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�E � APP�ICATIO�FOR �CONISTRUCTI�t�I PERMIT ���� <br /> TO BF COMPLETED IN BLACK INK—PLEASE PRINT I <br /> � � � � <br /> r0� x -^ BUILDING DEPARTMENT HEATING SYSTEM: GAS ❑ELECTRIC O <br /> y y y 259-8810 / � <br /> Y <br /> y� H DEMOLITION COMBINATION BUILDING MECHANICAL PLUMBING SIGN <br /> OIYNER MAiLADDf1F.55 CIiV 21P PItONE <br /> �H � Du� sf,1�? D�i2 P_o. �x �I�� Mc�tu�rFo 9�z�s 3S�1-���/7 I <br /> TENANT M11ARp DRESS CITV ZiP PNONE <br /> y <br /> ��Zi qRCHRECTORDE5IGNER MAILnDDRESS QTY ZIP PHONE <br /> o� d A�cv. i P9Is iY3. k�� auc-. u��Q�bz✓��Q7z a€S— y�oo _ <br /> GENEFALCONiRAGTOR MAILP'JDRE55 qiV ZIP PHCYE STRiELICENSEx�O/Z1�(�" <br /> ��g �E�i�,�odz,� Favns�rzP/usr-s iu�e (�b. BoK 115�'' �Uc���a uiA �275 74's 3s-77 ' <br /> MECMANICA�CONTRAGTOF hIFiLA00RE55 CItY ZiP PNCNE STATELICENSEa <br /> �y� PWAIOINGCONTR4CTOR RIAILADDRE55 CI7Y 2�P PMONE 5'ATEUCENSEt <br /> Hy <br /> gN <br /> � �y Ll�A OFIYORK I <br /> Y NEW ' �� ADDITION ' ALTERATION R�9AIR���� DEMOLITION WOODSTOVE�FRPLINSERT . BUILDINGRELOCATION <br /> �� � �� C/�/'�/��/q/��` n�1/� , �CONiAC;'T')P�ER{�SCN AND PHONE NO /J� � _ <br /> H O CA CJNiRACTPRICEOF WOf1K � �I CPCS�W v r^`–� � �7� I7 ���/"^� _ I <br /> ' - DESCRIBE 1VORK AND SOU4NE FOOTAGE INVOLYE <br /> �(�' � 7�5 - 3 S`�7 ' <br /> f'1iOPO5EDU5EOF8UIL0iNG i HEREBY CERTIFY THAT I HAVE REAO AND EXAMINED THIS <br /> ��� APPUCATION AND KNOW THE SAME TO BE TRUE AND CORRECT.ALL ', <br /> IEGnLDESCHIPT10NOFPROPERTY�SNOWNOELOWORATTACHFOURCOPIES� PRGVISIONSOFLAWSANDORDINANCESGOVEqNINGTHISNPEOF � <br /> �zV� WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR i <br /> ioT Z etocrc oF S NOT. THE GFANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br /> � ��1 AUTHORITY TO VIOLATE OR CANCEL THE PRCVISIONS OF ANV <br /> L�! OF -(J . [/'I� • OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE I <br /> PERFORMANCE OF CONSTRUCTION.THAT 1 AM/1UTHORIZED BY THE <br /> OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH � <br /> — APPUCATION IS MADE AND I COMPLY WITH THE STATE <br /> CONTRACTORSLAWIB�W ' 296200 WAC. <br /> k� ` _��q� <br /> � PRQIECTA� R� >�.=.+u°t� ���� on[ �. <br /> I� PLUMB��� ���� AU� MECHANICAL � � � <br /> NO. TYPE OF FI%TURE OR ITEM FEE NO. TYPE OF EOUIPMENT FEE <br /> ' ' 3 WATER CLOSET(TOILET) - _ A�C-A�HNDLG UNITS-H.R 1 � <br /> 'y� �ATHTUB - FORCED AIR SYSTEMS-B.T.U. M E.A � <br /> '�I LAVATORY(WASH BASIN) ,� � UNIT HEATERS-B.T.U. M <br /> SHOWER '- CLOTHES DRYERS <br /> ' � KITCHEN SINK 8 DISP i- VENrILATION F/�N ' <br /> ' I DISHWASHER - FANGE HOOD T— <br /> I LAUNDRYTRAV __ r J WATER HEATER <br /> '�1 'Z, CLOTHES WASHER ,o � WOOD STOVE <br /> URINAL ' METAL FIRtPLACE&CHIMNEY <br /> 1 ' DRINKING FOUNTAIN FIREPLACE INSERT ; � <br /> � FLOOR DRAIN HEAT PUMP -T <br /> 1 BACKFLOW PREVENTERS GAS PIPING ; <br /> FOOF DRAINS-RAINLEADERS ExHAUST FAN <br /> ' SINK(SERVICE-BAR,ETC.) � ;- �. <br /> � � <br /> 1 i <br /> ' SUB TOTAL S - SUB TOTAL S - <br /> ��- PERMIT S PERMIT S <br /> TOTAL FEE 5 7r TOTAL FEE 5 d'� '�- <br /> FOR OFFICE USE ONLY: � <br /> FRONTSEiBACK PEARSEi9ACK SIpES�idACK PL4NCMECH4UM9ER , / FEE RECEIPiNO <br /> ' U"�'r Zo Wsr 5� �s4.�+, :�L��`��/ � 5o% /S/ �� 7/ <br /> usezo LOTMEF VACRNiSIIE FEES VALUATION FEE � <br /> �I '� �� � BUILDING 217��Za, ` �� �sp <br /> tYPEOiLONiS.ALIOWABIE iYPEOft 05i.AC1UAl Oimr�:cr r.onrc'uua:;,cr.n5 —�" i" �I <br /> i <br /> 1T� �'� �` L° PLUMBING <br /> ,y_ � i�� <br /> 3 YZEo`�W/�; NO.OFSTOFiES 0 SE6IENT MECHANICAL �f O �� OG <br /> . �• � Yl�� � <br /> OCCUPRNCYLOAD FIHESPRNNLERSREOD HEIGIITUM17ATION AD�ITIONALPLANCHECN �/ ;qC <br /> '�Ft 4� `���� 7_f>_�.G2_ <br /> 2� SPRINKLER <br /> REASON FOR SPRINNLERS �— <br /> �LL�',�(JJ�J STATEBUILDINGSURCNARGE y ;� <br /> INTpKEOY PUNSRPGROYEUtiv CITYOFEV[RETT PUBLICWORKS <br /> LOCAL SALES v � OG <br /> q �M TAX CODE IS 3105 TOTA� ,e �, j� � y'S' <br />