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� � APPLICATIr'N FOR CONSTRUC�ON PERMIT � � <br /> TO BE COMPL'cTED IN BLACK INK—PLEASE PRINT �' <br /> ; ' c,�m � ��ry � �—'� <br /> DUILDING DEPARTMENT HEATING SYSTEM: �GAS O ELECTRIC O � <br /> 259•8810 <br /> i I DEMOLITION Ir COMBINATION CI BWLDINfi I:I MECHANICAL i I PLUMBING i i SIGN <br /> OWNEF MAILApUflESS LIT' Z� ��E <br /> Sel.�c'1" NOmEr,.�1 c 23� EI-YN ST EVE2�.l'T qBZ.o 3 z�- 1� 3 _ <br /> IEWWT IMKAWRE55 CITY M V�q11E <br /> MCMITECTORDE51('iNEH 1MIL�DDNE55 CI1V ZW PHONE <br /> GENEpk GONTry�CTpp y/y��pq1Eg5 WT( IW P110NE STATE IILENSE t <br /> SRmE Rs ncun� :flE.cN 1 i ieK-a <br /> MEGINNICKCANTMCTOR MAIL�WIIE55 ' �RV � � P1101E ST�TELICkNSE• <br /> PIUMBW6LONTRACTOR WIL�DDflE55 CITY N PHOHE STAIEIICEN5E1 <br /> CONTiNCT PqICE OFWO`.'�rc <br /> � �b _ <br /> DESCRIBEWORI(�NDSOUMiEFOOTAGEWVOLVEO ACTPERSp/Mq�VIqILNO. �—I�Q � <br /> l. I <br /> s Fe <br /> � 1 HEREBV CEflTIFY THAT I HAVE READ AND E%AMINED THIS <br /> PROPOSEDUSE OF BUkDING APPLICATION AND KNOW TME SAME TO BE TRUE AND CORRECT ALL <br /> ��F� PROVISIONS OF UWS ANO ORDINANCES GOVERNING THIS TYPE OF <br /> IkG�LDkSCNIPtqNOfPNp'GHfY�" NtlEIOWOR�TT�CHtWOCAPIES) WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br /> NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br /> , �ot eiocK or AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS Of ANY <br /> R I� S I 4 OTMER STATE OH IOCAL LAW REGULATING CONSTRUCTION OR TME <br /> PERFORMIINCE OF CONSTRUCTION.THAT 1 AM AUTHORI2ED BV THE <br /> OWNER OF THIS PROPERTV TO PERFORM THE WORN FOR WNICH <br /> � APPLICATION IS MADE AND I COMPLV WITH THE STATE <br /> PAIICEL TI1X ID.NUMBEP (�`QNT 5 LAW 1 27 RCW AND 2,��9,6�200 WAC. <br /> GONSTNUCTIOq LOAN LENDEfl.�ODRESS.TELEPlIdlE NUMBEN ��� <br /> /-z� -9 � <br /> PR0.IECT ADDflESS �"^"� w�E <br /> � T crtrewMuictwe�o — <br /> PLUMBNIfi IIECMANICAL . <br /> N0. TYPE OF fl1(TURE OR REM FEE NU. 7YPE OF EOUIPMENT FEE <br /> WATER CLOSET(TOILET) • � M�AMNDLG UNITS—Fi.P. <br /> � BATHTUB ' FORCED AIR SYSTEMS—B.LU. M E.A. � <br /> LAVATORY(Y�ASH BASIN) • � � UNIT HEATERS--B.T.U. M ; <br /> SHOWEP. � CLOTNES DRYERS <br /> KITCHEN SINK 8 DISP � � VENTILATION FAN <br /> DISHWRSHER � RANCE MOOD <br /> UUNURY TRAY ; WATER HEATER ' <br /> CLOTHES WASHER � WOOD STOVE <br /> URINAL ' METAL FIREPLACE(WOOD BURNING) <br /> DRINKING FOUNTAIN � FIREPUICE INSERT ; <br /> FLOOR DRAIN � HEAT PUMP <br /> BACKFLOW PREVENTERS ; GI1S PIPIN6 ; <br /> fi00F DRAIN�RAINLEAOERS � EXWIUST FAN � <br /> �SINK(SERVICE—BAR.ETC.) ' <br /> � <br /> � <br /> � <br /> � <br /> � � <br /> � <br /> SUB TOTAL S ; SUB TOTAL S <br /> PERMIT S � PERMIT S <br /> TOTALFE[ S ' TOTALFEE S � <br /> FOR OFFICE USF ONLY: �` ,30 ,�/?PCCG 'ot' G� G �3�2� <br /> ff10NTSE'BK1t�� MMSEIBIICR SIDE6E KANCIIECIIMtlER ' FEf _ 11ELEIDTNO <br /> � <br /> z.0 S `� <br /> useza� �oi� v FEES VALUASION FEE <br /> SI� YES ❑ ND �� _ � � � <br /> �� <br /> imacaai �oovsTot�s �wa� `oawe.�auro --- <br /> _3 r►wewa <br /> SItEOf ` FYESWWt�ER51Ed0 BI\SEIENi � � <br /> I5 3Z�f t R O wec�w�r.�► <br /> ❑ YES f3'NO <br /> ocaswrcrww �w[wkwx[on �rrrtu�unn� MD�TqN�IPtANGEGc �1-- <br /> � V / OiiER ���U <br /> N[�sa� — <br /> SUTE BUMDNCa SUfICINiK3E '�D <br /> wuucr�r ww�s ure�ov�o av �`��� p�C�g �J D', ` <br /> J 1� <br /> w� � i�COOE{S 31� �► .� � � <br />