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APPLICATIC�1 FOR CONSTRUC7'�N PERMIT � <br /> TO BE COMPLETED IN BLACK INK-PLEASE PRINT <br /> BUILDING DEPARTMENT HEATING SYSTEM: GAS ❑ELECTRIC ❑ <br /> � <br /> 259-8810 <br /> I 1 DEMOLITION I I COMBINATION i BUILDING }�MECHANICAL ! I PLUMBING I 1 SIGN <br /> OWNER MqI�ADO SS C ZIP PHONE <br /> �u1�L/,(/� /s�/o��v��� ��v ,�s9-7o�2 <br /> TENqNT MAIL qDDRESS CITY ZIP PHpNE <br /> AflCHITECTOPDESIGNER M�ILpODRESS CIIY ZIP PMONE <br /> GENERALCONTR�CTOR MAILADDRESS CITV ZIP PHONE STATELICENSEI <br /> MECHANICRL CONTRACTOR MqIL PDDPESS CITV ZIP PI IONE STATE LICENSE I <br /> �a ���ys�z��au�,,.�,�O�r�..��1 ,,;...i� ���� ��aa�',r/� <br /> PWMBING�ON}qpLTOR � MAILAODRE55 �Y ZIP PHONE STATEIICENSEt <br /> CLA55OF WORK <br /> I I NEW I 1 ADDITION � ALTERATION ��. '��. REPAIR I I DEMOLITION ! I WOODSTO\'E/FRPL INSERT i I BUILDING RELOCATION <br /> CONTACT FcRSON AN�PHONE NO. <br /> CONTRACT PRICE O�WORK Q• <br /> DE BEW RKANDSWAREFOOTA EINVOLVE <br /> � <br /> PROPOSEDUSEOFBUILDING I HEREBY CERTIFV THAT I HAVE READ AND EXAMINED THIS <br /> APPLICATION AND KNOW THE�AME TO BE TRUE AND CORRECT.ALL <br /> LEGALDESCRIPTIONOF PROPERTV(SHCWN BELOW ORATfACHFOUF COPIES� PROVISIONS OF LAWS AND ORDINANCES GOVEflNING THIS TYPE OF <br /> WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br /> ior e�ocK oF NOT. THE GRAN7ING OF A PERMIT DOES NOT PRESUME TO GIVE <br /> AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANV <br /> GTHER 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 MADF AND I COMPLY WITH THE STATE <br /> CONTRACTORS LAW 18.27 RCW AND 296200 WAC. - <br /> y/D � 9/�/�43 <br /> PR�0.I[E�CT ADDRESS {/,/� /�.��� q/� SiGNATUFE D1tE <br /> �J O��(O `�� ( `"`� / GTV BUS"CSS ULENSE NO <br /> PLUMBIN6 MECHANICAL <br /> N0. TYPE OF fl)(TURE OR ITEM FEE NO. TYPE OF EOUIPMENT FEE <br /> WATER CLOSET(TOILET) � A�C—A/HNDLG UNITS—H.P. , � <br /> BATHTUB ; � FORCED AIR SYSTEMS—B.T.0 M E.A. � <br /> LAVATORY(WASH BASIN) � UNIT HEATERS—B.T.U. M ' <br /> SHOWER � CLOTHES DRYERS � <br /> KITCHEN SINK 8 DISP ; VENTILATION FAN ; <br /> DISH�"IASHER � RANGE HOOD T <br /> LAUI. )RV TRAY ; WATER HEATER � <br /> CLOTHES WASHER � WOOD STOVE ; <br /> URINAL ; METAI FIREPLACE 8 CHIMNEY � <br /> DRINKING FOUNTAIN � FIREPLACE INSERT ; <br /> FLOOR DRAIN � HEAT PUMP � <br /> BACKFLOW PREVENTERS ; Z GAS PIPING ; <br /> ROOF DRAINS—RAINLEADERS � EXHAUST FAN � <br /> SINK(SERVICE—BAR,ETC.) ; � <br /> � ; <br /> � — <br /> — <br /> � , <br /> � - <br /> SUB TOTAL S ; SUB TOTAL $ ' <br /> PERMIT $ � PERMIT $ � <br /> TOTALFEE $ ' TOTALFEE $ � <br /> FOR OFFICE USE ONLY: <br /> FRONTSETBACK REARSETBACK SIDESETH�CK PLANCHECKNUMBER FEE RECEIPTNO. <br /> Z� � <br /> USEZONE LOTAREA VACANTSITE FEES VALUATION FEE <br /> BUILDING i <br /> ttPEOFLONiS.ALLOWABLE IYPEOFCONST.RC111RL acuvexcr Noamv[urocuxns i <br /> enouo � pLUMBING • <br /> i <br /> i <br /> SIZEOFBLOG. NO.OFSTORIES BASEMENT MECHANICAL � <br /> OCCUPANCY�O�D FIRE SFRNNLERS REO'D HEIGHT LIMITATION ADDITIONAL PLAN CHECK � <br /> � <br /> SPRINKLER � <br /> i <br /> REASON fOfl SPRINKLERS <br /> � STATE BUILDING SURCHARGE ; <br /> INTAKEBY PUNSAPPROVE�BV CITYOFEYEflETT PUBLICWORKS � <br /> LUCALSALES � <br /> TAX CODE IS 3105 �TAL � <br />