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- APPLICATIC i FOR CONSTRi.JCT �N PERMIT � <br />TO BE CCMPLETED IN BLACK INK—PLEASE PRINT <br />BUILDING DEPARTMENT �— <br />259-8810 <br />i' DEMOLITION I I COMBINATION <br />OtYNER AIAILAODB[SS <br />JD/�iv t ia> �t: 8z� <br />TENAN7 � / M�ILAD� 5 <br />/�/� � <br />ARCRiiECiOR�ESIG4ER MAILADpRESS <br />I�ESi�'irl �i�/E'S iiU�� <br />GENERqLCONTRACTOR I.IA:LADpiSE55 � <br />��s�-�a �� �;�.�,�T,, <br />MECHANICALCONiRACTOR MAILAO�RESS <br />PLUMBINGGONiRACTOR MA:.ApDRESS <br />HEN� ING SYSTEM: iJ GAS <br />CONiPALTPRICEOPWOR���tG. ��/� <br />DESCRIpE WORK AND SOUARE FOOiAGE RJVOLV[D <br />i BUILDING <br />CITV <br />t�ll/1�C�. <br />CITV <br />f7 /Sc'i <br />aCIiV <br />�S�CQ '�l <br />an <br />Cliv <br />- ELECTRIC �,] _ <br />i MECHANICAL <br />�„o�:E <br />� <br />' PIIO <br />PNO.'1E <br />r� C-C/� i <br />F��o��E <br />� PLUMBING <br />ST.>lE <br />ZIP PHONE SiATE <br />CONTACT PERSON AND PHONE NO <br />i_I SIGN <br />>s- ��3� �_:: <br />s' `L-.`,�D/l <br />;S3 as3j <br />• / 9f .S` <br />��'f/ /"�GCG�/1'- <br />r � <br />I <br />-�75- 2/3C �,-, <br />� y' I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br />���P eouseoFe �uoiNc APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />�YJ �I�T,1tJ PROVISIONS OF LAWS AND ORDI�.4NCES GOVERNING THIS TVPE OF <br />iewi_oEscaianoNCFaaoaeanisNcwrueeio�soanTlncNnvocoaies WORK WILL PE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br />ior '� o�ocn pF ����__ NOL THE G�iANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br />AUTHORITV TO VIOLATE OR CANCEL THE PROVISIONS O� ANY <br />. TC� /nTT/�i�//�/! OTHER STATE OR LOCAL LAW REGULATING CONST(iUCTION OR THE <br />— PERFORMANCE OF CONSTRl1CTI0N. THAT I AM AUTHORIZED BY THE <br />OWNER OF TIIIS PROPERTV TO PERFORM THE WORK FOR WHICH <br />Pnaee�rnxio.r+un+oea APPLICATION IS MACE AND I COMPLY WITH THE STATE <br />CONTRACTORS LAW 18.27 RCW AND 296.200 WAC. <br />CONSiRUQiONLOANI[Np[H.qODRESS.T[LEPHONENIIM�ER / _ l, _ . /1 / � <br />�- �'. Ci Td� <br />TYPE OF <br />WATER CLOSET <br />BATHTUB <br />LAVATORY�WASI <br />SHOWER <br />KITGHEN SINK 8 <br />DISHWASHER <br />DRINKING FOUNTAIN <br />FLOOR DF7AIN <br />BACKFLOIN PPEVENTERS <br />RCOF DRAINS—RAINLEAC <br />SINK (SERVICE—BAF. ETC <br />— �LGT—S <br />EM FEE <br />SUB TOTAL S <br />PERMIT S <br />TOTALFEE S <br />FOR OFFICE USE ONLY: <br />FRONTSETBACK NGRSET�ALH <br />/ �JA� <br />G(/ <br />US[ZONE lOTAREn <br />��� <br />I1PE 01 CONSi NO.OF STORIES <br />� �, i � <br />IpipN[ OV <br />HRE 5°RINNL[RS REO'D <br />r' % <br />� G.�K <br />1D FlRE AL�PM q[OD <br />SICE 5!1[iACj(/ <br />�/ <br />ai'!f SJ l I�t1:lL 1�:1 <br />MECHANICAL <br />NO. TYPE OF EOUIPMENT <br />A-C—AiHNDLG UNITS—H.P. <br />FORCED AIR SYSTEIdS—B.T.U. M C.A. <br />UNIT HEATERS—B.T.U. M <br />CLOTHES DRYERS <br />VENTILATION FAN <br />� RANGEHOOD <br />� WATER HEATER <br />WOODSTOVE <br />METAL FIREPLACE �WOOD BURNING) <br />FIREPLACE INSERT <br />HEAT PUMP <br />GAS PIPING <br />EXHAUST FAN <br />-' VES -. NO - <br />BUILDING <br />ozc��n•,;. �nromxuv�cur.�s - <br />'%3 � PLUMBING <br />BnSE�.+jNT MLCHFNICAL <br />��YES NO <br />I1[iGei urniiAiior+ AODITIONAL PLAN CHECK <br />Z�' _Aiw'n--. )iir/lr1 � <br />STATE BUILDING SURCHARGE <br />NinNsnaa/r;ovcoov CITYOFEVERE7T PUBUCwORKS <br />,� LOCALSALES <br />onre %7,,,/q3 TAX COOE IS 3105 TOTAL <br />TOTAL <br />��1 <br />YO <br />'vt <br />FEE <br />