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APPLICpTIC l FOR CONSTRUCT^ 1N PERMIT <br /> 70 BE COMPLETED IN BLACK INK—PLEASE PRINT � <br /> BUILDING DEPARTME�'T HEATING SYSTEM: ;�GAS U ELECTRIC J � <br /> 259-8810 -- <br /> DEMOLITION ! i COMBINATION � I BUILDING IXMECHANICAL ! PLUMBING � 1 SIGN <br /> OWNEAR t � (' KAilAJD/9E5p5�� CITV <br /> �T u (� IiC� � �I UM� !�J� 21P PHONE <br /> ,E��.,�. � �'u��rr- zs2-�96 �' <br /> MAILADpRE55 CiY 2iP PNONE <br /> �n�HRECTO�iDEEiGNEi ldNLpD�RE55 GTv Z�p <br /> PHONE <br /> G[N[fi�LCONTqAG7�R MAIL�OORE55 ��ry Z�� <br /> PHONE STATE UCENSE Y <br /> !'C.C��ANICRLCONiRACTOR M�ILADPFE55 <br /> t` piv CHOHF STATEL�.;ENSE• <br /> T��j`�ivS�z/✓.f,�J.rti�ooD�•iJ��ccF�.y��,�o�icivi�cE�PwA99n7y �/66�3 Ti�n�yHAa88X.�ct' <br /> ❑LUUpINGCONiqpCTOR MNIADDqE55 CITY <br /> Z�P �'NahE STq1E LICENSE� <br /> CONTqACT PRIC[OF WORK <br /> �� . <br /> DE. .R�BE WORM 10 g )AqE FpOTAGE INVULVE'`�� <br /> COIITApT PERSON AND PNONE N0. <br /> f �' <br /> � <br /> �__� �'='�'T�/O���� '—_ <br /> (/ <br /> r�;oro,rouseoFeuaoiNc I HEREBV CERTIFV THAT I HAVE READ AND EXAMINED THIS <br /> APPIICATION AND KNOW THE SAME TO BE TRUE AND CORRECT.ALL <br /> PROVISIONS OF LAINS AND ORDINANCES GOVERNING THIS TVPE OF <br /> irr,��oescaianor�oFeaoaeNrvisNowNee�o�voantrncNnvocovmsl WORK WILL BE COMPLETED WITN WHETHER SPECIFIED HEREIN OR <br /> toi p�p�K o� NOT. THE GRANTING OF A PEFMIT DOES NOT PRESUME TO GIVE <br /> AUTHORITY TO VICLATE Oti CANCEL THE PROVISIONS OF ANV <br /> — OTHER STATE OR LOCAL LAW REGULATING 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 /> rnr;ce�Tnzio r�uMeER APPLICATION IS MADE AND I COMPLY WITN THE STATE <br /> CONTRACTORS LAW 18,27 FCW AND 296200 WAC. <br /> COJ�iRUCTIONLOANLENOER.AD�RESS.TELEPlIONE NUMO[R �C'^C,L1' .a , <br /> PROJECTADD/RE�SS���/� U ��� <br /> ��� ('y(�_'�� 'L�� s �� oac <br /> Civ fllISiKE 55 L iCCNSC NJ <br /> PLUMBING MECHANICAL <br /> NO• TYPE OF FIXTURE OR ITEM FEE NO. TYPE OF E�UIPMENT <br /> WATER CLOSET(TOILET) FEE <br /> AiC—A/HNDLG UNIT6—H.P, � <br /> BATHTUB ; FOh:ED AIR SYSTEMS—B.T.U. M E.A. �-- <br /> _ LAVATORY(WASH BASIN) UNIT HE�TERS—B.T.U. h1 <br /> _ SHOWER CLOTHESDAYERS - <br /> KITCHEN SINK& DISP � VENTILATION FAN � <br /> DISHWASHER RANGE HOOD <br /> LAUNDRY TRAY WAT[R HEaTER <br /> _ CLOTH[S WASH[R � WOODSTOVE <br /> URINAL METAL FIREPLACE(WOOD BURNING) —�-- <br /> _ DRINKING FOUNTAIN ' FIREPLACE INSERT (�� <br /> FI.00R DRAIN ---� HEAT PUMP <br /> _ BACKFLOW PREVENTERS 'j'� GAS PIPI�G <br /> ROOF DRAINS—RAINLEADERS EXHAUST FAN - <br /> SINK�SERVICE—BAR.ETC.) — <br /> � — <br /> __ _ SUB TOTAL 5 SUB TOTAL 5 <br /> _ PERMIT 5 PERMIT $ <br /> TOTALFEE $ TOTAL FEE S � <br /> FOR OFFICE USE ONLY: <br /> FRONTSETBACK qEARS[TBACK $IpF.SETBACN P�ANCNECKNUl.IP A p <br /> EE PECEIPTNO <br /> usezoNe ioinqea vnenNrs�te F�S` � VALUATION FEE <br /> - YES �, NO eui�oiNc <br /> IYPEOi�ONSi. NO.OFSTORIES xfu�e�;cv NooroN[1u45uvns <br /> �p��� PLUMBING ; <br /> i <br /> SiZEOiBLOG. FIH65PPINKlER5RE00 DASE�IENT <br /> MC-CHANICAL <br /> �7 YEJ Cl NO <br /> OCCUPANCYLOAD FIqE�LARMRf00 Ni 9HTUTAITATION �DDI710NALPLANCHECK <br /> i <br /> rEnsoN O7HEN <br /> i-- <br /> STATE HUILDING SURCHAfiGE � <br /> iNT4KEBV PL�NSAPPROVF.DBV CITYOFF.VEREIT PUBIICWORKS <br /> LOCAL SALES _T_ <br /> or,re TAX CODE IS 3105 TOTAL <br />