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� � ppPLICATIC`1 FOR CONSTRUCT"lN PERMIT � <br />� TO BE COMPLETED IN BLACK INK—PLEASE PRINT <br />HEATING SYSTEM: ❑ GAS LECTRIC O_ <br />BUILDING DEPARTMENT <br />259-Bb10 <br />Cl DEMOLITION ❑ COMBINATION �i BUILDING l� MECHANICAL ❑ PLUMBING ❑ SIGN <br />OWNER MRILADDRE55 _ C�TY ZIP PHONE c^C . <br />TEN�NT MAILAD�RE55 CITY 21P PHONE <br />�n lu � ��C ZIP PHONE <br />�RCHITECTORDESIGNEF MRILADDPE55 ���Y <br />GENERI�LCONT ACTOH CITY 21P PHONE STATEL�CENSE� <br />MRIL ADDRESS �I��d <br />'/_� � `i�1i 2ccu 1���<<Rrzi9��_� <br />�CL• c�i�Y�1u•J;�- �OiO"i �P�"LCCu7�la.� ���Ci�Cn�,�1 (� �— <br />'. __"'"_"_ .�u� �nnoc<e GTV ZiP PNONE STATELICENSE• <br />PUIMBINGCONTRACTOR MRILADDI.ESS CITY 21P PHONE STRTELICENSE• <br />GONTRAC�TI PRICE OF WORK � ^ <br />DESCRIBE � O �ARE F00T110E INVOLVE� / <br />PROPOSED USE OF BUILOMG <br />LE6AL UESCRIPTION OF FR07EHTV 1�� BELOW OR/ A�TTACN TWO GOPIES� <br />� BLOCN pF 1'Ilti'� <br />�or <br />PARCELiA%ID.NUIPBER ' <br />�1.35�= L^('Y� - Ni ' ('Y `�i _ <br />CONSTRUCTION LOAN LENOER. ADDRESS. TfLEPHONE NUMBER <br />PRQIECT ADORESS <br />'c��'h � M Q-�..�`— <br />PLUMBINO <br />�,p, 7ypE OF FlXTURE OR ITEM <br />WATER CLOSET (TOILET) <br />BATHTUB <br />LAVATORY (WASH BASIN) <br />SHOWER <br />— Kirr.NEN SINK 6 DISP <br />FOR OFFICE USE ONLY: <br />FRONTSETBACN REAR� <br />I <br />us� � 1OT�: <br />C <br />Gtw':.1GT PERSON RND PHONE N0. <br />IB TOTAL $ _T <br />IRMIT $ _ <br />ITAL FEE $ <br />� SIDE SF.TB4LK � <br />V�GPNi SITE � <br />� �1 YES /J N� <br />rcruvu6r No11fIN2li�xcUxilS <br />S��g�p� FIRESPFMNLERSREO'D Bnstrnervi <br />bii • A�1ldV A� ❑ ves j�No <br />OCCUPANCV LOAD FIRE PURM REQ'0 NEIGNT LIMITRT�ON <br />.,/,. Na 1,8 <br />BY PlANS�PPROVED <br />DPTE �J�'f�{Ia'G, <br />OF <br />TAX CODE IS 3105 <br />ii ulXilc'Qi✓ _ <br />� HEREBY CERTIFY THAT I HAVE AEAD AND EXAMINED THIS <br />APPLICATION AND KNOW THE SAME 70 BE TRUE ANO CORRECT. ALL <br />PROVISIONS OF LAN1S AND ORDINANCES GOVEHNING THIS TVPE OF <br />WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br />NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br />AUTHORITY TO VIOLATE OR CANCEL THE PROYISIONS OF ANY <br />OTHER STATE OR LOCAL LAW REGULATING CONSTflUCTION OR THE <br />PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BV THE <br />OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br />qPPLICATION IS MAOE AND I COMPLY WITH THE STATE <br />CONTRACTORS L`�W 782� RCW AND 296200 WAC. <br />� <br />RANGE <br />T.U. <br />PUMP <br />FAN <br />Bl11LDING <br />PLUMBING <br />MECHANICAL <br />AODITIONAL PLAN CHECK <br />OTHEF <br />STATE BUILDING SURCHARGE <br />PUBLIC WORNS <br />TOT�L <br />SUB <br />0 <br />