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APPLICATIa ; FOR CONSTRUCT.'`�1N PERMIT � <br /> TO BE COMPLETED IN BLACK INK—PLEASE PRINT <br /> HEATING SYSTEM: U GAS !J ELECTRIC '.J �'� <br /> BUILDING DEPARTMENT <br /> 259•8810 <br /> DEMOLITION ✓COMBINATION �BUILDING I i MECHANICAL � ' pLUMBING � I SIGN <br /> OWNER MAIL�DORESS CITY ZIP PMON[ <br /> a �G e n He �„ m a f a 2�� ��,� �� �u� 9s:� oi a s9- .�ss� <br /> TENANi MAIL�OORES$ CIT1' 7.IP PMONE , <br /> ARG�HITEC.T�ORD'ESwIGNEF MNLADOPE55 GITY ZIP PNONE <br /> V � "'��' <br /> GEN�ERALC.�ONTRnAC^TOR h1AiL�DDRE55 GITY 21P PHONE STATELICENSE� • <br /> V y /w/ <br /> MEGHANIC�LWNiRACTOF h1AILAU0RES5 CITY ZIP PHONE SiATELICENSl� <br /> PL�UA7/81NG CONTRACTOR MAIL ADDRESS CI7Y ZIP PHONE STAIE LIC[NSE k <br /> C��I/ /'vI <br />� C TRACT PRICE OF WORK <br /> �7$Da. Oo <br /> DESCRIAE'NORN ANU SOUARE F TAGE IN LV 0 WNTACi PERSON AND PMONE NO. <br /> N EGU <br /> /d�'w s,'�/;n y Do o�-s Fra ���n . C� - �'/�O <br /> U'^'" �m� I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br /> PROPOSEUUSEOFBUILOING APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT.ALL <br /> r,-„�f��p, .�p�ZCt,q,Q� PROVISIONS OF LAWS AND ORDINANCES GOVeRNING THIS TYPE OF <br /> LEGALDESCR iIONOFPROPERTV�SH NBELOWORAnnqNTwoc� Pipv-esi � � WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br /> �oT�3_,z(f. Bi�K S'°a oF M�CXq,y �-o� NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br /> AUTHORITY TO VIOLATE OR CANCEI THE PROVIS�ONS OF ANY <br /> 3� .�,yry� OTHER STATE OR LOCP' =�'��'� ^°�ULATING CONSTRUCTION OR THE <br /> PERFORAIANCE OF CC ' �� - THAT I AM AUTHORIZED BY THE <br /> OWNER OF THIS PRO�l ' .r7FORM THE WORK FOR WHICH <br /> APPLICATION IS M�.�. . . �. I COMPLV WITH THE ST.ATE <br /> Pps/rs o�uMS o� a aZ 3 0 0 0 7 CONTRACTORS LAW 182?RCW AND 296.200 WAC. <br /> GONSTRUCTION LOAN LENDER.AO�RESS.TELEPMONE NIIMBER x� �/ /j n� � ^/3��� <br /> i <br /> k%!/�.�`.i -C/r <br /> PROJECTADDRESS saHe�mrz � o.a <br /> � 3 1 ��r.w��.��ss�,��„s��a <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM FEE N0. TVPE OF EOUIPMENT FEE <br /> / WATER CLOSET(TOILET) A/C—A�HNDLG UNITS—H.P. <br /> BATHTUB ' FORCED AIR SVSTEMS—B.T.U. M E.A. <br /> / LAVATORV(WASH BASIN) � UNIT HEATERS—B.T.U. tvl � <br /> SHOWER CLOTHES DRYERS <br /> KITCHEN SINK 8 DISP � VENTILATION FAN <br /> DISHWASHER RANGE HOOD <br /> LAUNDRYTRAY WATER HEATER ' <br /> CLOTHES WASHER � WOOD BTOVE � <br /> URINAL ' METAL FIREPLACE(WOOD BURNING) ' , <br /> DRINKING FOUNTAIN � FIREPLACE INSERT � ', <br /> FLOOR DRAIN HEAT PUMP , <br /> BACKFLOW PREVENTERS ; GAS PIPING <br /> ROOF DRAINS—RAINLEADEP3 � EXHAUST FAN � <br /> SINK(SERVICE—BAR.ETC.) � � <br /> � ' <br /> � ' <br /> � <br /> SUB TOTAL S ; SUB TOTAL 5 <br /> PERMIT S PERMIT S <br /> TOTAL FEE S ' TOTAL FEE 5 ' <br /> FOR OFFICE USE ONLY: <br /> FFONTSETB�� REARSETBACK SI�ESETBaCH/ PLANCHE NU�. ER FEE RECEnIPi O <br /> / C L�i- O �rl ,JJ N <br /> J l{ 7 <br /> � � use zorve LOT r1REA �AC�NT SITE FEES VALUATION FEE <br />,' ��',:.."-�. � �Z_ :l YES ;7 NO BUiLoiNG 7SGL� �U(J <br />� ����'�- - � NOOFSTORIES occur�x[r rva0�m5ntn:cu'a4 <br />', .�e,,� _ 7YCE Of C 1 Si. .nOUP ' <br /> PLUMBING i D�� <br /> �•�-'.i _� ''� . ��� <br />' E��"� �� � SIZEOFBL�G. FlRESPFINKLERSREO'D BASEMENT MECHANICAL � <br />� S �� � �-� YES �NO <br /> OCGUPANCV LO(�D FIRE ALARhI P[OD HEiGHT LIMI�TION ADOITION�L PLAN CHECK � <br /> NlP /..v OTHER � <br /> RE�SON <br /> STATE PUILDING SURCHARGE � � / % <br /> INTAKEBY PLANSAPPROVEO�Y CITYOFEUERETT PUBLICWORKS � <br /> `J �} LOCAL SALES <br /> OATE i8 g y TAX CODE IS 3105 TOTAL /,:�L/ j �� <br /> -s <br />