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.- <br /> APPLICATIL.� FOR CONSTRUC7 .ON PERMIT ��� <br /> TO BE COMPLETED IN BLACK INK-PLEASE PRINT <br /> HEATING SYSTEM: ❑GAS ❑ELECTRIC ❑ �I L <br /> BUILDING DEPARTMENT <br /> 259-8810 <br /> DEMOLITION COMBINATION BUILDING MECHANICAL PLUMBING i i SIGN <br /> OWNE MAIIADDflE55 ZiP P�OME <br /> .� �- �� �2 � Y� r /S'o.L ��c�� �v�►��v �i&,�o/ ��q �o9E' <br /> 7ENANT M�ILADDRESS CITV ZIP PIqNE <br /> ARCHIiECTOR�ESIGNER MAILADDRESS GITY ZIP PNONE <br /> GENEML CONTPACTOR MAIL ADDRESS GITY ZIP PHONE STATE LICENSE� <br /> MECMANICALCdJTXACTOR MIIIL�DDRE55 GTV 21P PHONE ST�TELICENSE� <br /> PLUAIBMGCONTR�CTOR M�ILADDRESS CITV 21P PMONE ST�TELILENSE� <br /> CLASS OF M/ORK � � � <br /> I J NEW i ' ADDITION WILTERATION I I qEPAIR �� ' DEMOLITION i ' WOODSTOVE/FRPL INSERT U BUILDING RELOCATION <br /> �� CONT�CT PEHSON AND AHONE NO. <br /> CpqTRAGTPRICEOFWORN � � <br /> pE$CpIBE WIXIK AND ARE FOOTAGE INVOLVED <br /> � 5L%�c�ci — �.�`� u r�- <br /> PROPOSEDUSEOFBU omc i HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br /> APPLICATION AND KNOW THE SAME TU BE TRUE AND CORHECT.ALL <br /> IECAL DESGRIPTION OF PROPEPTV(SHOWN BEIOW OR�1TACH fOUR CAPIES� PROVISIONS OF UWS AND ORDINANCES GOVERNIN6 THIS TYPE OF <br /> WORK WILL BE COMPLETED WITH WHETHER SPECIfIED HEREIN OR <br /> �oi e�ocK oF NOT. THE GRANTING OF A PERMIT DOES NOT PHESUME TO 61VE <br /> AUTHORITV TO VIOLATE OR CANCEL THE PROVISIONS Of ANY <br /> OTHER STATE OR LOCAL LAW REGULATINO CONSTAl1CT10N Oii THE <br /> PERFORMANCE OF CONSTRUCTION.THAT I AM AUTHORIZED BY THE <br /> OWNER OF THIS PROPERTV TO PERFORM THE WORK FOR WHICH <br /> APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> CONTRACTORS UW 1827 RCW AND 296200 WAC. <br /> � o ,�d �' �r x <br /> PROJECT IIDDRE&S SiGrMTURE �TE <br /> CItY F18NE69 LILENSE N0. <br /> p��ys�y MEC411MCAL <br /> N0. TYPE OF Fll(TURE OR ITEM FEE NO. T1PE OF EOUIPAIENT FEE <br /> , WATER CLOSET(TOILE� � AiCrNHNDLG UNITS--H.P. � <br /> BATHTUB ; FORCED AIR SYSTEMS—B.T.U. M E.A. y, <br /> LAVATORY(WASH BASIN) � UNIT HEATERS—B.T.U. M � _ <br /> � SHOWER ' CIOTMES DHYERS ! <br /> KITCHEN SINK 8 DISP � VENTIUTION FAN � <br /> � DISHWASHER � RAN(iE HOOD ' <br /> UUNDRY TRAY ; WATER HEATER ' <br /> � CLOTHES WASHER � WOOD STOVE � <br /> URINAL ' METAL FIREPUCE R CHIMNEV ' <br /> � DRINKING FOUNTAM � FIREPUCE INSERT � <br /> FLOOR DRAIN ' 'tEAT PUMP ' <br /> BACKFLOW PREVENTERS ; GAS PIPING � <br /> � ROOF DRAINS—RAINLEADERS � EXHAUST FAN � <br /> SINK(SERVICE—BAR,ETC.) � � <br /> � ' <br /> � ' <br /> � ' <br /> � ' <br /> � ' <br /> SUB TOTAL S � SUB TOTAI. S ' <br /> � PERM'7 $ PERMIT S � <br /> TOTALFEE S ' TOT4LFEE S ' � <br /> FOR OFFlCE USE ONLY: <br /> FRONT SETARCN RERfl SETB�CK SIDE SETB�CK PLAN CNECK MBER FEE RE��PT�� <br /> ,; as <br /> USE ZIXdE LOT AREA �ACANT SITE FEES VALUA710N FEE <br /> G��� � i �. <br /> BUILDING � c�'U ' <br /> flPEO�CONTS.�LLOWABLE n'PEOFLONST.ACTUAL OCCUrerK� MoorowFuiN6uNrt5 � <br /> �aa'�v PLUMBING i <br /> SIZEOFBLDG. NO.OFSTORIES BASEMENT MECHRNICAL � <br /> � <br /> OCCUPANCY LOAD FIRE SPPNKLENS PEOD HEIGHT LIMITATION ADDITIONAL PLAN CHECK i <br /> I' <br /> 1 <br /> SPRINKLER i <br /> REASON FOR SPRINKLEGS <br /> STATE BUILDING SURCHARGE � <br /> � <br /> INTAKEBY PLRNSAPPROVEDBY CITYOFEYEflE1T PUBLIGWORKS i <br /> LOCAL SALES � <br /> TAX CODEIS 3105 TOTAL <br /> a6.s-� <br />