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� <br /> � + APPLICATIOh�FOR CONSTRUCTIVN PERMIT ����P'� <br /> ma e�e.g�con TO BE COMPLETED IN INK—PLEASE PRINT ^ `�� /�` C � �i <br /> CIiV OF /V W,/ I <br /> eve rett HEATING SYSTEM: ❑GAS ELECTRIC ❑ � <br /> BUILDING DEPARIMENT <br /> 259-8810 <br /> I I DEMOUTION I I COMBINATION BUILDING 17 MECHANICAL 17 PLUMBING I 1 SIGN <br /> n0 NEF , _� MA�� ���SS 3 / l�V ZIP I'NONE <br /> � �t ,� � �9z � <br /> �y�A%L��`a77-NOyA � S1—.t500 <br /> Iu}. v -�f�-- <br /> TEN.\NT MAIIADDPE55 CIiV ZIP PNONE <br /> APGNIIECTOROES�GNEf1 MAILAUDRE55 CIiY 21P P110NE <br /> GENERAICONiNRCIOR MML�O�OESS CIi 2iP PHONE LICENSEI <br /> QG Q.,b�,c-�� S3o7 -�39'ouP9c � �12-�� �31-�$'�o Coao -Yrz-lGy-oa/ <br /> M[CIUNIC�LCONTR�CTOR MRII. DDAE55 GITY 21P PHONE UGENSEII <br /> PWMOiNOCd110AClOfi MAILAOORC:55 CIIV 21P PIION[ UGENSC� <br /> CLA55OF Yn71iK <br /> X NEW CI ADDITION CI ALTERATION I I REPAIR LJ DEMOLITION 17 WOODSTOVFJFRPL INSERT f.7 BUILOING flELOCATION <br /> arr p � ��h WN7 T{'ERSONANpPNONENO, � <br /> conrnnctrniceoFwoRK � / � <br /> DESCNIBE WORK RND SOUARE FOOTnGE INVOLVED <br /> �� � ��y <br /> rno seouseorr�avwc I HEREBY CERTIFY THAT I HAVE REA� AND EXAMINED THIS <br /> ��-�/ APFLICATION AND NNOW THE SAME TO BE TRUE ANO CORRECT.AlL <br /> LEO LOESCRINiIDNOF PROP[RtY�SIIOWN dELOW OR nnc��Founcories� PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br /> WORK WILL BE COMPLETED WITH WfiETHER SPECIFIED HEREIN OR <br /> ior �� —� eiocK.i� oF ./ _ NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GiVE <br /> G�'��n,q ,� , � •� AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br /> C ��� OTHER STATE O�i LOCAL LAW REGULATING CONSTRUCTION OR THE <br /> U PERFORMANCE OF CONSTRUCTION.THAT I AM AUTHORIZED BY THE <br /> OWNER OF THIS PROPERTY TO PERGORM THE WORK FOR WHICH <br /> -- APPLICATION IS IdADE AND I COMPLY WiTH THE STATE <br /> CONTRACTORS LAW 18.27 fiCW�ND 29G.2i0 WAC. <br /> SIGNA-�C7000RAUp101112E0AGENT DNE <br /> Pf10.1ECT ADDR[55 � <br /> _�`� 1 'r / APP���pNTSCITY9U5ME55LICENSEN FNOBUSINESSNAME <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM FEE NO. TYPE OF EQUIPMENT FEE <br /> � WATER CLOSET(TOILET) 1 _ PJC--NHNDLG UNITS—H.P. �_ <br /> � BATHTUB � FORCED AIR S`.'STEMS—B.T.U. M E.A. ; <br /> LAVATORY(WASH BASIN)� S� UNIT HEATERS—B.T.U. M <br /> SHOWER ' CLOTHES DRYERS � <br /> KITCHCN SINK 8 DISP VENTILATION FAN <br /> DISHWASHER S' RANGE HUOD � '. <br /> LAUNDFYTRAY ; WATER HEATER �__ ! <br /> � CLOTHES WASHER i WOOD STOVE _ � <br /> � URINA� ' METAL FIREPLACE&CHIMNEY � � <br /> DRINKING FOUNTAIN FIFEPLACE INSERT ; <br /> FLOOR DRAIN HEAT PUMP �— <br /> � BACKFLOW PREVENTERS GAS PIPING ; <br /> ROOF DRAINS—RAINL[ADEflS � �. EXH: ST FAN � <br /> �;,y SINK(SERVICE—BAR,FTC.) ; � , <br /> t __ ' � <br /> i _r � <br /> -- �'61L�11f��7-I �L+��lt{ul��A �IJf�U <br /> i � <br /> i <br /> SUB TOTAL $ SUB IOTAL $ ' <br /> PERMIT $ PERMIi $ i <br /> TOTACFEE S TOTALFEE $ �— , - <br /> FOR OFFICE USE ONLY: " <br /> FRONTSETORCK� RUNSETBn,K S�OES��GN PIINGMEC lIMOEfi FEE yC R[CEIPiNO. ' <br /> 23i -- <br /> usezone iornnen V4GNT511[ FEES VALUATION F E j <br /> R�L � pUILDING 2 / �h I <br /> IIPCOfGONIS.�LLOWAPIE IYP(OFCON7.PC111AL Oc[u��Ncr xOIXUv�w4ciwn5 —��w � V I <br /> � _ ��1 � PLUMBING ' � <br /> SRE OF O106. NOAF STOFIES OASEMENT MECHANICAL � /'1��") <br /> Q8y' SP 1 t..I� _ v; <br /> OCCUPAIlCYLOAD FIRESPRNHLERSR[00 IIEIGNi�JLI1.�111RilON AODITIONALPLANCNECK — � � <br /> �..I K� `�� OTHER <br /> PGSOH FOA SPRINNLERS —� <br /> STATE�UILDING SUFCHAfiGE `I SG <br /> iNrnneer r�nNsnarnoveoov CITYOFEV[RETT puoucwonres �r �lYfi <br /> \�,/y�` /J�/l LOCAI SALES <br /> V' `j +° S�� Tp.Y,COUE IS 3105 roTa. [ a'� <br />