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pPPLICATIP`�I FOR CONSTRl1CT�DN PERMIT � <br />TO BE COMPLETED IN BLACK INK-PLEASE PRINT <br />HEATING SYSTEM: ❑ GAS ❑ ELECTRIC ❑ <br />BUILDING DEPARTMENT `— <br />259•8810 <br />f-i DEMOLITION fiKCOMBINATION <br />pWNER �G MAILAD�RESS <br />❑ BUILDING <br />GITY <br />CITY <br />f"1 MECHANICAL <br />ZIP PI <br />PHONE <br />y�*PLUMBING ❑ SIGN <br />n <br />ARCH'TECTORDESICaNEP MAILAODRESS <br />GTY ZIP PHONE <br />GENERALCONTRACTOR MAILADPRE55 <br />CITV ZIP PMONE STATE LICENSE • <br />MECHANICAL WNTRACTOR MAIL RUDRESS <br />CIiV DP PHONE STATELICENSEI <br />���, Z�p PMONE STATE LICENSE 1 <br />PLUMBINGCONTRRCTOR MAllA00flES5 <br />CONiFACT PRICE OF WORK <br />DESCfl18E NIORK AND SOUARE FOOTAGE �NVOW EO <br />PROPOSED USE OyF ^.B�UILDING <br />LEGAL DESCflIPTION OF PROPERTV �SMOWN BELOW OP ATTACH TNO COPIES) <br />LOT—�i�— BLOCN — OF <br />P�RCELTAXI.D.NUMBER <br />�pNcTqp�7�pN LO�N LENDER. � <br />PROJECT ADDRESS <br />/�-�s � <br />PLUMDING <br />Np, TYPE O <br />WATER CLOSE' <br />BATHTUB <br />LAVATORY(WA <br />SHOWER <br />KITCHEN SINK <br />DISHWASHER <br />LAUNDRY TRA' <br />CLOTHES WAS <br />URINAL <br />DRINKING FOl <br />FLOOR DRAIN <br />FOR OFFICE USE ONLY: <br />FRCNTSETBACK REAR: <br />USEZONE ���A� <br />iYPE OF CON51. NO. OI <br />SIZE OF 6LDG. <br />REASON <br />INiANE <br />NUMBER <br />FIRE SPRINKLERS REO'0 <br />ALARM <br />PlANS <br />DATE <br />COMAGT PERSON AND PHONE NO. <br />I HEREBY CERTIFY THAT I HAVE READ AND E%AMINED THIS <br />APPLICATION AND KNOW THE SAME TO BE TFUE 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 ANV <br />OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br />PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br />OWNE OF THIS PROPEFTY TO PERFORM THE WORK FOR WHICH <br />AP L TION IS MADE AND I COMPLY WITH THE STATE. <br />� TORS LAW 18.27 RCW AND 296200 WAC. <br />o��c <br />SIGNI.iURE <br />TYPE OF EOUIPMENT I FEE <br />FORCED AIR SYSTEMS—B.T.U. M E.A. <br />UNIT HEATERS—B.T.U. M <br />RANGEHOOD <br />WATER HEATE <br />WOOD STOVE <br />METAL FIREPL <br />FIREPLACE IN <br />HEAT PUMP <br />GAS PIPING <br />FEE $ <br />SIDE SETBACK PLAN CHECK NG BER� <br />5 <br />VAGANT SITE FEES <br />❑ YES � N� BUILDING <br />OLLUP�NCY NO MdNFUINGUNrtS <br />r.Aouo pLUMBING <br />BRSEMENT MECHANICAL <br />❑ YES ❑ NO <br />HEIGHT LIMITATION ADDITIONAL PLAN CHECK <br />OTHER <br />STATE BUILOiNG SURCHARGE <br />CILUCAL SA ES PUBLIC WORKS <br />rer ennF IS A105 7orn� <br />$ <br />FEE <br />FEE I RECEIPT NO. <br />