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IG <br />4 <br />LIB <br />APPLICATIOrT- OR CONSTRUCTIN PERMIT <br />TO BE COMPLETED IN BLACK INK —PLEASE PRINT <br />HEATING SYSTEM: U GAS ELECTRIC U <br />BUILDING DEPARTMENT <br />259-8810 <br />I DEMOLITION COMBINATION X BUILDING MECHANICAL j( PLUMBING SIGN <br />OWNER ADDRESSMAIL CITY Zip PHONE <br />oauf `Er;n Akhc,( Wi11- ocean.lue E eleIt 4Buto3 3Y7-0;,3� ' <br />TENANT MAI-ADDRESS Clry 21P PHONE <br />�G In <br />ARCHITECT OR DESIGNER MAIL ADDRESS CITY ZIP PHONE <br />jC51.9A Lrnes �o10 �S` Sk SE �verel{ ?K '-3 353 a5-S I _ <br />GEkE L TRACTOR MAIL ADDRESS 'T CITY ZIP PHONE STATE LICENSES <br />R� S utl ConSi apes n P0 f5�c 0OL L4,,,hg I w4 `IBOW, 331/-3`10.24 c5colad.�S <br />np PHONE STATE LICENSE• <br />A � 'D - <br />MUMBINGCONTRACTOR MAIL ADDRESS CITY ZIP PHONE STATE LICENSE <br />mIIf(A10 AdonSrrtc LUA6-Ysrnln) Ly nTu&al 98y3e 776-86Dc? tV1:LLsAfrt44L7 <br />CLASS OF WORK <br />IIFAIlYI ITIFYN wnnOSTOVHFRPL INSERT 'BUILDING RELOCATION <br />I 11'ICO . <br />CONTRACT PACE OF WORK 1/ 34 C)oo °� q� <br />CONTACT PERSON AND PHONE NO <br />k ,tte^&c/ .- 331L_ yaa <br />DESCRIBE WORK AND SOUARE FOOTAGE INVOLVED <br />t m,ont,2bed, <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br />PRO 0 SEOFBUILDI G <br />vmtAPPLICATION <br />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 />LEGAL DESCRIPTION OF PROPERTY ISHOVM BELOW OR ATTACH FOUR COPIES) <br />LOT BLOCK OF <br />NOT. THE Gr.ANTING 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 CONST!AUCTION. THAT I AM AUTHORIZED BY THE <br />OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br />APPLICATION IS I;.ADE AND I COMPLY WITH THE STATE <br />CONTRACTORS LAW 13.27 RCW AND 295.200 WAC. <br />X <br />PROJECT ADDRESS <br />/I — v ` ' <br />Of <br />CITY Nl15Mi55 UCIN" Ib <br />PLUMBING <br />MECHANICAL <br />NO. TYPE OF FIXTURE OR ITEM FEE <br />NO. TYPE OF EQUIPMENT FEE <br />WATER CLOSET (TOILET) <br />- <br />ABC-NHNDLG UNITS-H.P. <br />t <br />BATHTUB <br />- <br />FORCED AIR SYSTEMS-B.T.U. M E.A. <br />LAVATORY (WASH BASIN) <br />/O - <br />UNIT HEATERS-B.T.U. M <br />t <br />SHOWER <br />j - <br />CLOTHES DRYERS <br />KITCHEN SINK A DISP <br />VENTILATION FAN <br />DISHWASHER <br />RANGE HOOD <br />LAUNDRY TRAY <br />WATER HEATER <br />CLOTHES WASHER <br />WOOD STOVE <br />URINAL <br />METAL FIREPLACE & CHIMNEY <br />DRINKING FOUNTAIN <br />FIREPLACE INSERT <br />FLOOR DRAIN <br />HEAT PUMP <br />BACKFLOW PREVENTERS <br />GAS PIPING <br />ROOF DRAINS-RAINLEADERS <br />/ <br />EXHAUST FAN <br />' <br />SINK (SERVICE -BAR, ETC.) <br />O i rr0 <br />SUB TOTAL $ <br />o'IS ; da <br />SUB TOTAL $ <br />,30 ' OD <br />PERMIT $ <br />PERMIT $ <br />T <br />TOTAL FEE $1 <br />TOTAL FEE $ <br />30' JZJ <br />FOR OFFICE USE ONLY: <br />REAR SE tE1ACC <br />SIOE5ETBA> ` <br />FRONT SETBACK <br />Z <br />1 <br />Z— <br />?� <br />USE Z E <br />r <br />LOT AREA <br />s5,9� <br />VACANT SITE <br />TYPE OF CONTS. ALLOWABLE <br />TYPE OF CONST ACTUAL <br />OLCUKAN. <br />NOVVAFLUNC UNITS <br />SIZE OF BLDG_ NO, OF STORIES BASEMEnI <br />Srt <br />25S <br />OCCUPANCY LOAD <br />FIRE SPRNKLERS REED HEIGHT IIMIT,TION <br />M /A N' <br />REASON FOR SPRINKLERS <br />., <br />LI <br />.j tt L/v/•� s I TAX <br />FAR <br />BUILDING <br />PLUMBING <br />MECHANICAL <br />ADDITIONAL PLAN CHECK <br />SPRINKLER <br />STATE BUILDING SURCHARGE <br />PUBLIC WORKS <br />TOTAL <br />d,J. �";- <br />FEE RECEIPT NO. <br />Q <br />lv <br />E <br />