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APPLICATIQ�1 FOR CONSTRUCT�N PERMIT <br /> TO BE COMPLETED IN BLACK INK—?LEASE PRIN7 � <br /> BUILDING DEPARTMENT HEATING SYSTEM: �GpS �J ELECTRIC J <br /> 259-8870 <br /> DEMOLITION COMBINATION BUILDING <br /> owNea x' JCMECHANICAL jepLUMBING <br /> Mna aooness �i�� _ SIGN <br /> e1 � zir /� /w�oN•el <br /> iENANiC b�\CY � O� ` �JCPKl�S\ p..J=�Ll'lE.�� 9 �3 Z.t) 3 l GYO� ZS Z.' \ ry. n � <br /> MPIL AD�RGSS (..v _ <br /> S[,.V�P _ , cia e��oNe <br /> ARCNRCCT OR 0[SiGN[R •MAIL AD01iESS �� . '�— .. --- — �� � � � -� - � - <br /> W Gy��`-�.T��T�� PNONE <br /> 1�ton�����ro �2� S ��_�lo .�.. <br /> ceruEan�coNttancroa ` M�RAD�NESS ��- - —�-�'�'-5�"�AS�_`s�' S�41 <br /> S�_\� D \��' � J . " '_ GiV --_ ZIP PNONE — <br /> SiATE LICENSE e <br /> MCCHqNICALCONiq�CiOfi MAiLAU0RC55 - . ��� -_—_�_---�---���--�— ���`---- - <br /> �i�_._.__ n CITV 21P _ _—_- <br /> . �e-I � '_ .�__., PHONE SiATELiCENSE• <br /> �__ <br /> ` —____--_---� <br /> PLUMBInGLONTRqCTOR 1,1qi�qDDRESS � <br /> ���___ <br /> CIiY PHONE <br /> � ,`� � .__ _ .- . . ... - . ..� _` ZIP STATE LiCENSE• <br /> ._ .. _ . --__�__ _ .� <br /> CON1R T PRICE OF WORK �- -'� - _-- �_. - - �—'-- <br /> �( oo c�o 0 <br /> DfC_r„tlEWORNANDSOUAqEPOOTAGEIIlVOW D 1 � <br /> ���� �OM �- G{jNS�C��C�nrJ CONIACTP[RSONqNDPNONENO. <br /> ZZD �a F;ro;s�tc�, I�UfJ �� ...«�'�M:•,1 �h.. �{< �o��e -... <br /> ZS2-'1040 <br /> �aovoseouseoFewioirvc I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br /> _ �LS; �����J APPLICATION AND KNOW THE SAME TO EC TRUE AND CORRECL ALL <br /> �ecnioescnianorvoFPaovearrisNowNee�owoanr.ncHnvocoaies; PROVISIONSOFLAWSANDOfiDINANCESGJVERNINGTHISTYPEOF <br /> 1VORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br /> LOi B�aK oF NOT. THE GRAN1lK(; OF A PERMIT DOES NOT PRESUME TO GIVE <br /> Lx.� �� � I ( AUTHORITV TO \'IOLATE OF CANCEL THE PROVISIONS OF ANY <br /> V�C-C� OTHER STATE OR LOCAL LAN'REGULATIPIG f.JNSTRUCTION OR THE <br /> � SND���r�/� OWN�R OFN HE3 PROPERTY TO PEF ORM HE WORKIFOR WHICH <br /> nnqceitnxinNUMo PPLICATION IS MFOE A1:0 I COMPLY WITH THE STATE <br /> �y�iq��"'��i8,�� .:ONTRACTORS LAW 78.27 R W AND 296.200 WAC. <br /> C0IJSTRUCiIO�N yL�OAry/��ENO_R.pODRE55,TREPMONyE N�UMpFR /� <br /> �D:-WG/a \ `4�N' EvL'St.0 E ( � , �� �„ y <br /> PROJECTADDRESS /_� •� <br /> 4�Zn S� � <vJ -y� sir.n�ru�c w�i i L <br /> `�YS E— ��IC.Il.\\ <br /> PLUMBING t sice�aruo .. __ <br /> NO. TYPE OF FIXTUpE OR ITEM MECHANICAL <br /> FEE NO. TYPE OF EQUIPMENT FEE <br /> WATER CLOSET(TpILET) ArC—A�HNDLG UNITS—H.P. <br /> � BATHTUB _ <br /> LAVATORV(WASH BASIN) `� FORCED AIR SVSTEMS—B.T.U. �.9 E.A. <br /> SHOWER D UNITHEATERS—B.T.U. M <br /> ( KITCHEN SINK 8 DISP � ( CLOTHES DRYERS <br /> � DISHWASHER VENTILATION FAN <br /> LAUNDRYTRAY � RANGEHOOD <br /> CLOTHES WASHER WATCR HEATER , <br /> URINAL D WOOD STOVE ��— <br /> DRINKING FOUNTAIN b7ETAL FIREPLACE(WOOD BURNING� i <br /> � FLOOR DRAIN FIREPLACE INSERT <br /> BACKFLOW PREVENTERS NEATPUMP � <br /> ROOF DRAINS—RAINLEADERS Z GAS PIPING g„\� �.T�yC <br /> O SINK(SERVICE—BAR,ETC.) EXHAUST FAN — <br /> T <br /> . SUB TOTAL 5 SUB TOTAL S <br /> PERMIT S PERMIT g <br /> TOTALFEE 5 TOTALFEE ^y <br /> FOR OFFICE USE ONLY: <br /> FRONiSGipq�N ' REARSEiDACN / <br /> SIDESEiBACK/ PLANC ECKNUfAO'R <br /> FEE Rt�.iIPiNO <br /> USEZON[ � ` � ��,�• � Z� <br /> IO1M[A VqLANT51tE <br /> FEES VALUATION FEE <br /> � �7 3 � YES �I NO BUILDING <br /> 1M[�FC�NSi ND FSiORIES f1LLpV:yL• NOO�DWFllI4i�MJ5 181733 � <br /> V-N � � , <br /> PLUMBING �(� O l <br /> 512[OFBLDG FlRESPRINrcI[qgNEOD BAS[ NT U <br /> 3326 SF �/' MGCHANICAL <br /> 663 s� Gne YES '- Np i�L� ' !�n <br /> oCCU�n��CY Lono FlR[qi�q��qEQ�p ��eGHr uMrtnnoN ADDITIONAL PLAN CHECK <br /> �A � � � l 3ln � G-D <br /> aEnSON OTHER <br /> �l� LI� <br /> STATE PWLDING SURCHARGE <br /> INTAR[BY PiANS APPpiVpO BV �.��J <br /> J a C'LOCAL SA ES PUBLIC WORKS ,� � <br /> � G',�' <br /> oa.e 3 TAX CODE IS 3105 TOTAL �, <br /> �,l.J �D <br />