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APPLICATI� FOR CONSTRUC'�JN PERMIT � <br /> TO BE COMPLETED IN BLACK INK—PLEASE PRINT <br /> HEATING SYSTEM: �,GAS ❑ELECTRIC ❑ <br /> BUILDING DEPARTMENT <br /> 259-6810 <br /> I i DEIiA0UT10N COMBINATION }�-BUILDING MECHANICAL PLUMBING `."1 SIGN <br /> PMONE <br /> OMMER MMLiNDRE55 ��ry Z�e '�AG` ^S�_/�^ / <br /> `� Cla -v a-r 'T O b O•fa <br /> � cm nv PNor+e <br /> ��T MAR ADDRE55 <br /> CITY ZIP PMONE �p��� T� <br /> �RCHITECTORDESIGNEfi MAILADORESS� � ���� � Y ^U( ���j ,�����,,�-1 GI�P.NDN/►fiL�L <br /> 7 �% <br /> oL �l�. OLTaIi 3� " <br /> cm na vHOHe s <br /> GENERQCONTR�CTOR MA�LFUDAESS <br /> ME�NiWIC�LCpNTpAC70R M�ILMDRE55 <br /> CITY 21P PNONE STATELICENSEI <br /> p�ry 21P PMONE ST�TE LICENSE� <br /> pL1AABMGCOMTRACTUR MAILADDRE55 <br /> CUSS OF WOMK � . <br /> � NEW i 1 ADDITION I I ALTERATION � . REPAIR '�, I DEMOLITION . WOODSTOVE/FRPL INSERT - � BUILDING RELOCATI <br /> � /f GONTA PE��DPH /�- � f � _'�� <br /> CANTRACTPRICEOFWORI(���7��^�'�'� �5�� <br /> DESCRIBEWW71(ANDSOU�HEFOOTAGE VOLVEU H✓� 'P <br /> g� FI <br /> ppOPOSEDUSEOFB�U0.DMG I HEFEBV CERTIFY THAT I HRVE READ AND EXAMINED THIS <br /> AI YL.Si�� KS "e APPLICATION AND KNOW TME SAME TO BE TRUE AND CORRECT.ALL <br /> eii � PROVISIONS OF LAWS AND ORDINANCES GOVERNING TH�S IYPE OF <br /> LEGILL.DE RIPTqNOFPR07ERiYl".+H��BELOWOR/lJ TTACHFWRCOPIES) y�ORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEHEIN OR <br /> iot� B��K � IC �F ���� NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br /> —�-- AUTHORITY 70 VIOLATE OR CANCEL THE PROVISIONS OF ANV <br /> OOf� � Ob - "a OTHER STATE OR LOCAL LAW FEGULATING CONSTRUCTION OR THE <br /> 39� ^ PERFORMANCE OF CONSTRUCTION.THAT I 11M RUTHORIZED 6Y THE <br /> OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br /> APPLICATION IS MADE AND I COMPLY 1VITH THE STATE <br /> CONTRACTORS LAW 1827 RCW AND 296.200 We C. <br /> �(� �' �'� <br /> s�cw�*un[ <br /> o�*[ <br /> PROJE MDRESS ' <br /> CIIV pUSMF:+S L�LENSE NO <br /> � MECH�VICAL �E <br /> �E Np. TYPE OF EOUIPMENT <br /> Np, TrpEOFFlXTIlRE0111TEM p��q�HNDLGUNITS—H.P. ' <br /> WATER CLOSET(TOILEn , FORCED AIR SVSTEMS—B.T.U. M E.A. ' <br /> BATHIUB � UNIT HEATERS—B.T.U. M ' <br /> VATORY(WASH BASIN) � OTHES DRYERS � <br /> � <br /> SH ER yE �.ATION FAN <br /> KITCH INK d DISP , RANG 00� � <br /> DISHWASH � WATER HE EH <br /> LAUNDRYTRA � yyppDSTOVE � <br /> CLOTMES WASHE , METAL FIREPLAC CHIMNEY � <br /> URINAI � FIREPLACE INSERT ' <br /> DRINKING FOUNTAIN , HEAT PUMP � <br /> FLOOR DRAIN � GAS PIPING ' <br /> BACKFLOW PREVENTERS � EXHAUSTFAN � <br /> ROOF DRAINS—RAINLEADERS � <br /> SINK(SERVICE—BAR,ETC.) � <br /> � <br /> � <br /> SUBTOTAL S ' SUBTOTAL E � <br /> PERMIT S ' <br /> PERMIT S ' TOTAL FEE S �' <br /> TOTALFEE $ � <br /> FOR OFFlCE USE ONLY: � REGEIPT NO <br /> FRONi SETB�C REAR SETB�OK SIDE S�TBALK � PU�N�E�K NU=OER O <br /> � � ��y� :�L.� ,� '7�//� <br /> � � � VALUATION FEE <br /> � V�CRNT SITE FEES <br /> � � Z E LOTAREA � <br /> � " _ BUILDING 2�Q 73 i <br /> !� <br /> 7ypppiCONTS.�ILOWABLE P.'PEOFCONSt.ACiORL ouu>/.Mcr xaavNnuxcuxirs �� <br /> � cnou3 ' pLUMBING <br /> h �_ ' '� <br /> NO.OFSTORIES BASEMENT MECHANICAL ' w <br /> pp si:e oF e�o�t + Z 'f�E 5 a <br /> a0 p/i A�DITIONAL PLAN CHECK <br /> � OCCUPANCY IOAD FIRE SPRNKLERS REO'0 HEIGHT LIMITATIOM � <br /> 28 ' � — <br /> A ��R <br /> REASON FOR SPRINKLERS $TATE BUILDING SUFCMARGE � <br /> i <br /> i � <br /> INTAKEBY PUNSpPPROVEDBY ��LOCALSIILEST PUDLIGWORKS � n <br /> J� TAX CODE IS 3105 �TAL /�� � �S� <br /> a � <br />