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APPLICATIO�. FOR CONSTRUCTt�N PERMIT � <br />TO BE COMPLETED IN BLACK INK—PLEASE PRINT <br />BUILDING DEPARTMENT HEATING SYSTEM: � GAS D ELECTRIC O <br />259•8810 <br />❑ DEMOLITION ❑ COMBINATION i7 BUILDING 1�MECHANICAL �—iPLUM8ING Ll SIGN <br />OWNER MAILADDPE55 LITY ZIP P1!ONE <br />To� Q�eeiw+ �'Q 3e.�� Ka� C�c� s�'rol zsz-3�J4 <br />TENANT MAIL A��RESS CITY Zla +'MONE <br />�RCHITECT OR DESIGNER M�IL ADDFESS dTY 21P PHONE <br />GENERA�CONTNRCTQR M�ILIDDRE55 <br />ZIP PMONE STRTELIf,EN5E1 <br />MECH4NILAL CONTqACTOR M�IL ADDRF�S CITY ZIP PHONE STATE LtCENSE � <br />F�.�ei s=-: �.G. S'/�.0 2411 !f �+ L=tievrTT 4�Zo/ ?SZ-3//L e2•�� CS-S/2/ C-Z <br />, <br />PLUMBING CONTRALTOR � MRIL AODFE55 CITY 21P PMONE STRTE UCEH�E � <br />COMTR�CT oq�E OF WOPK <br />DESCPIBE WOFlK �ND SOU�RE FOOTnGE INVOLVED <br />PROPOSED USE OF BUILDING <br />M <br />LEG.\L DESCPIPTION OF PROPERTY ISHOWN BELOW OH A71AGM TWO GOPIESI <br />LOT BLOCK OF <br />PARCELT�XID.NUMBEF <br />COP�STRUCTIONLOANLENOER.ADDRESS.TELEPHI <br />PROJECTADDRESB <br />((p�� �. WNd� UI�.Z <br />PLI)AAslpfi <br />N0. TYPE Of FlXTURE OR <br />WATER CIOSET (TOILET� <br />BATHTU6 <br />LAVATORV(WASH BASIN) <br />SHOWER <br />KITCHEN SINK 8 DISP <br />DISHWASHER <br />LAUNDRVTRAY <br />CLOTHES WASHER <br />UR�NAL <br />DIiINKING FOUN.TAIN <br />FLOOR DRAIN <br />BACKFLOW PREVENTERS <br />ROOF DRAIN5-RAI4LEADER; <br />SINK (SERVICE-BAR, ETC.) <br />FOR OFFICE USE ONLY: <br />FRO!ITSETBRCK REARSETBACK <br />USE20NE <br />TVVEOFCONSi. � N�� <br />RRER <br />FEE <br />CANTACi PEPSON RND PMJNE NO. <br />I HEREBV CERTIFY THAT I HAVE READ AND EXAMINED THIS <br />APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECL ALL <br />PROVISIONS OF LAWS AND ORDINANCES 30VERNING THIS TYPE OF <br />WGRK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br />NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO uIVE <br />AUTHORITV TO VIOLATE OR CANCEL THE PROVISIONS OF ANV <br />OTHEii STATE OR LOCAL LAW REGULAT;NG CONSTRUCTION OR THE <br />PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHOHIZED BY THE <br />OWNER OF THIS PROPERTY TO PERFORM THE WORK FGR WHICH <br />APPLICATION IS MADE AND I COMPLV WITH THE STATE <br />CONTRACTORS LF,W 1827 RCW AND 296.200 WAC. <br />x ��/.,.,.�`v�- � 8 2-l�'3 <br />S�GN� RE O�iE <br />OF EOUIPMENT <br />FORCED AIR SYSTEMS-B.T.U. <br />UNIT HEATERS-B.T.U. M <br />VENTILATION FAN <br />RANGEHOOD <br />WATER HEATER <br />WOOD STOVE <br />METAL FIREPLACE <br />FIREPLACE INSER' <br />HEAT PUMP <br />EXkAUST <br />SUB TOTAL $ ; SUB TOTAL $ �/ ' - <br />PERMIT $ � PERMIT $ � � � <br />TOTAL FEE $ � � � T07AL FEE $ � � <br />SIDESETBAGK PLANCHECK UMBER FEE AECEIPTNO. <br />/ �so'� <br />V�CANT SITE FEES VALUATION FEE <br />n ves ❑ No eui�oir,c � <br />� occurnrKr xoaow:uixcux�is � <br />�qq1° PLUMBINC� � <br />SIZEOFBLDG. FIRESPRINNLEPSPEO'0 <br />OCGJPANGV LOA� FIRE ALARM REO'0 <br />REASON i <br />�'j1 tS7� tib �tu <br />INTl1NE BV PLANS <br />BASEMENT MEC4ANICAL <br />❑ YES ❑ NO <br />ADDITIONAL PLAN CHECK <br />I OTHE(i <br />NO � m US �' M— STATE BUILDING SUFCHARGE <br />PUBLIC WORKS <br />"I q LOCAL SALES <br />onTE �� II Q7 7AJ( CODE IS 3105 TaT�� <br />��� <br />