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APPLICAT^1N FOR CONSTRUC"YON PERMIT � <br /> TO BE COMPLETED IN BLACK INK—PLEASE PRINT <br /> ���1 : SYc�mGP-� ���ry ��� <br /> BUILDING DEPARTMENT HEATING SYSTEM: �GAS O ELECTRIC ❑ � <br /> 259-8810 <br /> i I DEMOLITION � COMBINATION t I BUILDING I I MECHANICAL � I PLUMBING i i SIGN <br /> UWNER MAILAUDPE55 ' CITY iIP PIqNE <br /> �E�c�r N „��� ���� a37 Eu� �,r evee�rr q�zoi �s�- �sn i - <br /> IEIUNT MAiIADDPE55 CITY 2�P PHO�� <br /> ANGHITECT Oq UESIGNE{I YALL 110URES5 CIIY ZiP PI�O�+E <br /> t:ENE1IKCONINACIOR uAlADD11E55 CI1Y 21P PMONE SfAlElll:lNSEI —��"_�'� <br /> SkrnE Rs n[Un£t =FC��N 1 I idar-ti <br /> MECMNIIC�LCONIHACTOIi 1MRMOf1ESS GITY ZIP PIIONE ST�1EliLEN5E1 <br /> PLUMBWGCONTMCTOP NAIL/�WflE55 CITY iN PMONE SIAIkLIGLNSt� <br /> CONTMCT PRICE OFVKMN <br /> � <br /> OESGRIBE WORN AND SOW WE FOOTAGE WVOLVEU ACT PEPSON ANO PHONE N0. <br /> . rk z-sb'-�s�; <br /> ��F�' <br /> I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br /> FNOPOSED USE OF BURD4lG APPLICATION AND KNOW THE SAME TO BE�i fiUE AND COHRECT.ALL <br /> FQ- PROVISIONS OF LAWS AND ORDINANCES GO`/ERNING THIS TYPE OF <br /> LEG�LOE�SCfl�IPT10NOFP{IOPEPTY�SHONR10ElOWIXiATT�CMTWOCOPIES� WORK Wlll BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br /> �ot--L— eiocK oc NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br /> � AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br /> AI� D=- I SI � OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br /> PEflFORMANCE 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 STA7E <br /> 1'AqCEL TM I p NUMBkN �pryT RS W 8.27 RCW AND�p6.200 WAC. <br /> CONSTpUCTION lWN LENOER.ADDilESS.TEIEPMONE AUMBER �� <br /> Pfl0.1ECT ADDRESS 9 � ^ �_ ���� <br /> 5y� / � 5` C dI�Y�WSWF54lCFHSEMO IMII_ —_ _ __. _._ <br /> PLUMBING YECMANICAL <br /> NO. TYPE OF FU(TURE OR REM FEE NO. TYPE OF EOUIPMENT FEE <br /> WATER CLOSET(TOILET) � Al�MHNDLG UNITS—H.P. <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 8 DISP � � VENTIUTION FAN <br /> DISHWASHEfl � RANGE HOOD --� <br /> UUNDRY TRAY ; WATER HEATER <br /> CLOTHES WASHER � WOOD STOVE <br /> �T <br /> URINAL ' METAL FIREPLACE(WOOD BUFNING) <br /> , ORINKING FOUNTAM � FIREPLACE INSERT <br /> FLOOR DRAIN � HEAT PUMP <br /> BACKFtUW PREVENTERS ; GAS PIPING ; <br /> ROOF DRAINS—RAINLEADERS � E%HAUST FAN <br /> SINK(SERVICE—BAR,ETC.) ; <br /> � <br /> � <br /> � <br /> � <br /> SUB TOTAL S � SUB lOIAL f <br /> PERMIT S � PERMIT 5 <br /> TOTALFEE t ' TOTALFEE E <br /> FOFi OFfICE USE ONLY: <br /> I'HONTSETBACN REANSE761CY� SIOESET PlAXC11EC1(IAMIBER FEE NCCEIVINU <br /> � zo �"` 3a � <br /> use 2one io� en v�c E FEES VAIUATION FEE <br /> �2 YES ❑ NO BuaDurG 3 S / ' <br /> i.'E���Of//c--•ONSi MO OF S70pIE5 o¢�wu,a la aMFUMGIwtc '- - - - <br /> � 2 � C PLUMBING - /,��.. _._ <br /> _6r <br /> SIIE OF BIOG FINE SPflrtINlEflS REbD B�SEMENT � MECHANICAL /_/� <br /> /S Z S� �-- ----��� I�1 YES fB'NO _.___- --- - . _. _.U'Ci ; <br /> iN:1:�11WN:YIfMU 11111 ninnuplau INInIn1lYn�jqN ADDITIONALPI.ANCMI:CK <br /> k/� N� -- o,�t� � ; <br /> ,�.�� ;-- <br /> STATE BUILDING SURCHARGE /�; .571 <br /> �-s,c�c <br /> iNTN(EBY PtANSAeP{IOVEDBY CITYDFEVEHEI7 PUBLICWORKS �_ <br /> J M1j LOCAL SALES <br /> o�rc $�` 3 TA)I CODE IS 3105 roT� 2 � ;�Q <br />