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APPLICATIQ� '� FOR CONSTRUCT`-'1N PERMIT � <br />TO BE COMPLETED IN BLACK INK—PLEASE PRINT <br />3UILDING DEPARTMENT HEATING SYSTEM: U GAS U ELECTRIC U <br />?59•8810 <br />DEMOLITION i; COMBINATION � i BUILDING ! iMECHANICAL Ix'pLUMBIN(i I'I SI(iN <br />1WNER M�ILAOCNE55 CITY ZIP PHONE <br />EXz� �bVE�. 323 S�'tEGQAP�+ Qo — BGu.�,.vunr� q�512f+ (340) to11-2Z"Ir7 <br />ENRNT M�ILAODPESS GTV ZIP PMONE • <br />�RC'iITECTORDC5IGNER M�IL�ODRESS GTY ZIP PHONE <br />[�►,e,¢� Mceqiaa -13u� �Nr�.i LAJE' ENC¢G'�S q82o3 (20�) 353-29Hp, <br />IENER�LCONTP�GTOR MIIR�UDNE55 CITY 2iP PHONE STATELIGENSE� <br />l�Y[Et Z7N. SAIdE f\S ATjrJE <br />�ECNMlIGAICONTR�CTOR MAILACURESS Cltt ?IP PI;ONE ^TATEIICENSE/ <br />'WMBINGCONTNALTON MAILADDRESS Cltt ZIP PNONfi� STATEIICENSE/ <br />T ('j,U 4 ) <br />DYA.�c�c F�c Yi.nEc���,� -$oI Ka3 WOOo�.�J��.ct ��L11Z 4U3i�5'1 ,L�D/ANFP1�1q1�lo <br />'.LASSOF WORK <br />XNEW I I ADDITION I I ALTERATION I I REPAIR I I DEMOLITION I I WOODSTOVE/FRPL INSERT I 1 BUILOINO RELOCATION <br />:ONTPACTPRICEOFWORK � cy�. ��p <br />�[SGRIBE WONIf AND SOU�RE F40TAOE 1'1V VED �N STAI.L.f�IC\aq� <br />F�¢raz��h.twJ sticrsh- 4 ��..o�.,y. <br />'ROPOSEOUSEOFBU�LDINO � <br />�1.� f.�� �JMS <br />FGPl0E5CRIPTIONOFPRO'ERTY�SHOWNBELOWOR RACHFOUPCAPIES� <br />OT BLOCK OF <br />ATt'A.C'�HEi� <br />��� � 3 �aS �� <br />% <br />N0. <br />«. v �i d�a�o '� a <br />WATEti CLOSET <br />�iL•613y[�L"I <br />=0R OFFICE USE ONLY: <br />HONTSETBACN <br />i5E 20NE <br />/PE Of LONiS. PLl <br />.RE Of BIOG. <br />�CCUPANGYLOI <br />IE�60N FOR SPI <br />VTAKE BY <br />OR ITEM <br />REAR SETORCK <br />LOT AREA <br />Cf:NTqCi PERSON AND PHONE N0. <br />i HEREBV CERTIFY THAT I HAVE READ AND EXAMINED THIS <br />APPLICATION AND KNOW THE SAME TO BE TflUE AND CORRECT. AlL <br />PROVISIONS OF LAWS AND ORDINANCES GOVERNINO THIS TVPE OF <br />WORK WILL BF. COMPLETED WITH WHETHER SPECIFIED HEFlEIN OR <br />NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO CIVE <br />AUTHORITV TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br />OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br />PEFFORMANCE 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 />�.. �o x Ud�.w �.��c,-Kr /- �0-9 G <br />Gri-o�T� .uaE �t�Z�110 wh <br />SUB TOTAL $ <br />PERMIT $ <br />TOTALF[E $ <br />EIDE SETBAC <br />WGANT SIiE <br />MECHANICAL <br />FEE NO. riPE OF E�UIPMENT <br />� AIC-A/HNDLG UNITS-H.P. <br />' FORCEDAIRSYSTEMS-B.T.U. M E.A. <br />� UNIT HEATERS-B.T,U. M <br />' CLOTHES DRYERS <br />� VENTIIATION FAN <br />RANGE HOOD <br />; WATER HEATER <br />� WOOD STOVE <br />_�_ METAL FIREPLACE 8 CHIMNEY <br />FIREPIACEINSERT <br />� HEAT PUMP <br />� GAS PIPING <br />� EXHAUSTFAN <br />i <br />i <br />� <br />' SUB TOTAL 3 <br />� PERMIT S <br />TOTAI FEE $ <br />�39 Ho �// � <br />PLAN CHECK N FEE ��� RECEIPTNO. <br />iYPE Of LONSL �LiURL IXCuwKv x0 a �w[lUx4uNip <br />t�0u� <br />NO.OF STORI[S B�SEMENT <br />FIRE SPRNKLERS REOD HEIGHT LIMITATION <br />/�q� LOCAL SALES <br />2�1 TAXCODEIS31D5 <br />BUILDING <br />PLUMBING <br />MECHANICAL <br />ADDITiONAL PLAN CHECK <br />SPRINKLER <br />STATE BUILDING SUFCHAqGE <br />PUBLIC WORKS <br />TOTAL <br />