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pppLICpTIQ l FOR CONSTRUCT' lN PERMIT � <br /> TO BE COMPLETED IN BLACK INK—PLEASE PRINT <br /> HEATING SYSTEM: i,GAS ❑ELECTRIC ❑ <br /> BUILDING DEPARTMENT <br /> 259-8810 <br /> f7 DEMOLITION L I COMBINATION fJ BUILDING i MECHANICAL ! '', PLUMBING i ! SIGN <br /> 1,MEq MAIL�DDRE55 CITV ZIP PNONE <br /> �v�v� a Lldman �.SOb Uic�Or ��- Lverel� 9�"t� l asa - avc• 0 <br /> lE /Nt MAILADDRESS CITV 21P PNONE <br /> $Cl lt)L- — <br /> AqCMIIELTORDESIGNEF MAILPODFE55 GITV 21P PNOHE <br /> Sa YNR. — <br /> GENERALCONTFPCTOF MFILADDRE55 LITV ZIP PHONE SiATEUCENSEt <br /> MEC:iFNIGRLCONtFRGTOR MhILADDFE55 QTV ZIP PMOKE STATEUCENSE� <br /> PIUM�INGCONiRFCTOfl MAILRDORESS QTV ZI�' PMONE STATEUCENSE� <br /> CONTRACiPRICEOiWOFK � <br /> �ESCRiBE WORK PND SQUARE FOOIAGE INVOLVED CONTRGT PERSON�ND PHONE NO <br /> T�Qp�Qf ' �in urGh - ll2 f' <br /> —f-- <br /> I HEREFiY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br /> PROP EO USE OP BUILOING APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT.ALL <br /> h PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS NPE OF <br /> tec��o[¢AiPSoN�iy ovearv1ysNowrvoeiowoAp�lACH�OcoPiEs1 WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br /> , � � K �_� NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br /> ,p e�ocK oF 1 AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br /> � IO i' (', � Q l;� ,u � OTHER STATE OF LOCAL LAW REGULATING CONSTRUCTION OR THE <br /> m r,_{`� s 'F"�✓� a PERFORM4NCE OF CONSTRI'CTION.THAT I AM AUTNORIZED BY THE <br /> c� / OWNER OF THIS PROPERTV TO PERFORM THE WORK FOR WHICH <br /> �_) � I � G-C � "� C � � � ��� � APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> PnacE�tna i o.r+uueeA CONTRACTORS LAW 1827 RCW AND 296200 WAC. <br /> CONSiPUCiIONLOANLENOER.ADORE55.TELEPXONENUMBER W„ v �/ J��t�Yt ��.J' y� <br /> � �f� <br /> h n4 s�c��ro . / neiE <br /> PROJECTADDRESS I ^I C <br /> s('J TD r oirnosiucssucuHscNo <br /> PLUMBING MECHANICAI <br /> Np, TYPE OF FIXTURE OR ITEM FEt NO. TYPE OF EOUIPMENT FEE <br /> WATEfi CLOSET(TOILE(� A!C—A+HNDLG UNITS—N.P. � <br /> BAiHTUB FORCED AIR SVSTEMS-8?.U. M E.A. ' <br /> LAVATORY(WASH BASIN) UNIT HEATERS—B.T.U. N <br /> SHOWER <br /> � CLOTHES DRYERS <br /> KITCHEN SINK 8 DISP VENTILATION FAN <br /> DISHWASHER RANGE HOOD _ <br /> LAUNDRY TRAY WATER HEATER <br /> CLOTHES WASNER � WOOD STOVE <br /> — � METAL FIREPLACE IWOOD BURNING) <br /> URINAL — <br /> DRINKING FOUNTAIN FIREPLACE INSERT <br /> FLOOR DRAIN HEAT PUMP <br /> BACKFLOW PREVENTERS _ GAS PIPING <br /> ROOF DRAINS—RAINLEADEFS _ EXHAUST FAN <br /> SINK�SERVICE—BAR,ETC.) , <br /> i <br /> SUBTOTAL $ SUBTOTAL 5 <br /> PERMIT 5 PERMIT 5 <br /> TOTAI.FEE $ TOTALFEE 5 <br /> FOR OFFICE USE ONLY: <br /> FRONTSET�ACR REARSETBACK Si�[SEiBACK PLANCNEGNNUMBEA� FEE RECEIPiNO <br /> ��/�! <br /> usezoNe �otnaen vacnNisrte FEES VALUATION FEE <br /> .-: \�ES �. NO BUILOING j 'y� ' ��� <br /> 1VPf OF CON51. NO OF STORIES c>:rerc �a c�cwu��n6 ux+s <br /> �`�v"s� PLUMUING <br /> �-,J i <br /> 512EOF�lD6. FIRESaRiNNLERSREOC BASEMENT � � MECHANICAL <br /> ��� ,r— p �iYES YNo <br /> OCGl1PANCV LORO F:RE AL�RM PE00 HEIGHT LIM RT4TION <br /> ADDITIONAL PLAN CHECK <br /> � p _1�V� OTHEF <br /> RF.nSON STATE BUILDING SURCHARGE �j�-� <br /> INTAKEBY PlANSAPPROV�OY ��TyOFEVEREIT Pl1BLICWORKS <br /> J LOCAL SALES <br /> onTe 8 ? �I <br /> TAX CODE IS 3105 TaT^� ' `- �5`; <br />