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APPLICATIf�Y �OR CONSTRUCT^�N PERMIT � <br /> TO BE COMPLETED IN BLACK INK—PLEASE PRINT <br /> HEATING SYSTEM: �GAS U ELECTflIC ❑ � <br /> 3UILDING DEPARTMENT � <br /> 259-8810 <br /> i 1 OEMOLITION I_J COMBINATION i I BUILDING �MECHA4ICAL PLUMBING i I SIGN <br /> OWNER MAILr1��PE55 CIiY IP PHCNE <br /> � I�r_ .r � C D4!�f ✓ �y�,`J 11 �-YCdt.��' �S�,�Ov �J� "�(t� � <br /> TEN� MPI 4D�RCSS CITV ZIP PNONE <br /> i� 1� — <br /> ARCh11TECT OR DESIGNER MPIL ADDR[SS CITY ZIP PHUNE <br /> GENERAL CONTHaGT� MAR qD�RESS CIiY ZIP PHONE SiATE LILENSE/ <br /> I'1 I Va <br /> IALCHAN Rl C1O'N\T1RACTO� MPII ADDRESS CITY ZIP PMONE STATE UCENSE� <br /> � LN• <br /> PLUA101NGCOtJiRACTO/R MAILAO�RE55 CITV ZIP PHONE STATELICENSE• <br /> � l_ � �L�IhI CG� _— <br /> CONiRAC PRICEOF�Q$��0� <br /> I I 1 <br /> DESCRIBE WORK AND SOUAPE FOOTAGE INVOLVEO CO4TAGT PEPSON AN�PMONE N0. <br /> n �I���/1 , S q� / <br /> � Ov� 1�i �JY� G `y S l CI� I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br /> PROPOSEo l'se�F§UI}DING APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT.ALL <br /> � M1j PROVISIONS OF IAWS AND ORDINANCEJ GOVERNIN3 THIS TYPE OF <br /> L[GAL�ESCRIPTIONOFPROP[FTV�SHOWNBELOWORATTACHTNOCOPIES) WORK WILL BE COMPLE?ED WI7H WHETHER SPECIFIED HEREIN OR <br /> NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br /> tot B�ocK — oF — qUTHORITV TO VIOLATE OR CANCEL THG PROVISIONS OF ANY <br /> OTHER ST�TE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br /> — PERFORMANCE OF CONSTRUCTION.THAT I AM AUTHORIZED BY THE <br /> OWNEF OF THIS PRJPERTY TO PERFORM THE WORK FOR WHICH <br /> APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> raace�tnz i o.rvuusea CONTRACTORS LAW 18.27 RCW AND 29620/0�WAC. <br /> CONSTRUCiI'JNIOANLENDER,A�DRESS,TELEPNONENUMBER � y/�7 /� ^/I�_��'Lf� �/�l /rJ� <br /> x " �)t.��- /.�,1A4'A{�� J� ((J J <br /> PROJE D S^.r� "ON"10nc ���[ <br /> F�.� I���e � ��,.P�,5���5s����„t��� -- <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE ON ITEM FEE NO. 'YPE OF EOUIPMENT FEE <br /> WATEF CLOSET(TOILET) A�C—A�HNDLG UNITS—H.P. <br /> BATNTUB FORCED AIR SVSTEMS—B.TU. M E.A. <br /> LAVATORY(WASH BASIN) � UNIT HEATERS—B.T.U. M <br /> SHOWER � CLOTHES DPYERS <br /> KITCNEN SINK 8 DISP VENTILATION FHN ' <br /> T <br /> DISHWASHER RP.NGE HOOD <br /> LAUNDRVTRAY WATER HEATER <br /> CLOTHES WASHER i WOOD STOVE <br /> URINAI METAL FIREPLACE!WOOD BURNING) <br /> DRINKIWG FOUNTAIN FIRePLACE INSERT � <br /> T <br /> FLOOR DRAIN HEAT PUMP _ <br /> BACKFLOW PREVENTERS GAS PIPING � <br /> T <br /> ROOF DRAINS—RAINLEADERS EXHAUST FAN <br /> SINK�SERVICE—BAR,ETC.) — � <br /> ---T— <br /> T <br /> SUB TOTAL 5 SUB TOTAL 5 <br /> PEA1�11i S PERMIT S �_�_ <br /> TO',�LFEE 5 TOTALFEE 5 � <br /> FOR OFFICE USE ONLY: <br /> FFONTSETBPCK REARSETBAGN SIDESF.TBACK PLRNC [CKNUMBER FEE RECFIPTNJ. <br /> L � <br /> use zar+e �oTaae� vacaNT srte FFES VALUATION FEE <br /> ❑ YES i: NO BUILOING <br /> IYCf 1iGON5L NO.OFSTOR�ES O[Ccvu+fr x00tp'nFu'fn;uH��S <br /> �Aa1° PLUM�ING <br /> --+— <br /> SiZLOfBLDG. fIRESPRINN�[RSREO'D OASEMENi MECHANICAL <br /> i YES NO — <br /> OCCUPANCV LOAD FlRE AIARM1I fiE00 HEIGHi lllfITATION ADDITIONAL PLAN CHECK <br /> i <br /> O1HER <br /> REASON <br /> STFiF BUILDINu SURCHARGE <br /> MTAKEBY PLPNSAPPPOVEDUY CITYOFEVERE7T PUBUCWORKS <br /> IOCAL SALES <br /> o,,,� TAX CODE IS 3105 TOTAL <br />