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� <br />M <br />� <br />C <br />� <br />APPLICATIC^1 FOR CONSTRUCT`�N PERMIT � <br />TO BE COMPLETED IN BLACK INK—PLEASE PRINT <br />BUILDING DEPARTMENT HEATING SYSTEM: ❑ GAS ❑ ELECTRIC O <br />259-8810 <br />❑ DEMOLI110N ❑ COMBINATION ❑ BUILDING C9' YIIECHANICAL ❑ PLUMBING G SICaN <br />O�MNEM ! � IMRMDRESS CITY ZIP PHONE <br />TEN11Nf AUIL�DDRESS CITY ZIP Pl10NE <br />�RCHITECTOROE516NER WI�ADDRESS CITV 21P PHONE <br />=wnPvss3,oa D�.A 2zz9 Sp,ckso�l �1�e.1i u�ll. �f8zo3 33'$— 3Zeo <br />aENERAL TOR MAILADDRESS CITY ZIP PIIONE STIRELICEH8E1 <br />U..�..a A4rsa�en '71�A_ .7��TK C� _�.�.v.f��.\\IYIP ��� d9� �� AG9S <br />, ,.�,, ,.y�•� <br />e <br />.- <br />UE9CRlE WOIIK <br />CITV ZIP PMONE <br />TNPI..RIE Cl!'�U�NQ WA. pnZ"7- <br />PHONE ST�TE LICENSE • <br />CqNTACT PERSON AND PMONE NO. <br />Z"r� <br />i HEREBY CERTIFY TNAT I HAVE READ AND EXAMINED THIS <br />rnoroseo use oc wwma APPLICATION ANO KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />PROVISIONS OF LAWS AND ORDINANCES CiOVERNINO THIS TYPE OF <br />LEOALDESCRIPTpNOFPROFERiV�SNOWNBELOWOR�T�ACMTWOCOPIE3) WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br />ioT Z, �� �_ ��(�,� ��� NOT. THE GRANTINO OF A PERMIT DOES NOT PRESUME TO 61VE <br />AUTHORITY TO VIOLATE OR CANCEI THE PROVISIONS OF AMY <br />� y, Z OTHER STATE OR LOCAL LAW RE6UlATING CONSTRUCTION OR THE <br />PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br />OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br />APPLICATION IS MADE AND I CO PLV WITH THE STATE <br />PARCELTAXI.D.NUMBER CONT./� � LAW 7RCW tND . WAC. <br />iqN L IENOCR. ADDRE55. TELEPMONE NUMBER <br />��A t�..�,�J�e.,n a1e„�,. .. A 5//d/93 <br />� No. rnE oF Flxtune on <br />WATER CL0.SET (TOILE� <br />BATHTUB <br />� LAVATORY (WASH BASIN) <br />' SHOWER <br />i <br />� KITCHEN SINK 8 DISP <br />� � DISHWASHER <br />� LAUNDRYTfUY <br />CLOTHES WASHER <br />� URINAL <br />� DqINKING FOUNTAIN <br />`r FLOOR DMIN <br />' BACKFLOW PpEVENTERS <br />ROOF DRAIN�RAINLEADER <br />; � SINK (SERVICE—BAR, ETC.) <br />� <br />5 <br />FOR OFFlCE USE ONLY: <br />FRONT SETB�CK REAR SET&1CN <br />USEZONE <br />TYPEOFLON$T. <br />SIZE OF BLO(3. <br />OCCUPANCYLOAD <br />LOTAREA <br />FIRE <br />I�' <br />TOTAL FEE <br />FORCED AIR SYSTEMS-B.T.U. M E.A. <br />UNIT HEATERS-B.T.U. M <br />CLOTHES DRYERS <br />VENTIUITION FAN <br />RANGEHOOD <br />WATER HEATER <br />WOOD STOVE <br />METAL FIREPLACE (WOOD BURNING) <br />FIREPLACE INSERT <br />HEAT PUMP <br />GAS PIPING <br />EXHALIST FAN <br />NUMBER <br />VACANT SITE FEES <br />rJ YES ❑ NO BUILDING <br />OCNF�NLY NO OiphFll�NGllHiiS <br />cawr p�UMBING <br />BASEMENT MECHANICRL <br />❑ ves n No <br />HEiGHT LIMiTA7lON ADDITIONAI PUN CHECK <br />OTHER <br />STATE BUILDING SUFCHARGE <br />SUB TOTAL S <br />PERMIT S <br />m <br />i <br />! <br />I <br />