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�A <br /> 3 � APPLICATIOI�OR CONSTRUCTIG��J PERMIT ��� : <br /> F, � <br /> TO BE COMPLETED IN BLACK INK—PLEASE PRINT <br /> � <br /> HEATING SYSTEM� U GAS ❑ELECTRIC I]__ � <br /> �I��(y BUILDING DEPARTMENT <br /> ^�� � 259-8810 I � <br /> DEMOLITION I COMBINATIAN , BUILDING MECHANICAL LUMBING ' SIGN <br /> OWNER MAiLRD�RE55 GIT� ZiP PHONE <br /> ��� r`�au / �. s se_ J ��r�. �d'�u � � s —�3 <br /> , � MAIIADDFE55 ��T� 71P P�E <br /> � TE � <br /> .�� ` CItV 21P �'HONE <br /> ARCNRECTOPOESIGNER M�ILA�OHE55 <br /> � CITY ZIP PYONE STAT�ry$��S � <br /> ��� - GENERN.CON C A MRILADDFE55 (/ S <br /> y i -�on-/—acr SG/�GuP� vle.� G�a E���� ��ao_� 3,53 3»z _ G I . <br /> ��� �' QfpR MML AODRESS dTY ZIP NNaNE �T�iE IICENSE♦ <br /> MEGHUIIG�I. ONTR� <br /> � � <br /> U CITY ZIP PMONE STAT[LICENS[s <br /> � �y PIUMdINGC(N�TRRGTON �MAILRODfiE55 <br /> M� ���/= <br /> y t cuss oF woaK <br /> �~� , I i NEW I.I ADDITION �. ! ALTERATION REPAIR ' DEMOLITION '� WOODSTOVEiFRPL INSERT � BUILDING FELOCATION <br /> � CONTACt FERSON PND PHONE NO. <br /> � � � <br /> � CONTflACT PRICE OF WORK <br /> � . OESCRI WOFKANOSO�IAREFOOTAGEINVOLVEO <br /> (A �f' � �. �. <br /> -�-"- PROPOSEOUSEOFBUItDI � HEREBY CERTIFY THAT I HAVE READ AND EXAM�NED THIS <br /> S, APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT.ALL <br /> LEGPLDESGH�PTIONOFVROVERTV�SHOWNDEtOWORATiACHFOURCUPI[5� PROVISIONSOFLAWSANDORDINANCESGOVERNINGTHISNPEOF <br /> WORK WILL B_COMPLCTEU WITH WHETHER SPECIFIED HEREIN OR <br /> ,, ,z,,. , . � �oT Bi�K oF NOT. THE GRANTI�'G OF A PERMIT DOES NOT PRESUME TO GIVE <br /> � �y,i.. � i AUTHORITY TC VIOLATE OF CAfICEL THE PROVISIONS OF ANY <br /> �6�a'�j��� ` PERFORMANC6 OF OONSTRUCTION.THAT I AM AUTHORI ED BY THE � <br /> y S ���t,�t � OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br />� l �.�t�t <br /> APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> p.,:,.. :_;;�;r;�.;:,.� .: CONTRACTORS LAW 18.27 RCW AND 296200 WAC. <br /> ' X �t>l�� � ��f���-9-�� <br /> � i sCverunc °"'� <br /> � PRQIECT PODHE55 �/n/ <br /> � � - �r��� /i `Ja �//(t /� CIiVBUSMLSSIICENSENO <br /> ,J ( <br /> PLUMBING MECHANICAL I <br /> �I ' NO. TYPE OF FIXTURE OR ITEM FEE NO. TYPE OF EOUIPMENT FEE <br /> ' I WATER CLOSET(TOILET} A�C—AMN�LG UNITS—H.P. <br /> � FORCED NR SYSTEMS—B.T.U. M E.1. <br /> � . � BATHTUB � � <br /> LAVATORY�WASH BASIN) UNIT HEATERS—B.T.U. M � <br /> � �� C� � SHOWER CLOTHESDRYERS � <br /> . KITCHEN SINK 8 DISP VENTILATION FAN __T I <br /> � DISHWASHER � RANGF.HOOD — � <br /> 3 LAUNDRV TRAY WATER HEATER I <br /> .�� �� � CLOTHESWASHEF ,i WOODSTOVE <br /> URINAI. ' METAL FIREPLACE 8 CHIMNEV <br /> - I � DRINKING FOUNTAIN FIREPLACE INSERT �I <br /> ,{ _ . FlOOR DRAIN �' HEAT PUMP _ ; I <br /> I 1 BACKFLOW PREVENTERS / GAS PIPING i <br /> �� i EXHAUSI"FAN <br /> ROOF DRAINS—RAINLEADERS i i <br /> : i SINK(SERVICE—BAR,ETC.) , <br /> � �1� <br /> �� � <br /> i 1 SUB TOTAL 5 � <br /> � SUB TOTAL 3 � � <br /> ; � PERMIT S PERMIT $ � � <br /> TOTALrEE $ TOTALFE[ 5 <br /> FOR OFFICE USE ONLY: <br /> FIiONT SETOACK RERR SETUACK SI�E SETBACK PLAN CHECK N �ER <br /> FEE FEGEIPTNO. <br /> ❑SEZONE LOTAREA VACANTSttE ' FEES'� VAIUATION FEE ' <br /> � <br /> BUILDING <br /> 1VPEO�CONtS.AIIOW/BLE iYP[OfLONSi.PGP1AL ot[u�uBv v0o�w.9uxcuwa <br /> r.4our PLUMOING i <br /> SREOF6LDG NO.OFSiOFIES BPSEMENT ,y1ECHANICAL � I <br /> i <br /> A�DITIONAL PLAN CHECK � 1 <br /> OCCUPANCYLOAD FiRESPRNNLER5RE0'D NEIGMTLIMITATiON i I <br /> SPRMKLER � � i <br /> RERSON FOR SPRINKLEFS i , <br /> STAiE�UIL�ING SUPCHARGE I I <br /> INTAKEBY PLRNSPPPROVEDOV CITYOFEVERE7T PUPLICWORK$ � <br /> LOCAL SALES � <br />, TAX CODE IS 3105 TOTAL � � <br />