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APPLICATIQ'" FOR CONSTRUCTCIN PERMIT � <br /> TO BE COMPLETED IN BLACK INK—PLEASE PRINT <br /> BUILDING DEPARTMENT HEATING SYSTEM: J GAS �ELECTRIC _l _ <br /> 259-8810 <br /> i 1 DEMOLITION ❑ COMBINATION ;Xj BUILDING C I MECHANICAL I:.I PLUMBING f_i SIGN <br /> OWNER MOILADDRESS CITV 21P PMONE <br /> I-Io�s��JG hloFE Pc� fjoX 78,�.3 EUE�RFti %b'�o1 ZSS-���y <br /> TENANT MRILAOORESS CITV ZIP PNONF. <br /> ARCHITECTOFiDE51GNER MAILADORESS UTY ZIP PHONE <br /> SrrPHr"� sioRy Pobv� aev3 ^'�o�N� vcµ�n,J 98�7j 33L .3;7� <br /> GENERALCONTRACTOR UAILADDRESS pTY ZIP P110NE STATEUCENSEs <br /> rloUs�n1G �rorr' �o civx �8a3 cveaFTr 9k��� �sa— a2��i <br /> MECHPNICALCONTRACIOR lA�ILADORESS CITV ZIP PHONE oTATELICENSEt <br /> PLUM8INGCONTRACTOR MAILADORE55 CITV 21P PNONf. STATELICENSE• <br /> CONTRACT PRICE OF WJRK <br /> DESl.lnoc WORK AND SOUARE FOOTAGE INVOLVED CONTACT PEFSON ANO PMONE NO. <br /> � 3- rsEonoo,•-• a� sroa�i i�Pi�nr•�,�.�rt nS. P�.,sl.� �s8- az1y <br /> �A f�.. PGr+t� �� ..i0 i+ m.�c�f- Y�,.APtSC Y '�9 <br /> [pn�•m..../��rq 2o..rn ( '.2090 F7 ' )_ �-e R I HEREBY CERTIFY THAT 1 HAVE READ AND EXAMINED THIS <br /> rnerasc�ueE-e�ewe�e• APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT.ALL <br /> T!1 N r.+5� 7�0.��+c �a J � I N C o�+^d r�o�-� •� G PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br /> � LEGALDESCRIPTIONOFPPOPERTV�SNOWNBElOW09ATTACHTWOCOPIES� WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br /> �oT �7 � 18 e�aK ��� oF Fu"aFr7 cliJ. rl NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br /> AUTHORITY TO VIOLATE OR CANC%EL THE PROVISIONS OF ANY <br /> P L A T � N0. H3 7�' 7 7 x— [) i 7 ' c��O 4 I to '_ OTHER STATE OR LOCAL LAW REGUUITING CONSTRUCTION OR THE <br /> PERFORR7ANCE OF CUNSTRUCTION.THAT I A�d AUTHORIZED BV THE <br /> I G t S S �- l=i i` W � T A i+ L L OVJNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br /> APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> ��R CONTRACTORS lAW 18.27 RCW AND 296.200 WAC. <br /> , , c 7 .ZO 77;L - ✓ L-"sT A'✓• �'I TA1C <br /> � ER <br /> � y � - ��� - �q -ozoo �, ii�a�/�93 <br /> . PROJECT ADDRESS � S�GN�tUPE ��E <br /> BOSMESSLiCEN. � O <br /> � �MBINO MECHANICAL <br /> � N0. TYPE OF FlXTURE OR REM FEE NO. TYPE OF EOUIPMENT FEE <br /> S. WATER CLOSET(TOILET) � A/C—A/HNDLG UNITS—H.P. <br /> . BATHTUB ' FORCED AIR SYSTEMS—B.T.U. M E.A. <br /> . LAVATORY(WASH BASIN) � UNIT HEATERS—B.T.U. M � <br /> SHOWER ' CLOTHES DRYERS ' <br /> KITCHEN SINK&DISP VENTILATION FAN � <br /> • D�SHWASHER � RANGEHOOD <br /> LAUNDRY TRAY ; WATER HEATER ' <br /> ' CLOTHES WASHER � WOOD STOVE � <br /> URINAL ' METAL FIREPLACE(W000 BURNING) <br /> DRINKING FOUNTAIN FIREPLACE INSERT � � <br /> FLOOR DRA�N � HEAT PUMP ' __ <br /> � BACKFLOW PREVENTERS ; GAS PIPING � _ <br /> ROOF DRAINS—RAINLEA�ERS � EXHAUST FAN � <br /> SINK(SERVICE—BAR,ETC.) ; <br /> . � <br /> � <br /> � � <br /> SUB TOTAL $ ; SUB TOTAL $ <br /> PERMIT S PERMIT $ � <br /> TOTAL FEF. $ ' TOTAL FFE $ ' <br /> FOR OFFICE USE ONLY: �`2��25�.�2�C�� <br /> FRONTSETBA� NEARSET� � SIDES�TBFCN PLANCHECNNUMBER FEE REGEIPTNO. <br /> ' � �-b� <br /> USE Zp�y��� LOT AREA VACANT SITE � FEES VALUATION FEE <br /> fi/�3 ,�� �� ��1 YES NO BUILDING �(J 1pV�., � Z ���J <br /> 1\ <br /> iVPEOFCONSi NO.OFSTORIES ,..'�rq�.�y i2���iV uH�R i <br /> •�1 1 °"1D PLUMBING � <br /> .aN 2 KI �Z.�F�Ir�I <br /> SIZE OF BLDG. IRE SPRINNLERS REO'0 BASEMENT MECHANICAL �T <br /> �Ci$ �� � G YES jC NO � <br /> OCCUPA�lCYLOAU FIREALARMFEOD NEIGNT IMITATION ADDITIONALPLANCHECN <br /> 3 ND '9O� � `3QDW OTHER ) — <br /> REASON <br /> STATE BUILDING SURCHARGE ��� <br /> INTAKEBV PLANSAPPROVEUBY CITYOFEYEHETT PUBLICWORKS � � <br /> LOCAL SALES <br /> DATE 2M a � TAX CODE IS 3105 TOTAL 7J` ;� <br />