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TO BE COMPLETED IN BLACK INK -PLEASE PRINT <br />m1 <br />BUILDING DEPARTMENT HEATING SYSTEM:.N GAS J ELECTRIC J <br />259.8810 <br />❑ DEMOLITION ❑ COMBINATION O BUILDING MECHANICAL ❑PLUMBING ❑ SIGN <br />DYNNEIIi- - MAE ADM" I i) zlv T -RNONE <br />TENAMI \ MAA ADOIIEN CITY ZIP PHONE <br />77rMAIL <br />ADONEN <br />CITY DP PHONE STATE LICENSE 0 <br />GAILGONT/STOR <br />VAILADDIIEN <br />CITY ZIP PHONE STATE LICENSE / <br />N • CAL\ <br />MLNIM QONTMCTOR <br />MAR ADDRESS <br />CRY zip PHONE STATE LICENSES <br />DESCRIBE WOM AND SQUARE FOOTAGE INVOLVED � n �P 11^C I CONTACT PERSON AND PHONE NO 1 IC- <br />C Q' <br />QfL C� �wRi� <br />nI <br />CL <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br />APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br />WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br />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 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 COMPLY WITH THE STATE <br />CONTRACTORS LAW 18.27 RCW AND 296.200 WAG. <br />_ % <br />X ?.�� / 1� 't/Y f� A51�I/" <br />PROPOSED USE OF BUEDNO - - <br />— I <br />LEGAL DESCRIPTIGNOF PROPERTY )SHOWN BELOW OR ATTACH TWO COPIES) <br />LOi BLOCK OF <br />PARCEL TM I.D.1ANSER <br />l UNDER, ADORE TElFR101E N{AMER <br />�,, r l�l�. <br />PROJECT ADDRESS <br />srr YT Y - ^�" IMTE <br />1.1•IPISNISSIK.1 YSf /K/ <br />PLUMBING <br />MECHANICAL <br />NO. <br />TYPE OF FIXTURE OR ITEM <br />FEE <br />NO. <br />TYPE OF EQUIPMENT <br />FEE <br />WATER CLOSET (TOILET) <br />A'C—AIHNDLG UNITS—H. P. <br />BATHTUB <br />FORCED AIR SYSTEMS—B.T.U. M E.A. <br />LAVATORY WASH BASIN) <br />UNIT HEATERS—B.T.U. M <br />SHOWER I.CLOTHES <br />DRYERS <br />KITCHEN SINK 8 DISP <br />VENTILATION FAN <br />; <br />DISHWASHER <br />RANGE HOOD <br />LAUNDRY TRAY <br />WATER HEATER <br />CLOTHES WASHER <br />WOOD STOVE <br />URINAL <br />' <br />METAL FIREPLACE (WOOD BURNING) <br />DRINKING FOUNTAIN <br />FIREPLACE INSERT <br />FLOOR DRAIN <br />HEAT PUMP <br />BACKFLOW PREVENTERS <br />GAS PIPING <br />ROOF DRAINS—RAINLEADERS <br />T <br />EXHAUST FAN <br />SINK SERVICE —BAR, ETC.) <br />I <br />SUB TOTAL f <br />SUB TOTAL f <br />PERMIT f <br />PERMIT f <br />TOTAL FEE S <br />TOTAL FEE 5 <br />FOR OFFICE USE ONLY: <br />FROM BTBACK <br />REAR SETBACK <br />SIDE SETBACK <br />PLAN CHECK NUMBER <br />FEE <br />RECEIPT NO. <br />v -7 ' <br />USEZONE <br />LOT AREA <br />VACANT SITE <br />FEES I <br />VALUATION <br />FEE <br />YES _ NO <br />BUILDING <br />TYPE OF CONIT. <br />NO OF STORIES <br />acunM. <br />ro wowNl 41441ls <br />OSOV• <br />PLUMBING <br />� <br />SIZE OF ROD. <br />FIRE SPRINKLERS REO'D <br />BASEMENT <br />MECHANICAL <br />1 <br />— <br />❑ YES ❑ NO <br />ADDITIONAL PLAN CHECK <br />1 <br />OCCUPANCY LOAD <br />FIRE ALARM REO'0 <br />HEIGHT LIMITATION <br />OTHER <br />_ <br />REASON <br />-- <br />STATE BUILDING SURCHARGE <br />; <br />INTAKE BY <br />PUNS APPROVED BY -T-CITY <br />OF EVEFE(T <br />PUBLIC WORKS <br />' <br />LOCAL SALES <br />DATE <br />TAX CODE IF, 3105 <br />TOTAL <br />i <br />