIQNE ST�TELICENSEI <br /> 5��1�.� �',I('. �O. ' <br /> MEClWlILALLONTR�CTOR MA0.�OORE55 CITY ZIP PlIONE STATELICENSEI . <br /> pLWelqCpNTRAGTqi W0.Md1ESS CRV Z1P P110NE STAIELICEN5E1 <br /> GONTMCT PRICE OF WO�iR <br /> OESCRIBE WdMf�ND'.JUARE fOOTAOE INVOWED CONTIIGT VEq50N M!D PIIONE N0. <br /> � �D ^ � � <br /> � I HEREBV CERTIFY THAT 1 HAYE READ AND EXAMINED THIS I <br /> . rnovosFo use os euiw+, APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT.ALL I <br /> � i Pno�ns�aus oF uws�wD ononuNceB aoven�o n��s Tvre oF i <br /> �au oesc�avraHaFvnoremvis�awvee�owoa�n�iwowvEs� YVORK YVILL BE CAMPLETED NATH NM1IETMER SPECIfIED FIEREIN OR <br /> NOT. THE aRANTINO OF A PERMIT DOES NOT PRESUME TO fiIVE <br /> tor — e�ax oF AUTHOHITV TO VIOLATE OR CANCEL THE PROVISIONS OF ANV . <br /> OTHER S7ATE Ofi LOCAL UW RE(iULATIN6(�NSTRUCTION OR THE � <br /> � PERFORMANCE OF CONSTRUCTION.THAT I AM AU�FIORRED BV THE � <br /> • OW1iER OF THIS PROPERTY TO PERFt�iM THE WORK FOR NMICM • <br /> ! APPLICATION IS MADE AND 1 COMPLV WITM THE STATE � <br /> I ru�i iu i o a �pN TORS UW 1827 RCW AND 2D8.20D WAC. � <br /> j - O �D�A� �3 <br /> LO1lSTRUCTION l4W IFIQER.l100PE85.7E1EP110NE Ml\!ER � <br /> � �� fW�1WE WfE _� � <br /> GfvlIM4M�Cl41Ew0 <br /> R� � <br /> � �. 1r������R� � �. n����� � <br /> � w��a aosEr�ra�n �N►mao u+rts-a.a � <br /> 4 g�TM� FORCEO AIR SVSTEM�B.LU. M EA ' <br /> LIWATORV(WASH BASM) UNIT HEAIERS—B.T.U. M � <br /> g►q►yEp � CLOTMES DRVERS � <br /> KITCf1EN SIM(�DISP VENfIUTION FAN ; <br /> • p�yy�;�q � RAPKiE HOOD � <br /> � LAUNDRVTRAY ' WATER MEATER <br /> CLOTHES WASNER � Yt00D STOVE � <br /> Up� METAL FIREPLACE�WOOD BURNMN3) <br /> DRNN(iNG FOUNTAM FIREPLACE INSERT � <br /> FLOOR DRI1M HEAT PUUP ' <br /> g11CKFLpyy pqEyENTEpg GAS PIPM6 <br /> pppp pp��NS--HM►xE/�pEps EXHAUST FAN <br /> SMlK�SERVICE�AR.ETC.) � <br /> r <br /> SUBTOTAL f SUB?OTAL f <br /> PERAMT f PERMIT f <br /> TOTAL FEE f TOTALFEE f <br /> r�on o�ce uae o�r: <br /> •�.a�iaeTs�ac ��abcre� socscrn.a RANCMU(NUMEEN rte ntccnia <br /> �:,�zo�c ior/wu v.cw�,srcc Fip V11LUAilON /� <br /> ' �. YES ' NO ���y <br /> IY�I d COKi Iq O�BTOAEB �rt:.nv. +n now��r,w��� <br /> VYr �'��� <br /> � <br /> sizto�sWa rwtsdn�tEnsaEao e�stwtMr 4�ECM�N�C�L <br /> res ' wo <br /> o[�.UNM6rtw0 rw[�u�auREaD MEbNliqMi�rqry �DDIT�ON�IPlNIC11ECA� <br /> OTII[Il � <br /> —�—�— <br /> R(A80H <br /> 51AiC BV4D�N6 SUNCM�N6E <br /> MiN�E Br pIAN!��i�'[DT' W'���� p�g��yppqKS <br /> L�� <br /> WTf 1�Ci��»� TOiM. <br />