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the D APPLICATION <br />CONRUCIO <br />ever <br />PERMIT <br />DEPT. OF COMMUNITY DEVELOPMENT SERVICES 'I ^ <br />CITY HALL 259-8745 c' s"'o�} <br />E VENET I. WA 98201 ❑COMBINATION 9 BUILDINAL ❑MECHANICAL ❑PLUMBING PERMIT NO. <br />NAI( <br />` )Ir <br />[-UCR'617 9F.Ci <br />ARCHIcTILCI OR DISIf.N1R MAIL ADDRI SS (ITT ZIP PITON( <br />CINIRAI CONRACIOR MAIL ADDRESS CDY ZIP PHONE UCtNSI <br />Srt.R7c <br />MAIL ADDRESS <br />ZIP <br />I ICI NSI <br />PIUMBINC COMMCIOR MAIL ADDRESS {IIY ZIP PHONE UCLN511 <br />LIA]SUI WORK -- <br />❑NEW ❑ADDITION ❑ALTERATION ❑REPAIR ❑DEMOLITION ❑FENCE ❑SIGNGARAGE ❑BUILDING RELOCATION <br />VALOAIION OF WORK <br />DISCRIBI WORK <br />reoroslD eu(o�r emlDlNc ��99 ���� <br />4=Ajz ;Jr C.PAP9C' t /i'/IS'c AC_ <br />I HEREBY CERTIFY THAT 1 HAVE REA AND EXAMINED THIS AP <br />PLICAI ION AND KNOW THE SAME TO BE TRUE AND CORRECT ALL <br />PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE <br />OF WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN <br />OR NOT THE GRANTING OF A PERMIT DOES NOT PRESUME TO <br />GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF <br />ANY OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION <br />OR THE PERFORMANCE OF CONSTRUCTION. <br />SIGNATURE OF CONTRACTOR OR AUTNORIZEDACLNT DATE <br />� LTj ('� / J J <br />Elul DISCRIPHON OF VROPIRIYISDOWN BELOW OR ATTACH WURCOPRM <br />q/��� <br />un ZS'_3LT BLOCKAjj _Ol _f �wt d C C-C+ /' - <br />„7„ <br />/ T '7G'.0 !2!'C7a KOC iil <br />�. Al >! O, fJ/n fs f� _ 2C; %%; CI�A'/JI <br />Fun uroRlu O - $/UL Ef. CUB <br />PIOMBING <br />MECHANICAL <br />NO. <br />TYPE OF IIXTURF <br />IF[ <br />NO. <br />TYPE OF EQUIPMENT <br />ITT <br />SVAi1R C 10511110ut TI <br />AIR (ONI) UNITS-IIP fA <br />HUHiL'B <br />RFIRIGERAIIONUNITS-IIP fA <br />L AVAIORY (WASH RASINI <br />RUDE NS-11P IA <br />SHOWER <br />GAS HIED AC UNITS -TONNAGE EA <br />KITCHEN SINK A DISP <br />FORCED AT SYSIEMS-BI D MIA <br />DISWASHIR <br />W'AF HI.AIIRS-BTU M <br />IAUNDRNTRAY <br />UNIT HIATIRS-B7U M . <br />(101141S WASHER <br />IVAPORAIWE COOIORS <br />WATIR HE AI I _ <br />CIOTIIFSURNIRS <br />VRINAL <br />VENTILATION FAN <br />DRINKING FOUNTAIN <br />RAN( -,I HOOD <br />BOOR DRAIN <br />AIR HANDI ING UNIT- C f M <br />VACUUM BREAKERS <br />SIOVI <br />ROOT DRAINS-RAINLtADt RS <br />MITA111RIP1ACF &CHIMNEY <br />SINK P I RVICI - BAR, 1 TC I <br />SUB TOTAL <br />SUB TOTAL R <br />PERMIT <br />S <br />PERMIT L <br />TOTAL ILF <br />si <br />TOTAL fit S <br />SIDE YARD SETBACK <br />SIRIE1 SI111A(K <br />RIAR YARD StiBA(K <br />PLAN(C/III K NUMN[R <br />-2 ( /3/'i9 <br />PLAN <br />ILL �O j <br />CIIUKiII <br />R��fCEIPI N�C C/ <br />USI ZONE <br />LOT AREA <br />VAUNT S1T1 DYES ONO <br />)IFS <br />VALUATION <br />i[[ <br />TVPF Of CONS? <br />OCCUPANCY GROUP <br />NO OF DWELLING UNITS <br />BUILDING <br />S <br />SIZE OF BLDG <br />NO Of STORIES <br />MAX OCC LOAD <br />PLUMBING <br />_— <br />I IRE ZONE <br />BASEMENT <br />III DROOMS <br />TIRE SPRINKLERS <br />REQUIRED <br />' IYIS F1140 <br />MECHANICAL <br />APPROVALS <br />BY <br />DUE <br />OTHIR <br />I INVIRONMINIAL CHECK LIST <br />rl Nnl IN <br />1, 11(. <br />SEC 10 n..I <br />1 BUILDING PLANS <br />I FIRE HYDRANT <br />TOTAL <br />111I PROTECTION SYSTIM <br />PERMIT VALIDATION <br />WHIN PROPI RLV VALIDATED UN THIS SPACE) 71115 IS YOUR PERMIT <br />GRADING I K( AVAI ION & CLE AR INGIGRUBRING <br />DRAINAGE <br />[NVIRONMINIAL IMPACT +TAT[MENT <br />11FALTH DISTRICT <br />rTLICAIION ACC BY <br />PLANS CHECKED BY <br />APPR FOR ISSUANCE HY <br />F79 <br />I <br />