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KAe l APPLICATIO*FOR CONSTRUCTI&1 PERMIT <br />TO BE COMPLETED IN BLACK INK —PLEASE PRINT OL <br />BUILDING DEPARTMENT HEATING SYSTEM: ❑ GAS ❑ ELECTRIC ❑ <br />259-8810 / ,5prinkIfY <br />I.I DEMOLITION I I COMBINATION CI BUILDING !. MECHANICAL ❑ PLUMBING ❑ SIGN <br />Ly <br />cgltMCTPfPCEOFWCFK 4827 COD <br />DESC"ME 1VDAK AND 50UAnE FOOTAGE PNOIVED <br />CONTACTPERSONANDr'OIENO N ;/rnn;j` <br />Z <br />�CC`llII`��5 �rlsi�Il re�rl C <br />4- <br />�� �I(a <br />S s,leIh In YKIM 19LAI Id Ivl. <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 GP. E <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 />CONTRACT LAW 18.27 RCW AND 296.200 WAG. <br />PROrOSmusEOF OULOIND 5 toa l r <br />Jay Inl4, an i C I I� <br />«cAL DEscwrtana rnm[nrvlsrgvm PMowoRAnAcn txvmPlESI <br />LOT- MOCK OF <br />- <br />PARCEL TAA 1 D NUuofn 00 <br />- -O _0� <br />CCNSIRUC7CN LOAN LENDEn, ADDRESS. IFIE""E NU.BUR <br />PROJECT ADDRESS <br />deco _verjri 9 o <br />s++• �A�rJ •IE <br />N.P wSSTC1YW <br />PLUMBING <br />MECHANICAL <br />NO. <br />TYPE OF FIXTURE OR REM <br />FEE <br />NO. <br />TYPE OF EQUIPMENT <br />FEE <br />WATER CLOSET (TOILET) <br />AIC-AMNDLG 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 <br />CLOTHES DRYERS <br />_ <br />KITCHEN SINK S DISP <br />VENTILATION FAN <br />DISHWASHER <br />RANGE HOOD <br />LAUNDRY TRAY <br />WATER HEATER <br />CLOTHES WASHER <br />WOOD STOVE <br />URINAL <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 />EXHAUST FAN <br />_T <br />SINK (SERVICE -OAR, ETC.) <br />SUBTOTAL S <br />SUBTOTAL $ <br />PERMIT S <br />PERMIT $ <br />_ <br />TOTALFEE $ <br />TOTAL FEE f <br />I FOR <br />IM U COE6T <br />--LL-J- y L <br />❑ YES ❑ NO <br />o¢uNEr FPamu�olrn <br />uRP <br />❑ YES O NO <br />BUILDING <br />PLUMBING <br />MECHANICAL <br />ADDITIONALCHECK. <br />OTIIER <br />�Lf% <br />STATE BUILAG <br />SURCHARGE <br />PUBLIC WORKS <br />TOTAL <br />FEE I RECEIPT NO <br />ala LC7 <br />