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, TO BE COMPLETED IN BLACK INK—PLEASE PRINT �T <br /> BUILDING DEPARTMENT HEATING SYSTEM: GAS ❑ELECTRIC J � <br /> 259-8610 <br /> i 1 DEMOLITION 17 COMBINATION [�BUILDING i I MECHANICAL ❑ PLUMBING f 1 SIGN <br /> OWNER MM�AOOFESS CITV 21P PNONE <br /> ��olnt� k�ca�S,S iF,7Q u��� E�)d.Y� (_)�� �`h717� 7 i 5' - b 29 <br /> TEN4NT MAILADDRE55 CIiV 2IP PHONE <br /> ARCHITECTOROES NER MFRAUORESS "IiY ZIP FHONE <br /> GENEPALG'NiRAC70R` �MAII DU���� `� �s� �� ��� �� �_ �(��� <br /> CITY ZIP PMONE STAiELICENSEs <br /> _ ��Y <br /> MECMANICALCONTRAGTOF MA�I.A�DRESS CITY 21P PHONE STATELICENSErt <br /> �� <br /> PWMBINGWMR4GiOR MAILAD�RESS CITV 21P PHOYE STATELILENSEP <br /> �� <br /> ONTBACT PR16�OF IYORN <br /> � P � �o ` <br /> OESCPIOE W K AND SOUARE FOOTqGE INVOLVED GONTACT PERSON�ND PNONE N0. � C Q� O� <br /> C� � • <br /> Q� ' <br /> ��� � � � i HEREBV CERTIFY THAT I HAVE READ AND EXAMINED THIS <br /> PROPOSEO USE OF B�IILOING APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT.ALL <br /> �y(�(�QR�: �(�'�(� PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br /> LEGALDnESCRIPTIONOFPPO ER�'�SHOWN ie�owoan ncHnvo PIES � WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br /> tot—l— BLOCK � oF �-> �C NOT. THE GRANTING OF A PERA7IT DOES NOT PRESUME TO GIVE <br /> ��f� ',.,_/ AUTHORITV TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br /> �O(��yn �o �i/�VE7- OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br /> � PERFORMANCE OF CONSTRUCTION.THAT I AM AUTHORIZED BY THE <br /> OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br /> APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> rnece�tnx i .NUMo�n CONTRACTORS L{�W 78.27 RCW AND 296.200 WAC. <br /> -d z� - r�9 , <br /> CONSiRUCTIONLOANLENDER,ADDRESS.TELEPNONE Ni1M�[R � �� q7 <br /> l ��� � Z a —� <br /> PROJECT ADDRESS s�cv+n . /1� o�re <br /> CI1Vfl ,i $SL!CENSCNO <br /> PIUMBING ME ANICAL' <br /> N0. TYPE OF FIXTURE OR ITEM FEE NO. TYPE OF E�UIPMENT FEE I <br /> WATER CLOSET(TOILET) A/C—AMNDLG UNITS—H.P. <br /> / BATHTUB ; / FORCED AIR SYSTEMS—B.T.U. M E.Fl. <br /> LAVATORY(WASH BASIN) � UNIT HEATERS—B.T.U. M <br /> SHOWER / CLOTHESDRYERS <br /> KITCHEN SINK& DISP � � VENTILATION FAN ' <br /> DISHWASHFR � RANGE HOOD <br /> -----� <br /> LAUNDRY TRAY ; WATER HEATER <br /> CLOTHES WASHER � WOOD STOVE _ <br /> URINAL ; METAI FIREPLACE(WOOD BURNING) � <br /> DRINKING FOUNTAIN FIREPLACE INSERT � <br /> FLOOR DRAIN � HEAT PUMP <br /> RACKFLOW PREVENTERS 6A5 PIPING <br /> ROOF DRAINS—RAINLEADERS � EXHAUST FAN _ <br /> SINK(SERVICE—BAR.ETC.) <br /> � <br />! SUB TOTAL S �' SUB TOTAL 5 " <br /> PERMIT 5 PERMIT S <br /> TOTAL FEE $ ' TOTAL FEE S <br /> FOR OFFICE USE ONLY: <br /> FRONTS��N PEARSETBACK SIDESETBACK PLANCH�CKNOMBER FEE/�� /O EGEI TNO Z <br /> I � C/ �7 S <br /> J � <br /> USEZON —� LOTAREA vncnntsire FEES VALUATION FEE <br /> ,�I I:� YES _i NO BUILDING ����y � � �.� <br /> 7VPE Of LON51. NOAF SIDPoES oc<u�a!;Cv NO or owEwNGU��ts --� i <br /> / 1 � °� � PWMBING __ <br /> V <br /> SIZE OF BLDG. FIRE SPRI KLERS REO'D BASEMENT MECHANICAL <br /> q SF � i7 YES ��.� NO � <br /> OCCUPANC LOAD FIRE�LA /R�EOD HEIGNTLIMITATION ADDITIONALPLANCHECK � <br /> V / � <br /> OTHER ' <br /> REASON — �/ �— <br />' STATE BUILDING SURCHARGE U <br /> i Ll?U <br /> I INTANEOV PLANS� P EDBV CITYOFEVERE7T PUBLICWORKS -�— <br />� LOCAL SALF.S , <br />, pq,� .� �.� TA% CODE IS 3105 TOTAL �"j(%� ����� <br />