Laserfiche WebLink
APPLICATIG J FOR CONSTRUCT.JN PERMIT � <br /> TO BE COMPLETED IN BLACK INK—PLEASE PRINT <br /> HEATING SYSTEM: ' GAS ❑EIECTRIC J <br /> BUILDING DEPARTMENT <br /> 259-8810 <br /> DEMOLITION f 7 COMBINATION I 1 BUILDING ❑ MECHANICAL ❑PLUMBING ❑ SIGN <br /> OWr1ER MAILADDRESS UTV ZIP PHONE <br /> 1/�flL�re2 Ul, G�,o�c� .JR. Szo 4�� Sr se F��'r w.q 95'zo3 Lsz-aY3/ <br /> TENANT MFIIADDRE55 CITV ZIP PMONE <br /> 1 CITV ZIP PN01lE <br /> qRCHITECT OR�ESIGNER MAIL AUDRESS <br /> �I CITV ZIP PMONE STATELICENSE• <br /> GENERALCONTRACTOR MAILADDFESS <br /> ,�1IA — <br /> MECNANICA�L(COANTRACTOR MFIL ADDRE55 CITY 2�P PNONE STATE LICENSE II <br /> N�I7 <br /> �iT� Z�p PHONE STATELICENSE� <br /> PLUMBINGGONTRRCiOF MRILAODRESS <br /> CON�RICE OF WORK � <br /> UESGRIBE WOqN AND SOURRE FOOTAGE INVOLVED CONT�CT PERSON AND PMONE NO. <br /> �t ,�1N � G nf [!L <br /> _��p�x i. �Q,(% f=pbr/{ ` � �I � i HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br /> PROPOSEDUSEOFBUILDING APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECL ALL <br /> JU� PROVISION�OF LAWS AND ORDINANC[S GOVERNING THIS TYPE OF <br /> IEGALDESCRIPTIONOFPROPERTYISNOWNBELOWORATiACHTWOCOPIES) WORK N'ILL dE COMPLETED WITH WIIETHER SPECIFIED HEREIN OF <br /> �or�-I� Z2 BLOGK SO2 _ oF M I�EY CAuP �OMIAw�'S NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br /> AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br /> •TH�RO Appynp,r,l 7p E•l�E7T A['[p201u6 ?fi ?tK= 0 OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br /> iu ✓�L y � aAn p�F 3$• RF�oR�s PERFORMANCE OF CONSTRUCTION.THAT 1 AM AUTHORIZED BY THE <br /> 74�� IdBMOrO OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br /> _� �p���.} �q,r,ny W �/b'rN APPLICATIOY IS MADE AND I COMPLY WITH THE STATE <br /> PpRCELTrIX ID.NUMBEP CONTRACTORS LAW iB.27 RC AND 296200 WAC. <br /> S15 A -SbZ-021 -pU09 J <br /> CUNSTRU����O�N LENDER.ADDRESS.TELEPMONE NUMBER q J/�/�� <br /> ^ 'v �� <br /> �r SiGN .E O�iE <br /> pROJEI.'T ADDRESS � <br /> .Z3� !,� ��-.yjL7j�' cnreusn+essucer+ser+o <br /> PLUMBING MECHANICAL <br /> FEE N0. TYPE OF E�UIPMENT FEE <br /> . N0. TYPE OF FIXTURE OR ITEM q��_p�HNDLG UNITS—H.P. ' <br /> WATER CLOSET(TOILET) � <br /> BATHTUB FORCED AIR SYSTEMS—B.T.U. M E.A. <br /> LAVATORY(WASH BASIN) UNIT HEATERS--B.T.U. M � <br /> SHOWER CLOTHES DRYERS � <br /> KITCHEN SINK&DISP VENTILATION FAN ' <br /> DISHWASHER � RANGE HOOD � <br /> LAUNDRYTRAY WATERIiEATER � <br /> CLOTHES WASHER � WOOD STOVE ' <br /> METAL FIREPLACE(WOOD BURNING) ' <br /> URINAL ' <br /> DRINKING FOUNTAIN FIREPLACE INSERT ' <br /> � HEATPUMP <br /> FIOOR ORAIN GAS PIPING ' <br /> BACKFLOW PREVENTERS � EXHAUSTFAN � <br /> ROOF DRAINS—RAINLEADERS <br /> SINK(SERVICE—BAR,ETC.) � <br /> � <br /> � � <br /> SUB TOTAL $ ' SUB TOTAL 5 � <br /> PERMIT S ' <br /> PERMIT S ' TOTALfEE S <br /> TOTALFEE 5 <br /> FOR OFFICE USE ONLY: Receivr r+o. <br /> SIDESET�ACK PLANCHECKN M�GR FEE <br /> FHONT SEiBACK REAF SEIDACK � <br /> S VALUATION FEE <br /> USE ZONE l0T AREA VACANT SIiE ; <br /> G YES � NO BUILDING <br /> i <br /> 1YFE OF CONST NO.OF STORIES Mcu^nnp No o�m4ELUu,N:Js i <br /> �An�P p�UMBING ' <br /> SIZEOFBLDG. FIRESPPINKLERSREOU BASEM'_NT MECHANICAL � <br /> �-1 YES ❑ NO � <br /> NEiGnT uMiratioN ADDITIONAL PLAN CHECK ' <br /> OCCUPRNCYLOAD FlREALARMREOD i <br /> OTHER ' <br /> � v <br /> nEnSON STATE BUILDING SURCHARGE ' <br /> IN�AKEBV PL�NSAPPROVEOB� CITYOFEUERE7T PUOLICWORKS I <br /> LOCAL SALES � <br /> DATE <br /> TA%CODEIS 3105 rorn� <br />