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APPLICATIQ�► ` FOR CONSTRUCTI �N PERMIT �+' <br />TO BE :.OMPLETED IN BLACK INK—PLEASE PRINT <br />I HEATING SYSTEM: U GAS 0 ELECTRIC ❑ � <br />BUILDING DEPP.RTMENT <br />259•8810 <br />i � DEMOLITION � COMBINATION X BUILDING ' MECHANICAL PIUMBING SIGN <br />OWNER MAILADDPESS GITY ZIP PNONE <br />��wA�f-FQ '41�9 V�E�7 V�EW �Z FV-QE�T �2U3 4�M'259'iOSi WY.'.'259-'7AV�� <br />TENRNT M4ILAODRE55 C�T�' ZIP PHONE <br />SAME (\S APDJ6 <br />ARGNREGTOR DESIGNER MFIL RUDRESS GRV ZIP PNONE <br />SP AS P2�/ <br />GENERALCONTRAGTOP MAILADDRESS GITV ZIP PMONE STATEUCENSEt <br />5 M� �.s Ae-.wE <br />MECN�NIC�L CONTRACTOR MAIL �DDFESS GITY ZIP PHONE STFTE LIGENSE t <br />N�P� <br />PLUMBINGGONTRALTOF MAILA�ORESS CITY ZIP PNONE STATELICEN:[• <br />CUSS OF WORK <br />� i NEW �ADDITION : '. ALTEPATiON <br />DESCRIBE WORR ANO SOUARE FOOTAGE INVGLYED <br />ADv.z�oN to Fx.s�.�+[� `�base <br />PROPOSED USE OF BUILDING <br />LEG�L DESCRIPTION OF PFOPF <br />LOT '�9 BIOCK <br />DRAIN <br />� <br />�SNOWN BEIOW OR ATTACH <br />OF <br />FOR OFFICE USE ONLY: <br />FRONTSETBAGK REARSETBAC % <br />� � � <br />USE 20NE ��t pREA <br />iYCC Of CONIS. ALLUWABIE 1YPE OF CON57. ACiI <br />SRE OF BLDG N0. OF STORIcS <br />$$0 SP GaA I <br />OCGUPANCYLOR� FIRESPRNKLERS <br />I Q N� <br />REASUN FOR SPRINKLERS <br />INTAKE BY PlANS APPROVEI <br />REPAIR '� � DEMOLITION WOODSTOVE/FRPL INSERT BUILDING RELOCATION <br />I CONTACT PERSON AND PMONE NO. <br />% W �+. -% <br />t. <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br />APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />i LOPIES� PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TVPE OF <br />WORK WILL BE COMPIETED WITH WHETHER SPECIFIED HEREIN OR <br />NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br />AUTHORITY TO VIOLATE Oii CANCEL THE PROVISIONS OF ANY <br />OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br />PERFORMANCE OF CONSTRUCTION. THAT i AM AUTHORIZED BY THE <br />OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br />E APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />CONTRACTORS lAW 1827 RCW AND 296200 WAC. <br />ONON\SF� A � �� <br />Y .f/�<�n,n�� � Izal9� <br />� oeic <br />sa *uai <br />ITAL $ <br />5 <br />FEE $ <br />SIDE SETB�;CK <br />C� <br />J <br />VACFNTSRE <br />IMLOVA4CY NOO�NV(IIP.uUM1I15 <br />OF <br />FEE <br />FORCED AIR SVSTEMS-B.T.U. M <br />UNIT HEATERS-B.T.U. M <br />CLOTHES DRYERS <br />VENTILATION FAN <br />RANGEHOOD <br />WATER HEATER <br />WOOD STOVE <br />METAL FIFEPLACE 8 CHIMNEV <br />FIREPLACE INSERT <br />HEAT PUMP <br />GAS PIPING <br />EXHAUST FAN __ <br />SUBTOT�L $ <br />PERMIT 5 <br />PLAN CMEGN NUMNtN � I " " � ' ^�^ <br />Rc�3I '710, O5 � �r� � <br />BUILDING <br />PLUMBING <br />MECHANICAL <br />A0�71TIONAL PLAN CHEGK <br />SPRINKLER <br />STPTE OUILDING SURCHARGE <br />PUBLIC WOFKS <br />LYYPL VnVLo <br />��� z/�/4Z TAX CODE IS 3105 T�T^� <br />