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n...,-;k <br /> fi <br /> .r:, �.`t` <br /> APPLICATION FOR CONSTRUCTIOPI PERM17 � �� <br /> TO BE CQMPLETED IN BLACK INK—PLEASE PRINT � <br /> f HEATING SYSTEM: GAS U ELECTRIC U <br /> BUILDING DEPARTMENT <br /> 259-8810 <br /> i i DEMOLITION I I COMBINATION BUILDING I i MECHANICAL I I PLUMBING I I SIGN <br /> awm:n MML�I)011ESS crtv nr rnonE <br /> �v�,z�;.- l�.sii✓4 Au77� P�r���. Ov.�ra2 ST ��aia�i �B7vi a58' �izv <br /> � n �y 1[N�Ni M�iL�U�R[55 QIV 21P PIION[ <br /> F7 �p <br /> !i � <br /> p nnc�nrec*onoesicr+en unanooness crtv zm rua+E <br /> � � � A�it��'/�1,� A�l.1i7KT5 /4t72 /�CCW� �_ ��E!I CU/1 1nf'ZO/ ��' .�/6� <br /> f.[NEMLCON1NACi0� AIAILAD011[55 CItY ZIP PIIONE SIDIEUGENSEI <br /> s � � 1D=�,��� ti— <br /> I.IECI:ANIC�LCONIII�CTOR M1URMORE55 CIiY IIP PIIONE SiR1ELICENSE� <br /> q W M — <br /> � � � PWMOINGCONiMC100 AUIL�UDl1E55 CIIY )p` I'iN)flf SIAff:LIC[NS[� <br /> CL�SSOf WOf1K <br /> � � ! I NEW I I ADDITION I I ALTERATION ��REPAIR I I DEMOLITION I I WOODSTOVFJFRPL INSERT I I BUILDING RELOCATION <br /> eor+rner rmsoe n ruor+e rvo. <br /> � � � � / a5r- 3i�i <br /> M CONtRACTCRICEOFWOAK � UOO QOD T �$�PTT <br /> (0 M OESCi1i0EW00KANO50U�ItEF00t�f.EINVOlVEO <br /> g �+ /� 9' �ou.:.,✓4 u�.� - �.¢nw <br /> � � PROPOSEDUSEOFP�IiIDING l I HERER! CEHTIFV THAT I HAVE READ AND E%AMINED THIS <br /> LOCJ /A�COiic� /� /Nli APPLICATION AtID KNOW THE SAME TO BE TRUE AND CORRECT.ALL <br /> � �eeuoescnmTwNOFrnormrv�s�ovmoeiowor+nrincnrouncormsi PROV�SIONSOPLAWSANDORDINANCESGOVERNINOTHISTYPEOF <br /> -- � - WOFK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OH <br /> ipr o�ocK or __ NOT. THE GRANTING 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 CONSTRUCTION 7R THE <br /> PERFORMANCE OF CONSTRUCTION.THAT I AM AUTHORIZED BY THE <br /> OWNER OF THIS PPOPERTV TO PERFORM THE WORK FOR WHICH <br /> APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> CON A ORS LAW .27�200 WAC. <br /> «,Us x /��.� /- 3 •FZ <br /> ❑naecreooaess s�c�.�u�c a'�E � <br /> �3i�— /y'/(� �/� y�/hCOC.0 S� LIIYBUSMCSSIILfN5FN0 <br /> ���`���` �'�� PLUMBING MECHANICAL <br /> k � NO. TYPE OF FIXTURE OR ITEM FEE NO. TYPE OF EOUIPMENT FEE <br /> � WATER CLOSET(TOILET) � AIC—A/HNDLG UNITS—H.P. � <br /> � BATHTUB ; � FORCED AIR SYSTEMS—B.LU. M E.A. ' <br /> � _— <br /> LAVATORY(WASH BASIN) UNIi HFATERS—B.T.U. M _T_ <br /> ��� SHOW�R ' CI' ,ESDRYERS ' <br /> ' KITCHEN SINK 8 DISP i VcNTILATION FAN i <br /> ' DISHWASHER RANGE HOOD � <br /> LAUNDRVTRAY � WATER HEATER <br /> ��� • CLOTHESWASHER � WWDS70VE � <br /> � ' URINAL ' METAL FIREPLACE 8 CHIMNEY ' <br /> , DRINKING FOUNTAIN i FIREPLACE INSERT i <br /> ', FLOOR DRAIN HEAT PUMP ' <br /> I ��� BACKFLOW PREVENTFR3 ; GAS PIPING i <br /> 1�' ; ROOF DRAINS—RA!IJLEADEPS ' E%HAUST FAN ; <br /> � I SINK(SERVICE—PAR,ETC.) � � <br /> i i <br /> T <br /> � ��� � r . <br /> , <br /> � � _ <br /> I �. SUBTOTAL E i SUBTOTAL S <br /> � � PEFMIT S � PERMIT S <br /> � ' I�. � TOTAL FEE S TOTAL FEE S <br /> FOR OFFlCE USE ONLY: 3 <br /> FfiONTSEIB�CN RE�RSETO�CK SIDES[IDALK PUNCBECNNUMUEfl FEE AECEIPTNO. . <br /> � _�`�\ 1 I P��l ��-_�-�` <br /> use ra+`e/ �oT nnen vncnr�i sm FEES VALUATION FEE <br /> � i—` BUILOING ' <br /> IYI'EOfLON1S.AllOWABLE 7VPEOfC0Y51.ACIWI cp�'� �a���^���5 � <br /> �,f � PLUMBING � <br /> V � � <br /> SIIEOPBLOIi. NO.OFSIURIES BA EMENi MECHANICAL ' <br /> /W> - ND � <br /> • OCGUP/�NCYLO�D FIRESPRNKlENSPEOD IIEIG1rtLIMI1�iKK1 RDDITIONALPLANCNECK i <br /> � A i <br /> /�-�D SPRINKLER � <br /> OEIISONFORSPRINNlEf15 — --�— <br /> STATE BU�LDING SURCIIARGE i <br /> � <br /> � INIANE DY PIANS�PPROVEOBV CITY OF�VEREIT PUBLIC WORNS � <br /> ,� LOCAL SALES , <br /> , ✓M TAR CODEIS 3105 TOTAL ; f <br />