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APPLICATIQ'' FOR CONSTRUCT�N PERMIT � <br /> TO BE COMPLETED IN BLACK INK—PLEASE PRINT <br /> HEATING SYSTEM: ❑GAS O ELECTRIC ❑ <br /> BUILDING DEPARTMENT <br /> 259•8810 <br /> ❑ DEMOLITtON [� COMBINATION ❑ BUILDING ❑MECHANICAL ❑PLUMBING ❑ SIGN <br /> owr+�f��' A LC�1✓��ooaess 2 � I 3 �1 17�f t�-��/fi 1v1� �'l g�� 2.S 9— g�6$ <br /> TEIUNT MRILADORE55 CITV 21P � PHONE <br /> �RCHITECTIXiDES1GNER MAILADDRESS GTV IIP PHONE <br /> �/A���-�+ �N-�'r 413L �l�l�t+A'J A�f c'��rr wA 9g�� Ls �--� y.rb <br /> GENERALCONTHACTbR MAILADDRE55 CITY � ZIP PHONE STATEUCENSE• <br /> �� E� !� a p/Ac./l�c ,►f z3ooN <br /> MECH�NICALGONTRAGTOR M�ILADDRESS CITV ZIP PHONE STATELICENSEt <br /> PLUMBINGCONTPAGTOR MAIL��DRESS GITV ZIP PHONE ST�T[LICENSEt <br /> De : rr kRoH :.� • �r l� � � zs -L� aa 3 <br /> CONTPACT PRICE OF WORM <br /> 6aoo - ^ <br /> �ESCRI EWORKANO �REFOOTAGEINVOWEO CONTRCTPERSONANDPHONENO. C/�/��y' �LSL^ / Y <br /> (/ �//��71 .s ��I' <br /> Go s �f �� .� P�/'Sr r <br /> I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br /> PROPOSEO USE OF BU�LDING APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECL ALL <br /> �Q��P��� PFOVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br /> LEGALOESCiiIPT10NOFPROPERT(V��SpHO�WNBELOWOFATTACHTYOCOPIES� WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br /> �-c 4 -�-C�-- oF p`� 6� EtiK�� NOT. THE GRAP:TING OF A PERMIT DOES NOT PRESUME TO GNE <br /> �or siocK AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br /> OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br /> � PERFORMANCE OF CONSTRUCTION.THAT 1 AM AUTHORIZED BY THE <br /> OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br /> APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> PAHCELTA%ID.NUM ER CONTRACTORS LAW 1827 RCW AND 296.200 WAC. <br /> � �� 0 � O 00 � ��y���. <br /> CONSTRUCTION LOAN LENOER.ADDRESS.TELEPHONE NUMBER (o- t�-93 <br /> � x i/M�� <br /> sroH�i c o�.e <br /> PROJECTADORESS 3l3 l-�E Rr <br /> 'L T�-JD cmausmc55ucfMSFr+o <br /> PLUMBIN6 MECMANICAI _ , <br /> Np, TYPE OF FlXTURE OR ITEM FEE NO. TYPE OF EOUIPMENT �E <br /> y WATER CLOSET(TOILE� � NC—A/HNDLG UNITS—H.P. � <br /> i <br /> BATHTUB ; FORCED AIF SYSTEMB—B.T.U. M E.A. ' . .,,�� <br /> y LAVATORY(WASH BASIN) � UNIT HEATERS—B.T.U. M <br /> SHOWER ' CLOTHES DRYERS ' '�•; <br /> KITCHEN SINK R DISP � � VENTILATION FAN ' - -ri_f�� <br /> � DISHWASHER RANGE HOOD ' ;i� <br /> LAUNDRY TRAY WATER HEATER <br /> 1 WOOD STOVE ' .,� <br /> CLOTHES WASHER ' <br /> URINAL ' METAL FIREPLACE(WOOD BURNING) ' . <br /> DRINKING FOUNTAIN FIREPLACE INSERT � <br /> FLOOR DRAIN ' HEAT PUMP ' <br /> BACKFLOW PREVENTERS ; GAS PIPING � <br /> ROOF DRA�NS—RAINLEADERS � E%HAUST FAN <br /> SINK(SERVICE—BAR.ETC.) � <br /> � <br /> � ' <br /> SUB TOTAL $ ' SUB TOTAL S ' <br /> PERMIT $ PERMIT $ � <br /> TOTAL FEE $ ' TOTAL FEE $ ' <br /> FOR OFFICE USE ONLY: <br /> RECEIPT NO. <br /> FRONTSETBRCK REARSETBACI( SIOESETBACN PLANCHECNNUMBEP FEE <br /> useza+e LOTARE� VRG�NTSITE FEES VALUATION FEE <br /> ❑ YES ❑ NO BUILDING �i (?O(9 ' � <br /> 7YPEOFGN51. NO.OFSTORIES oCC.i°extv MOno'MmxGu4rtS � <br /> 2 10YS PLUMBING ' <br /> - ,1 � �� <br /> SIZE OF BLW. FIflE SPAINKLERS REO'D BASEy�NT MECHANICAL <br /> �� ,��G p U'YES u NO ; <br /> OCCUPANGYLOAO FIREAIARMHEO'0 HEIGHTLIMITATION <br /> ADDITIONAL PLAN CHECK <br /> O OTHER � <br /> REASON i � <br /> STATE BUILDING SURCHARGE <br /> INTAnEO� PLANSl�PP,RO�EUBY CITYOFEVEHETT i'UBLICWORKS —T <br /> J �:�' LOCAL SAIES <br /> onr TAl(CODE IS 3105 �TAL <br />