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CONSTRUCTION <br />PERMIT APPLICATION <br />COMBINATION • BUILDING • MECHANICAL If PLUMBING <br />r12 z/77 <br />OWN R / MAIL ADDHLSS <br />2/657 <br />ZIP PHONE <br />ARCHITECT OR DESIGNER � MAIL ADDRESS <br />PHONE LICENSE NO <br />G ERALC NTR STOR MAIL ADDRESS PHONE LICE SE NO. <br />r <br />�LIIetie7 .�ic�t%Cf��� .5�cc '",ti����.<aGLiA,, <br />.35.3�7i� ,?23 ci Lv <br />MECHANICAL CONTRACTOR MAIL ADDRESS <br />PHONE LICENSE NO. <br />PLUMBING CONTRACTOR MAIL ADDRESS <br />PHONE LICENSE NO. <br />PERMIT <br />CLASS OF WORK <br />' <br />❑COMBINATION <br />);�DUILOING ❑PLUMBING ❑MECHANICAL <br />❑NEW <br />❑ADOITIUN ❑ALTEFInf1uN �*C1'Alil <br />VALUATION OF WORK <br />G <br />a, G fl1 <br />❑DEMOLISH <br />_- <br />❑FENCE ❑SIGN ❑':1VIMMING Pool.. <br />S If IJ <br />WORK <br />1 <br />r c MC�ctZc-o1, <br />PROPOSED USE <br />OTH ER PERMITS OR APPROVALS <br />REZONE SPECIAL USE <br />VARIANCE SHORLINE <br />LEGAL ULSC{i I PT ION OF PROPERTY ISHOW EL W R A AC <br />FOUR COPIES) ((������ ��� �• '�. <br />LOT �BLDCK Z)-OF_ ' <br />Cr Is <br />SE PA CHECK LIST REQUIRED <br />LZ -0CJ L <br />Lf YES <br />L� NO <br />JO ADDRESS <br />MECHANICAL <br />PLUMBING <br />TYPE <br />OF ENERGY ❑GAS ❑ELE C. <br />TV PE OF EQUIPMENT FEE <br />NO. <br />_ <br />- <br />_ _ _ <br />AIR CONO. UNITS-H.P. EA.-- 5_-•_- I_ <br />RH RiuERniiov UNl tS nv. En --� <br />NO. <br />TYPE OF FIXTURE OR ITEM <br />FEE <br />flA1H TABS <br />S <br />- <br />-_ <br />- <br />BOILERS ILP EA. ..- _-i--T <br />FORCED AIR SYSTEMS B.T.V. MEA. <br />-_. __.__ ____... _._.__ _ -_ L <br />1 <br />-----` ' - 1— <br />S SPACE d WALL HEAT AiERS O.T.U.H.1 <br />CLOTHES WASHEI< <br />1 <br />H <br />DISH WAS-:115 <br />I <br />DRINKING FOUNTAINS <br />I <br />FI OOH DRAINS <br />I <br />KITCHEN SINKS & DISP. <br />I <br />UNIT HEATERS B.T.V._-�- <br />IIAII SINKS <br />I <br />EVAPORATIVE_COOL_E14S <br />CLOTHES DRYERS <br />i 1 <br />f1LIOP DRAINS RAIN LEADERS <br />1 <br />SHOWER BATHS <br />VENTILATION FAN ---i- <br />T! <br />SERVICE SINKS <br />RANGE HOOD I <br />SUMPS SEWAGE PUMP <br />'-'"'"—"- �— <br />AIR IIANDL•NG UNIT C.F.M. <br />URINALS I <br />__. .-_..___-.._.-.... ..__.-.._...�__...-__._- <br />WAILIT CLOSETS 1 <br />.. ... .."___. .._... _ _ ._.. .... 1... ...._T__ <br />-'-TICK I <br />WATER LIE AlER7 ELECTRIC <br />.. _. WATER HEATER <br />WASH BASIIJS � 1 <br />FAC. BUILT FIREPLACE !4 CHIMNEY 1 __ <br />- <br />LAUNDRY TIIAYS "- <br />_ <br />GAS. SYSTEM: NO OP OUTLI. I! T <br />-" <br />-- SOLI TOTAL. S- <br />I <br />PERMIT .-S <br />1 <br />TOTAL. FEE S I__ <br />SUB TOTAL <br />THIS PERMIT BECOMES NLII L AND VOID 11 W011K ON CONSTnUC <br />_ PERMIT S <br />T)DN AUTHORIZED IS NOT COMMLNCED WITIUN 1?0 DAYS. OR IF <br />TOTAL FEE <br />CONSTRUCTION OR WORK IN SUSPENDED Oil ABANDONED FOR A <br />WATER EERVICE S17F. BEOG SUPPLY SIZE-__ <br />PCnioo OF 120 DAYS AT ANY FIMF. AFTER WOnK I'.1 Cn SBJENCEO. <br />__ <br />I LIE RLUY CERTIFY THAT I IIAVE READ ANO E'(AMIN( n THIS AP <br />SIDEt, .. BACK HLAR YAnUSETBACK <br />PLICATION AND KNOW TIIL SAME TO ILL TRUE AND CDHRf'.CT. ALL <br />PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE <br />OF WORK WILL BE COMPLIED WITH WIIETNETI ::PF.CIFILO HEREINI <br />_ __ -- <br />US4 ZUNk Wl AfILA VACANT SITE <br />OR NOT. THE GRANTING OF A PERMIT OOES NOT PRESUME TO <br />❑YES ONO <br />GIVE AU111OnITY TO VIOLATE OR CANCCL TIIE PROVISIONS OF <br />ANY OTHLn STATE OR LOCAL LAW IILGULATIN(I CONSTIIUCTION <br />TYPE OF CONST. OCCUPANCY GROUP NO. OF DWELLING <br />0If THL PLRFOHMANCE OF CONSTRUCTIONr <br />UNITS <br />SIZE OF BLDG. NO. OF STORIES MAX. OCC. LOAD <br />X <br />_'T�1 <br />SIGN4�E'WCONTRACTOROHAUTWC AGENT OATE- <br />{IIItl.ONE---- IIA!iF MLNf flHL til•IIINK I.LII,S <br />t <br />PLOVIHEU <br />11LAN CIILCK NUMOLn PLANCF':CK FEL <br />OYES ONO <br />FLE RECEIPT NO <br />SPECIAL CONDITIONS: <br />FEES VALUATION FEE <br />I <br />--'--"-'--"- <br />BUILDING i I <br />SEPA REVIEW COMPLETE DYES ❑ NO <br />PLUMnIN(: 1 <br />`--."-I <br />contact planninq dept. <br />MLCIIANICAL i <br />- - <br />1 <br />OTHER I <br />AnIICAIIUN µLIFILUYY PlAN5C4IlK1UVT.1M00VID UHLWAKi IIY <br />PENALTY SEC. 707(a) ) <br />1 <br />TOTAL i <br />