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APPLIGATIO' ' FOR CONSTRUCTI'�N PERMIT �✓�� <br /> TO BE COMPLETED IN BLACK INK—PLEASE PRINT <br /> HEATING SYSTEM: �GAS ❑ELECTRIC ❑ , <br /> BUILDING DEPARTMENT <br /> 259-8810 <br /> ❑ DEMOLITION i_I COMBINATION L'. BUILDING f l MECHANICAL C.l PLU�v181NG SIGN <br /> O�R M0.I:ALDnESS CIN 21P PHONE <br /> I�`�G�� /-�/�l.��6�tJ 3�II�. IVo2�,.: �ue,� e1-1 �`d2a I 252 I9S� / <br /> T�€`IiANT ` MAILADDRESS CITY ZIP PHONE <br /> {��E�C�- � l M��/�NI�y� — <br /> ARCNITEGTORDESIGNER UAILA��RES1 CITY 21P PHONE <br /> �:`C �` ��� ✓-f w t��o nJ _ -- <br /> �GEN AL NiR\ACy`�`R'`1Li� ��� D�F -�� � CITY Z:P PNONE STATEUCENSE= <br /> PG'' w.N�F�n�� �3y I� Z J✓J �Q-�-o � � y2 J � 2 rJ2 �72 CJ -- <br /> MECHANICh.CONTRhCTOR 1.NiLAO ESS CITV ZIP PHONE SiAT6LICENSEa <br /> ✓ � <br /> PLUMBINGCONTRACTOR MhIL�DORESS CITV ZIP PHONE SL1TElICENSEM <br /> �__' _—_ <br /> CONTRACT PPICE OF 1V0 <br /> vr' C`��. �� -- <br /> DESCRIBE WORN AND SOUAPE FOOTAGE INVOWEO CONTACT PERSON PNU PHONE NO.p�`I� �ynYL. Y�/ <br /> M1. <br /> �.�S��I d� S�k' a S� � - � �2�9- <br /> i HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br /> PROPOSEDUSEOFBIIILDING APPLICATION AND KNOW THE SAME TO BE Tfl1�C AND CUnriECT.ALl <br /> U��I i �.y 5'.�a,�q PROVISIONS OF LAWS AND ORDINANCES GJVERNING THIS TYPE OF � <br /> LEG�LDESCRIPTIONOFPPOPERTY�SHOWNBELOWORATTACNTWOForiesi a( WORK WILL BE COMPLETED WITH WHclHER SPECIFIED HEREIN OR <br /> LOT � �� BIOCK� CF �� '�� `� � ` NOT. THE GRANTING OF A PERMff DOES NOT PRESUME TO GNE <br /> AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANV <br /> OTHER STATE OR LOCAL LAW HEGULATING CONSTRUCTION OR THE <br /> -- PERFORMANCE OF CONSTRUCTIO�.Tf:dT I AM�UTHORIZED �Y TNE <br /> � .� -,� d d. � (j�Js �QO(p OWNER OF THIS PROPERTY TO PERFORM THE 6VORK FOR '.NHICH <br /> APPLICATION IS MADE AND I COMPLY WITH TIIE S�Il�TE <br /> `' PARCELTA%I D,NUMBEF I�/ /b�O `� CONTRACTORS LAW 7827 RCW AND 296.200 WAC. <br /> , � � ��� � �, - - - <br /> CONSTRUCTIOtI LOAN LENDER.ADDPESS.TELE�NE A'JMBER <br /> � '�� �k� <br /> PROJECTADDRESS Y c/� 1 �/� s�cr+.im�e 'J ---.^^'E. _. . . . .. <br /> 3�''��..nfl)If��A� LC�(!l)Q,}-L .�'vI�'� ciivxisi�+[5siicEvsEna <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM FEE NO. TYPE OF EOUIPMENT FEE <br /> WATER CLOSET(TOILET) � FVC—NHNDLG UNITS—H.P. _ <br /> BATHTUB FORCED AIF SYSTEMS—B.T.U. 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 /> DISHWASHEF � RA�GE HOOD ' <br /> LAUNDRY TRAY ' WATER HEATER ' <br /> CLCITHES WASHER WOOD STOVE � <br /> URINAL ; METAL FIREPLACE(WOOD BURNING) ' <br /> DRINKING FOUNTAIN � FIREPLACE INSERT _ <br /> FLOOR DRAIN HEAT PUMP <br /> BACKFLOW PREVENTERS � GAS PIPING <br /> ROOF ORAINS—RAINLEADERS � EXHAUST FAN ' <br /> SINK(SERVICE—BAR,ETC.) � ' <br /> � I <br /> � <br /> SUB TOTAL S SUB TOTAL 5 /5 ', [7 <br /> PERMIT $ � PERMIT S <br /> TOTALFEE 5 TOTALFEE S �� ' (=t� <br /> FOR OFFICE USE ONLY: <br /> FRONT52TB1.LK RE�IISETBAFK SIDESETBACK PLANCHEC�� � FEE RECGIPTNO. <br /> 2� S� C' <br /> usezor+e �oraaea VACANTSRE FEES VALUATION FEE <br /> �I ❑ YES �N� BUILDING j �_iv:7 <br /> lYPEOFCONSi. NO.OFSTORIES o[NrANc+ 60ormvttu9,L`ats � <br /> � I f9CJ" � PLUMBING � <br /> SRE OF BIDG. FIRE SPRINKLEPS REO'D BASEIdENT �NO MECHANICAL /�' (�(� <br /> �O Slt" �7 ' .' YES . � <br /> OGCUPANLY 104D FIPE�L�RM REO'D MEIGHT LIMITATION ADDITIONAL PLAN CHECK �� i t, <br /> � J OTHER ' <br /> REASON i ( 1 <br /> STATE BUILDING SURCHABGE � / <br /> INTARE�V FLANSAPPROVEDBV CITYOFEUERETT PUBLICWORHS �� � <br /> J�3 LOCAL SALES <br /> DATE � Z� y TAX CODE IS 3105 rorn� ' ��, �;%�—; <br />