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APPLICATIO'". FOR CONSTRUCT! -�1� PERMIT � <br />TO BE COMPLETED IN BLACK INK—PLEASE PRINT <br />HEATING SYSTEM: f� GAS ❑ ELECTRIC ❑_ <br />BU;LDING DEPARTMENT <br />259-8810 <br />C_ DEMOLITIQN liC COMBINATION Ll BUILDII:G 1 i MECHANICAL [7 PLUMBING Ll SIGN <br />GWNFR MAIL�DDFESS CI7Y 21P PHONE <br />EVEKBft 5!.tr�o� p�ST 2 4-'13o tol.fi+y �v�KL?`r 957�.'� a3�-¢zua <br />TENANT MAIL ADDRE55 GTY 21P PHONE <br />�.�I G .�� w'e/ivE <br />pRGH11ECTOROESIGhER t1AI�A�URE55 GITV ZIP PMONE <br />GENE�AL <br />AIAIL ADORE55 <br />CITY Z�P <br />� Bl/E)KEIT ' <br />CIIY Z�P <br />PNONE <br />;39- <br />PMONE <br />ST+.TE LICENSE � <br />SJfM.E I17 Ilfldl�E <br />PLUMBINGCONiRACiOR MAILADDRE55 CITV ZIP PNONE STATEUCEN�EM <br />CONTFACT PRIGE OF WORN <br />'� 32i 120 • o0 <br />DESCRIBE WORK AND SOUARE FOOTAGE INVOLVED <br />t�aa�rs (�rrxox. <br />PPCPOSED USE OF BUII.DING <br />YF,Y157/Nd` vrrrvp� - nv vi�nivuz _ <br />�EGAL DESCRIPTION OF PROPEFiV (SMOWN BEIOW OR ATTACH TWO COPIES� <br />LOT--- BLOCK -- OF <br />PARGELTAXI.D.NUMBER <br />CONSTRUCTIONLOANLENDER.ADORESS, <br />TYPE <br />& DISP <br />URINAL <br />ROOF <br />.EPHONENUMBER <br />� W!� /!/ 4✓ � <br />OR ITEM FEE <br />ctine �trro�,cr. <br />GONTAGT PERSON AND PHONE NO. <br />kEGN SM�IT�Fi '1.C,'1� 3/ L l <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br />APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br />WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br />NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br />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 />r.nura/OTOR9 L9WJtE29 RCW Aplp 296.200 WAC. <br />TYPE OF EOUIPM <br />/C—A/HNDLG UNITS—H.P. <br />F ED AIR SYSTEMS—B: <br />UNIT QTERS—B.T.U. M <br />RANGEHOOD <br />WATER HEATER <br />WOOD STOVE <br />METAL FIREPLA <br />FIREPLACE INSI <br />HEAT PUMP <br />GAS PIPING <br />EXHAUSTFAN <br />� <br />SUBTOTAL 3 I <br />PERMIT $ <br />TOTAL FEE 5 <br />FOR OFFICE USE ONLY: <br />conur ccrweru FEAR SETBACK SIDE SETBACK PLAN GNECK <br />USEZONE <br />�JPD �G� <br />SIZE OF OLDG <br />OCCUPANCYI <br />REASON <br />INTAKE BY <br />LOT AREA <br />NO.OF $TOFIES <br />SPNINKI.ERS REO'D <br />9RE ALARM <br />PLANS APPROVED BV <br />VACANT SITE <br />t=_ YES C� NO <br />acwevcr xoorewauxcuxns <br />LNOLP <br />BASEMENI <br />❑ YES i7 NO <br />NEIGHT LIMRqTION <br />OF <br />pq,E �l-�/g� I TAX CODE IS 3105 <br />BUILDMG <br />PLUMBING _ <br />MECHANICAL <br />ADDITIONAL PLA� CHECK <br />OTHER <br />ST'.TE BUILDING SUR�HAFGE <br />PUBLIC WORKS <br />TOTAL <br />FEE <br />E.A. <br />� <br />� <br />SUB TOTAL 3 <br />PERMIT $ � <br />TOTAL FFE $ ' <br />FEE RECEIPTNO <br />VALUATION FEE <br />� ���U ' — <br />i <br />i <br />� <br />i <br />