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N �I l S f <br />APPLICATIC�'i FOR CONSTRUCT"9N PERMiT � <br />TO BE COMPLETED IN BLACK INK—PLEASE PRINT <br />HEATING SYSTEM: G�GAS ❑ ELECTRIC U <br />BUILDING DEPARTMENT <br />259-8810 <br />❑ DEMOLITION !: CONiBINRiION ❑ BUILC:'IG G/iMECHANICAL ❑ PLUMBING ❑ SIGN <br />OWNER \ <br />MA!L�DDFESS Ci1V ZiP PHOYE <br />rrF✓E.QFXifY iI/// SPoif/J�✓E UQ. `E✓EXE7T49Ao3 a?9'wNe '�a.30 - <br />TEN/JiT MRILADDRE55 <br />ARCHITECTORDESIGNER MRRADDNESS <br />CITY 21P PMONE <br />GENERRLCOMTRAGTOR MRILADDRE55 CITY ZIP PHONE STATEUCENSE• <br />MECHANIC�LCCNlTRACTbR MAILADDFESS LITY ZIP PlIONE'7y.gj��T�TELICENSE� �N � <br />rwi-ni FNER6.V SYS7S777Lt / 97�i/ �r�Tf/ F%i/F Li �YA�NWOO� u%Bi�.i�i STr�ICFJ9� E.tOLL�h <br />PLUMBING <br />PPIGE OF WORK <br />S�UAREFOO7AGEINVOLVED <br />use oF euaoir+a <br />�EGRL OESCRIPTNNJ OF PROPEFiV (SHOYM BELOW OP ATTAGH TMlO fAPIES� <br />LOT BIOCN OF <br />PAPCELTAXID.NUMBER <br />CONSTRUGTION <br />FOR OFFICE USE ONLY: <br />�.....�.«m��v REARSETBALN <br />USEZONt <br />iVPE Of CONST. <br />SIZE OF BL W <br />OCCUPANf,YI <br />REASON <br />NIIMBER <br />NO. OF STORIES <br />FIHE SPBINRlEHS REO'� <br />FIRE AURM REO'0 <br />PLANS APPRO`/EO BY <br />o�re <br />C�N <br />fANTqCT <br />I HEREBY CERTIFY THAT I HAVE READ AND EY.AMINED THIS <br />APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECL ALL <br />PROJISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br />WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br />NOT. THE GRANT�NG OF A PERMIT DOES NOT PRESUME TO GIVE <br />AUTHO�ITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br />OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br />PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORI2ED BY THE <br />OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br />APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />CONTRACTORS LAW 1827 RCW AND 296.200 WAC. <br />: � J1 f�/8/9s/ <br />DATE <br />SqMAtpRE if �1'I . r i _— <br />AIH SYSTEMS—B.T.U. M E.A. <br />,TERS—B.T.U. M <br />FAN <br />WOOD <br />METAL <br />SUB TOTAL E <br />PERMIT E <br />pLqNLHECKI�UMBER FEE I RECEIPTNO. <br />VFCANT gITE �cw — <br />i <br />❑ YES ❑ N� euILDING � <br />� <br />aa�xcr xoamnuixcuxns � <br />c4WP pLUMBING ' <br />BnSEMEr+T MECHANICAL —�. <br />❑ YES ❑ NO � <br />MEIGHT LIMIT�TION ADDITIONAL PLAN CHECK <br />i <br />OTHER <br />STATE BUILDING SURCHARGE <br />� <br />C�LOCAL SA ES T PUBLIC WORKS � <br />r�v cnnF IS 3105 TOTAL � <br />