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APPLICATIQ" FOR CONSTAUCT�IN PERMIT � <br /> TO BE COMPLETED IN BLACK INK—PLEASE PRINT <br /> ' BUILDING DEPARTMENT HEATING SYSTEM: ❑GAS ❑ELECTHIC O <br /> 259-8810 <br /> LIT10N ❑ CpMBINA710N O BUILDING ❑MECHANICAL ❑PLUMBING ❑ SIGN <br /> OWN MAIL/�DDNE55 CITY 21P E <br /> j�v� su.�wsaa� /G�Y A�u��Eu� [/�E Ft�kF7r 48x3 ?�5 3-s9�� <br /> TENANT M�IL ADDRE55 pTY ZIP PHONE <br /> ARCNITECTORDESIGNEH MARADDRE55 CITY ZIP PMONE <br /> GEhERALCp1TR�GTpR MAIIMDRESS CITY 21P PIIONE ST�TELICENSE� <br /> MECNMIIC�LGONTq11LTOR MAIL�DDHE55 CITY ZIV PHONE ST�TELICENSE� <br /> PLUTASMG CONTRIICTOR MAR�DDRE55 CITv 21P PHONE ST�TE LILENSE 1 <br /> Cd/TR/�CT P(i1GE OF WJIM( <br /> DESCRIBE WOIIK MID SOU�RE FOOT/�(3E MVOLVED (',pNT�CT PERSON�ND PHONE NO. <br /> s� c�s �D Ia <br /> i HEREBY CERTIFY THAT 1 HAVE READ AND EXAMINED THIS <br /> rnoroseo use av eunomc APPUCATION AND KNOW THE SAME TO BE TRUE AND CORRECT.ALL <br /> ' PROVISIONS OF LAWS AND OROINANCES OOVERNINO THIS TYPE OF <br /> LEOALDESCRIPTIOHOF%qPEqTY�S110WpBELOWORATi�CHTWOCOPIES� yVORK WILL BE COMPLETED WITH WHETHER SPECIFIED MEREIN OR <br /> iot �� � NOT. ?NE ORANTIN6 Of A PERMIT OOES NOT PRE3UME TO GIVE <br /> AUTMORITV TO VIOLATE OR CANCEL THE PROVISIONS OF ANV <br /> OTHER STATE OR LOCAL UW RECaUU►Tttrf3 CONSTRUCTION OR THE <br /> � PERFORMANCE OF CANSTRUCTION.TH11T I AM AUTHORIZED 8V THE <br /> � OWNEH OF TMIS PROPERTV TO PERFORM i'HE WORK FOR WHICH <br /> PI1RCEtT�%ID.qUhlEF APPLICATION IS MI10E AND 1 COMPLV WITH THE STATE <br /> . �ACT QY CW AND 296.200 WAC. <br /> CONSTI7UCTION 1011N LENOER.�D011ES8.TELEPMONE NUGBER <br /> �oq�efs TUNE WTE <br /> %�4 CR- Vffw L�4-+U tXr cT rn..uMtesi�cc�seNo <br /> KUINMO MECN11MG1L <br /> No. tr�of A�o�rt�w � No. rv�oF�Nr � <br /> WATER CLOSET(TOILET) � A/C�IMNDLG UNITS—M.P. � <br /> . � BATHTUB ' FORCED AIR SVSTEMS--B.LU. M E.A. � <br /> IAVATORY(YNASM B11SIN) � UNIT HEATERS—B.T.U. M ; <br /> 9110YVER � CLOTHE6 DRVERS � <br /> � KITCHEN SINK 8 DISP ; VENTIUITION FAN ; <br /> DISMWASHER � FMI(iE HOOD �_ <br /> LAUNONY TRAY ; WATER HEATER ' <br /> CLOT}1ES WASMER � WOOD STOVE <br /> UpINAL � METAL FIREPUCE(WOOD BURNING) <br /> DIiINKIN6 fOUNTAIN � FIAEPUICE INSERT � � <br /> � �ppq pp�m HEAT PUMP � <br /> BACKFLOW PREVENTERS ; 6AS PIPIN(i <br /> ROOF DRAMS--HAINLEADERS EKHAUST fAN � <br /> SINK(SERVICE�IIR,ETC.) ; <br /> � � <br /> T <br /> 1 � <br /> 1 <br /> 1 <br /> T <br /> SUB TOTAL S ; SUB TOTAL { �5 ' -- <br /> PERMIT S � PEHMIT { / y_ <br /> TOTAL FEE S TOTAL FEE t ' <br /> Fon o�ce use on�r: <br /> FNONT SETBACN RE�R 6ETB�CN SIDE SETB�CK PLAN CHE N FEE �ECEIPT NO. <br /> 3 <br /> USE 20NE lOT 11RE� V�CANT SRE FEES VALUAiION FEE <br /> ❑ YES ❑ NO BUILDING � <br /> TVPEOiCON57 NO.OFSTOR�ES occuwxv MaaunuiNGUM�*s i <br /> caouv pLUMBING i <br /> SITE OF BLW FIHE SP111NKLEFS REO'D BASEA�ENT MECHANICAL <br /> [i YES '�l NO � <br /> OCCUP�NCV LOAD FIRE AL�iMI REO'D MEIGHT LIMITATION ADDITIONAL PUN CHECK i <br /> OTHER � <br /> REASON <br /> STRTE BUILDING SURCHARGE <br /> MUKE BV PL�NS�PPROVEO BY Gir OF E!Y.E,IINEIT PUBLIC WOiiKS i <br /> l��i <br /> oArE ���_»� TOT�I <br />