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ppPLICATIQ"` FOR CONSTRUCT'"�N PERMIT � <br />TO BE COMPLETED IN BLACK INK—PLEASE PRINT <br />NFn7iNG SYSTEM: �GAS O ELECTRIC: U <br />BUILDING DEPARTMENT <br />259-8810 <br />❑ DEMOLITION ❑ COMBINATION L 1 871LDING ❑ MECHANICAL oNE ❑ PLUMBING ❑ SIG <br />µ�IL ADDRESS ��ry <br />OWNER = 3S1 ��� — <br />. i - - " - ' - - � � t� ai S'd.ic.G� t�✓. �✓ 'i�/i0 <br />21P <br />ARCHITEGTORUESIGNER M�RADDBESS <br />dTY 21P <br />MAIL <br />C1�, 21P PHONE <br />�MECMI�NIC�ICONTRACTOR MMLRODRESS � y��(ySY/I1E <br />� , •� sat�s,a �Vos i9 ,i✓N� /// PHONE <br />CITY <br />CpNTRACT PHIGE OF WORK <br />ylORK �ND SOUARE FOOTAGE INVOLVED <br />use c� euaoinc <br />. <br />IEGAL DESCR�PTION OF FROPEPTV (SHOWN BEIOW OR ATT7�CH 1W0 COPIES� <br />LOT BLOCK OF <br />PARGELTAXLU.NUMBEP <br />.Li/t� aa/i� <br />TRAY <br />FOR OFFICE USE ONLY: <br />FRONTSETBAGN REAR`• <br />Z�E I LOi <br />ttPE Of G045i. <br />INTANE <br />IRE SPRINNLERS REOD <br />IRE PIARM RWD <br />PLRNSAPPAOVE�B� <br />nnr� <br />GONTRCT PEFS�N RND PHONE N0. <br />� <br />s <br />s <br />SIDE SETBACK <br />JACANT SITE <br />❑ YES ❑ NO <br />tttUO�N[v NOIXPVRLiHG�'NiiS <br />GFW> <br />BASEMENT <br />❑ YES O NO <br />�--�— <br />HEIGNT LIMITATION <br />aTr o ee RVF � <br />LOCIIL SALES <br />TAX CODE IS 3105 <br />STRTE LICENSE � <br />STATE LILENSE � <br />2%b �..��AAfi <br />i HEREBY CERTIFY THAT I HAVE READ AND .:XAMINED THIS <br />APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br />WORK WILL BE COMPLETED WITH WHETHEH SPECIFIED HEREIN OR <br />NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br />AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br />O1�1ER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br />PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br />OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br />ppPLICATION IS MADE AND I COMPLY WITH THE STATE <br />CONTFiACTO S LAW 1827 RCW ND 296200 WAC. <br />DeiE <br />SIONI.TI E • <br />T.U. <br />INSERT <br />BUILDING <br />P�UMBING <br />MECHANICAL <br />ADDITIONAL PLAN CHECK <br />OTHER <br />STA1 E nUILDING SURCHARGE <br />PU9LIG �YORKS <br />TOTRL <br />�a �S <br />