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�.,5��� <br /> APPLICATIC � l FOR CONSTRUCT"-lN PERMIT � <br /> TO BE COMPLETED IN BLACK INK—PLEASE PRINT <br /> BUILDING DEPARTMENT HEATING SYSTEM: ❑GAS U ELECTRIC ❑ � <br /> 259-8810 / <br /> (1 DEMOLITION I I COMBINATION I I BUILDING I_1MECHANICAL fifPLUMBING ❑ SIGN <br /> OWNER� � MM�qODRE55 /��7 ,CcITJV {��21P ` PHONE <br /> (��_..�-T/�lS\ O,.-� T.', �-r��d' �� l�)-Q �, P,rA" lJ �rY � ') " - %s �'fo'�- � <br /> TENANT MAIL AOORESS CRY ZIP PMONE <br /> qHCHITF.CTORDESIGNER IANLAD�RE55 CITV ZIP PHOKe <br /> GENERAL CONTR�CTOR MAIL AODRE55 CIIY 21P PNONE STATE LICENSE� <br /> MECH�NICALCONTRACTOR M4ILADDNE55 CITV ZIP PMONE STFTELICENSE� <br /> PWMBINGGONTRACTOR MAILAODRESS CITY ZIP PHONE STAiELICENSEa <br /> � ,� � u r <br /> CONiPRCT PRICE OF WORK <br /> DESCFIBE WORK AND SOU�FE FOOTAGE INVOLVED CONTACT PEflSUN ANO PHONE N0. <br /> i HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br /> PROPOS u�oF uaoiNc APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT.ALL <br /> PROVISInNS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br /> LEGALOESCRIPTIONOFPROPERTVISIIOWNBELOWORATTAClIiWOCOPIES) WORK WILL BE COMPLETED WITH INHETHER SPECIFIED HEREIN OR <br /> NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br /> iot etocK oF 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 /> PAHLEL TA%ID.NUMBEF CONTRACTORS L�W 18.27 RCW AND 29�200 WAC. <br /> CONSTRUCTION LOAN LEN�ER.A��DR�E�SS�..,T�EIEPHONE/N�UMBEF \ - <br /> )C�1 � C'�c�_t++l.�_ ]f <br /> P�CT ADDRESS scti�r � o�� � <br /> ii I BlISMESS LiCENS[NO <br /> PLUMBING MECHANICAL <br /> N0. TYPE OF FIXTURE OR ITEM FEE N0. TYPE OF EOUIPMENT FEE <br /> WATER CLOSET(TOILET) � AIC—A'HNDLG UNITS—H.P. <br /> BATHTUB FORCED AIR SYSTEMS—B.T.U. M E.A. <br /> � LAVATOPY(�^.'ASH BASIN) � UNIT HEATERS—B.T.U. M � <br /> � SHUt1�ER CLOTHES DRYERS <br /> '<fiCHEN SINK 8 DI�P VENTILATION FAN <br /> � UISHWO.aHER RANGE HOOD <br /> LAUNDr7Y TRAY ; WATER HEATER ` <br /> CLOTHE3 WASHER � WOOD STOVE � <br /> i <br /> URINAL ' METAL FIREPLACE(WOOD BURNING) ; <br /> DRINKING FOUNTAIN � FIREPLACE INSERT � <br /> FLOOR DRAIN HEAT PUMP <br /> BACKFLOW PREVENTERS GAS PIPING � <br /> ROOF DRAINS—RAINLEADERS � EXHAUST FAN � <br /> SINK(SERVICE—BAR,ETC.) <br /> — � ' <br /> � ' <br /> SUBTOTAL S 'pO SUBTOTAL 5 ' <br /> PERMIT S �00 PERMIT 5 <br /> TOTAL FEE S S5;°G TOTAL FEE 5 <br /> FOR OFFICE USE ONLY: <br /> FflONTSETBACK REARSETBFCK SIOESETBACK PLANCHECKNU6�BER FEE RELEIPTNO. <br /> USE20NE IOTAREA VACFNTSITE FEES VALUATION FEE <br /> ❑ YES � Na BUILDING ' <br /> 1VPf Of CONSL NO.OF$TORIE$ aCucA!�CY HO Oi CNllla�cunn5 � <br /> ceouo p�UMBING � <br /> _ � <br /> SIZEOF�LDG. FIIlESPRINNLERSREO'D BASElAENT MECHANICAL � <br /> ',=1 YES !S NO <br /> OCCUPANCV LOAO FIPE ALAflM fiEOD HEIGHT LIlAITATION ADOITIONAL PLAN CHECN <br /> OTHER ' <br /> _ _ _—T— <br /> RE�SON <br /> STA7E BUILDWG SURCHARGE <br /> i <br /> INTANEOV PLANSAPPROVED�V CITYOFEVEflETT PU�LICWORHS i <br /> LOCAL SALES �— <br /> op,E TAX COUE IS 3105 TOTAL ; <br />