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APPLICATIO'.a.' FOR CONSTRUCTI�N PERMIT � <br />TO BE COMPLETED IN BLACK INK—PLEASE PRINT <br />BUILDING DEPARTMENT HEAiING SYSTEM: �C'iAS ❑ ELECTRIC ❑ � <br />259•8810 <br />L I DEMOLITION t I COMBINATION L I BUILDING ! I MECHANICAL CI PLUMBING I I SIGN <br />ON?!ER AUILADURE55 CITY 21P PHONE <br />.�/LL S,4u.f/DE32�' 57�1 !`ETw�AtE.A7� Eri 9'g�,o/ 2.52 O��o <br />TEN�WT M�0.MD9E55 CITY 21P PWJNE <br />MA0. ADDRESS <br />GEHERAICONTR�CTOq MAIIADDRESS <br />CITY ZIP <br />CITY <br />ST�TE 4LEh5E i <br />MECNNIILIILCONTRACTON AUILIIDDRE55 LITY ZIP PMONE STATEIICENSE• <br />a/FZ.�LBrI�.fSA{l�X7HL �iF//E..A.1/1/4'EU/6Wd4. EY. �YZO/ ZSL-��//�/ EyE7ZG5'S/L�/f`) <br />pLUA1BIppCpNTRACTpp IMILADDf1E55 LITY ZIP PMONE ST�TELICEHSE/ <br />PRIGE `OF WORK <br />� Y <br />VOIM N/D 60U�RE FOOT�GE IHVOIVED <br />�irr fXG�% i�J�T �i� <br />useoFeu�omc <br />LEGAL OESCNIMION OF VPOPERTV �SMONT! BELOW OR ATT�CH 1 WO COPIES� <br />�or e�ocic oF <br />PARCELTA%I.O.NUANEX <br />WATER CLOSET (TOIL <br />BATMTUB <br />LAVATORY (WASM BA: <br />SHOWER <br />KITCHEN SINK 8 DISP <br />URINAL <br />FLOOR DRAIN <br />BACKFLOW PREVENTERS <br />ROOF DRAINS--RAINLEADERS <br />FOR OFFIGE USE ONLY: <br />FPONTSETBI�CK RE�HSETB�CK <br />USEZONE <br />1YPE OF CONST. <br />SIZE OF BLDG. <br />occuruar �o�o <br />PEASON <br />INTAI(E BY <br />- <br />SUB TOTAL $ <br />PERMIT S <br />LOT AflE� <br />NO.OF STORIES <br />FIflE SPRINKLEHS REO'D <br />FIRE AURM REOD <br />PlANS APPROVED 6Y <br />D�TE <br />VACANT SITE <br />❑ YES ❑ NO <br />OCCUMNLY NOO�OWFIIiNGIIMii6 <br />4PWP <br />BASEMENT <br />❑ YES ❑ NO <br />TAX <br />CANiACT PERSON RND PNONE 1q. <br />i HEREBV CERTIFV THAT I HAVE READ AND EXAMINED TMIS <br />APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />PflOVISIONS OF LAWS AND ORDINANCES GOVERNING TMIS TYPE OF <br />WORK WILL BE COMPLETED WITH WHETHEfl SPECIFIED HEREIN OR <br />NOT. THE GHANTING OF A PERMIT DOES N0T PRESUME TO GIVE <br />AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANV <br />OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br />PERFORMANCE OF CONSTRUCTION. THAT t AM AUTHORIZED BY THE <br />OWNER OF THIS PROPERTV TO PERPORM TME WORK FOR WHICH <br />APPLICATION IS MADE AND I COMPLV WITH TIIE STATE <br />CONTRACTORS LAW 1827 RCW AND 2%200 WAC. <br />� ,�� 6-/.3-9ri <br />s E a.E <br />crcv eusmEss ie.Nu w <br />M <br />RANGEHOOD <br />WATFR HEATEF. _� <br />WOOD STOVF <br />METAL FIRF'UCE IWOOD BURNING) ; <br />�� <br />BUILDING <br />PLUMBING _ <br />MECHRNICAL <br />ADDITIONAL PLhN CHECK <br />OTHEP <br />STATE 6UILDI�aG SURCMAFGE <br />PUBLIC WO <br />TO1AL <br />FEE <br />—�—. <br />SUB TOTAL f , v ' � <br />PERMIT 8 � <br />TOTAL FEE S ? ! " <br />�X <br />tl <br />