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APPLICATIC 1 FOR CONSTRUCT )N PERMIT � <br />TO BE COMPLETED IN BLACK INK—PLEASE PRINT <br />BUILDING DEPARTMENT HEATING SYSTEM: . GAS J ELECTRIC LJ <br />259-8810 / <br />DEMOLITION COMBINATION BUILDING i�'MECHANICAL PLUMBING ! 1 SIGN <br />0'NN[R MAILqODRE55 CITV ,1 ZIP PHON[ <br />�anr�..r h o.. �Mcl(rr F�fnTT q8��1 .iSD^3109 <br />TENANT AIAIL�DDFE�S C17Y ZIP PHONE <br />RRCHIiECT OF DESIGNER <br />G@NERALWNiRnCTOR <br />MAIt ADORESS <br />IAAIL �DOiiESS <br />CITV ZiP <br />CITV ZIP <br />PNONE <br />PHONE SiATE LIC[NSE s <br />MELMANICALLONIR4GTOR MAitp00RE55 GiV '/ 21P P��ONE STATEIICENSE� <br />�Prti�(o.. 5���� Shr.� M�'4a1 P.9. 6>,c ISop t�✓t.�77 9fao6 2)�3��N E✓E�GS-S�.ZU:7 <br />PLUM ING CONTRAGiOR MAIL A��B[55 CITY 21P PHONE STAIE LIC[NSE t <br />GONiRACi PBICE OP \YORK <br />f <br />DESLP19E WORN AND SOUARE i00iRGE INVOLVED <br />�-� <br />�r <br />PROPOSED USE OF BUII�ING <br />Res ��a �., � � <br />lEG/ L DESCRIPTION OF PpOPERTY iSNOWN BELOW OR �TTACN TWO COPIES) <br />IOT-- DLOCK -- OF <br />PAPLELTAXIO NUMBER <br />CONSTRUCiIONLOPHLENOER,AD�RESS.iELEPHONENUM�EF <br />PROJECT ADDRESS <br />KITCHEN SINK 8 DISP <br />DISHWASHER <br />LAUiJDRY TRAY <br />CLOTHES WASHER <br />URINAL <br />DRINKING FOUNTAIN <br />FLOOR DRAIN <br />BACKFLOW PREVENTERS <br />ROOF DRAINS—RAINLEADERS <br />SINK 1SERVICE—BAH. ETC.) <br />FOR OFFICE USE ONLY: <br />FRONi5ET9ACK REARSFTBACK <br />USE ZON[ <br />tvrE or coNsi. <br />SIZE OF pLDG <br />OCCUPANCVLOAD <br />REASON <br />INTAN[ BV <br />SUB TOTAL <br />PERMIT <br />TOTAL FEE <br />lOT AREA <br />NO OF SiORIES <br />FIqF. SPRMNIERS PEO'0 <br />FlFE ALAqM REOD <br />PLANS APPROVED DY <br />onie <br />FEE <br />SIOESETBACN <br />VAC/ NT SIiE <br />YES 1 NO <br />n2uoatiC7 r�dO�bNFUryG�NuS <br />r,uouv <br />BASEMENT <br />i '�. YES '�' NO <br />HEIGHT I IM1IIIATION <br />LOCAL SALES <br />rax cooe is s�os <br />CONTAGT <br />Ey <br />i HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br />APPLICATION AND KNOW THE SAME TO 8E TRUE AND CORRECT. AlL <br />PROVISIONS OF LAWS AND OfiDINANCES GOVERNING THIS NPE OF <br />WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br />NOT. THE GRANTING OF .4 PERMIT DOES NOT PRESUME TO GIVE <br />AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br />OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION UR THE <br />PERFORAIANCE OF CONSTRUCTION. THAT I AM AUTHORI -D BY THE <br />OWNER OF THIS PROPERTY TO PERFORM THE WORK Fl, ' WHIC4 <br />APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />CONTRACTORS LAW 1827 RCW AND 296200 WAC. <br />�.(r w�., / v- I 3• 9 H <br />�vc�+ni oerz — <br />Qiv BUSM[ ° ., ��[N5� NO <br />MECNnNICAL <br />it0. TYPE OF EOUIPMENT FEE <br />A�C—NHNDLG UNITS—H.P. <br />j FORCED AIR SVSTEMS—B.T.U. �� A. �_ <br />UNIT HEATERS—B.T.U. M <br />CLOTHES DRYERS <br />VENTILATION FAN <br />RANGEHOOD � <br />METAL FIREPLAGE (WOOD BURNING) � , <br />HEAT PUMP <br />GAS PIPING <br />EXHAUST FAN <br />PLANCNECKNUMBEH � �EE <br />BUILDING <br />PLUh1BING <br />MECHANICAL <br />AODITIONAL PLAN CNECK <br />OTI{EF <br />STATE BUILDMG SURCHARGE <br />FlUBLIC WORKS <br />TOTAL <br />J�LLSIII <br />