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APPLICATI�''1 FOR CONSTRUCT''1N PERMIT � <br /> TO BE COMPLETEO IN BLACK INK-PLEASE PRINT <br /> HEATING SYSTEM: �GAS ❑ELECTRIC ❑ <br /> BUILDING��EPARTMENT <br /> 259-8810 <br /> i l DEMOLITION ❑ COMBINATION BUILDING I i MECHANICAL ❑PLUMBING i_] SIGN <br /> Gl,•itoru K�tt Po��e�, S'/3g �v�-�-tt- 98'u�6 YYY-�596 <br /> TENANT MFIIA�DRESS LITV Z�P PNONE <br /> ARCHITECTOR OESIGNEfl MAII ADDRESS dTY ZIP PNONE <br /> Li�r.,e� ����i./20 �.��'� [�i.,� fE �i.�o.+c� t�&'Yl�! 9�.t-O�19,f <br /> GENER�LCONTA�GTOR M�ILAdDRE55 CITY ZIP PHONE STRTE�IGENSER <br /> ��b_ '�rr�. �(�o�( t73.�o[ AE� s� �oal. 9$�9 � '�1'�Sj'S"S AEkbSCG�f.7a6 <br /> MECHANIGALCONTNACTOR MAILA7DRE55 CITV 21P PMONE SiATEIIGENSEI <br /> PLUMBMGCONTRACiOR MAIL�DDNESS LITY ZIP PHONE STATELIGF'NSE� <br /> CONTRAGT PRICE OF WORN <br /> D SL.o <br /> DESGRIBEN'ORRA SWARE TAGEI VOLVEfI LONTACTPENSONANDFMONENO. <br /> o " w <br /> • �l�f� �!�/ G2 ���B�E�FY�THAT���VtE R�D AND EXAMINED THIS <br /> 1sY34 !'cae'N.cioor ns <br /> PF ;OSED USE Oi Bl11LDING 7 APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT.ALL <br /> ����.,Zy�y�/�r��l�B0.� Ity PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br /> �ec�� SnCBIPTI OFPROPEF �f4 SNowr+BELOWOR�TfACHiWOWPIE51 WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br /> � -5 � �/T_ NOT THE GaANTING OF A PERM�T DOES NOT PRESUME TO GIVE <br /> LOT ` BLOLK-- OF � / �a AUTHORITV TO VIOLATE OR CANCEL THE PROVISIONS OF ANV <br /> OYHER STATE OR LOCAL lAW REGULATING CONSTRUCTION OR THE <br /> PERFORMANCE OP CONSTRUCTION.THAT I AM AUTHORIZED BY THE <br /> OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br /> . APPIICATION IS MADE AND I COMPLV WITH THF. STATE <br /> PARCEL T�%I.O.NUMBER CONTRwACTORS LAW 1827 FCW ANAD 296200 WAC. <br /> CONSTRUCTIONLOANLEN�ER.ADDRE53,TELEPHONENUMBER �� /�f ' ��/♦� <br /> � x J V ,\��� (�/ SI <br /> . ECT A scH�r E o.rE T r— <br /> crtv eusmcss i�c[HSE�+o <br /> � p�,�p MECNANICAL <br /> ; llp, TYrE OF fl1(TURE OR rtEM FEE NO. TYPE OF EOUIPMENT FEE <br /> . WATER CLOSET(TOILET) / / A/C--A/HNDLG UNITS—H.P. � <br /> � BATHTUB ; / FORCED AIR SVSTEMS-9.T.U. M E.A. <br /> ' LAVATOPY(WASH BASIN) / � UNIT HEATEqS--B.LU. M � <br /> , /, SHOWER / CLOTHESDRYERS / <br /> KITCHEN SINK 8 DISF' VENTILATION FAN ' <br /> ' /� DISHWASHEfl �/ � RANGE HOOD � —� <br /> �� UUNDRV TRAY ; / WATER HEATER � <br /> � CLOTHES WASHER WOOD STOVE <br /> UFINAL ' METAL FIREPLACE(WOOD BURNING) � <br /> DRINKING FOUNTAIN / FIREPLACE INSERT X <br /> FLOOR DRAIN HEAT PUMP <br /> BACKFLOW PREVENTERS ; GAS PIPING K <br /> ROOF DRAINS—RAINLEADERS � EXHAUST FAN <br /> ; SINK(SERVICE--BAf2,ETC.) � ; . <br /> � <br /> � <br /> ; � <br /> � <br /> SUB TOTAL $ SUB TOTAL $ <br /> PERMIT $ � PERMIT $ <br /> TOTAL FEE $ TOTAL FEE 8 <br /> FOR OFFICE USE ONLY: <br /> FRONTSETB�CK REARSETBAC SIDESEIBALK/ PLANCH NNUMBER FEE PEGEIPTNO. <br /> zo � ,�.�` 5 /S .��9-j s 9�'/�/ <br /> use zor+E �ot nRen V�CRNT SITE FEES VALUA^ON FEE <br /> � ❑ YES �' N� eUiLDirvG 03 86 Z �Q ,� <br /> iYPE Of CONST. �'70.f F STORI[5 acuouK� xo a ow[uixc ux��s � � <br /> �"�1P � PLUMBING � <br /> -n! 3 <br /> SQEOFBLDG FI{iESPPINKLEF5RE0'D BRSEMENT � � MECHANICAL / ' <br /> 252oS `.7A/t O G YES I�IJO � <br /> OCCUP�NCYLO�D fIRE4URMREOD MEIGNTLLMJj[TI� ADDITIONALPLANCHECK <br /> NA v K3 <br /> OTHER A I <br /> REASON <br /> STATE DUILDING SURCHARGE n � /! <br /> INT�KEBY FIRVSAPPROVEOBY CITYOFEVERE7T PUBLICWORKS `✓1 <br /> J � LOCAL SALES i ,/� <br /> �qTE. � TAX COUE IS 3105 �r�� � <br /> ( <br />