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�-. <br />APPLICATIOR FOR CONSTRUCTII`'V PERMIT � <br />TO BE COMPLETED IN BLACK INK—PLEASE PRINT <br />BUILDING DEPARTMENT HEATING SYSTEM: ❑ GAS O ELECTRIC ❑ � <br />259-8810 . <br />�( DEMOLITION I_7 COMBINATION 1-1 BUILDING ❑ MECHANICAL CI PLUMBING IJ SIGN <br />ownen Mna�ooness cirv zir rHorie <br />M6 MAB 3zo +og'u *� '� s°� "�l4v�- wa 98004 '1•53 -o3Z4 <br />ZIP PIIONE <br />noicl�. <br />ARCHITECiOR0E5IGNER AUIL�ODRESS . CITV ZIP PHONE <br />riot�tl�. �,�s <br />GE�EHALCONTRACTOR M�ILAODRESS CITY ZiP PFqNE STATELICENSE� <br />SDt� 'Pa'Ba�lbB'b �+�1Lavu,� W11 98ocr-� 6�-9-35�4 sve.eo�k#Z3i.8� <br />MECHANICALCON7A�CiOR MAIL�UDOESS CI*Y ZIP PNONE S��IELICEN9E1 <br />rlorv� <br />PLUMBINOCONifl�CiOR MAtLADDfiE53 CIiY ZIP Pk10NE STATELICENSEI <br />*uoi't�t_ <br />CONTqACT PflICE OF WORK <br />5ocn`� <br />DE8CHIBE WORK AND SOU�RE FOOT�OE INVOLVEO <br />Cloea.yr4ov�' �i <br />IqPOSED USE OF BUILDMq <br />118 SF <br />OF PROPERTV (SFIOWN BELOW OR 11TTACH l WO COPIES) <br />LOT BIOCI( -- aF <br />PARCF.L TAX I.D. NUMBER_, . <br />rANSTNUCTION IOAN LENOER. RUDNE55. <br />' �� Vf <br />l215 50''_'� 51' <br />QR ITEM <br />BATHTUB <br />LAVATORV(WA <br />SHOWER <br />KITCHEN SINK <br />DISHWASHER <br />LAUNDRYTRA <br />CLOTP�ES WA: <br />URINf,L <br />DRINKING FOl <br />FLOOR DRAIN <br />BACKFLOW PF <br />ROOF DRAINS <br />SINK ISERV�CI <br />FOR OFFICE USE ONLY: <br />FPONTSETBACN NEMSETBRCN <br />TYPE OF CONST. <br />SIZE OF BLOO <br />OCCUPANCVI <br />REASON <br />INTANE BY <br />TOTAL $ <br />TOTAL FEE <br />LOT �RE� <br />NO.OF STORIES <br />FIRE SPPINKLEBS REO'D <br />FIRE �LAfiM REO'D <br />PLANS APPROVED BY <br />DATE <br />CONTAC� PEf150N AND PHONE NO. <br />I HEREBY CERTIFY THl;T I HAVE READ AND EXAMINED THIS <br />APPLICATION AND KNOW 'i HE SAME TO BE THUE AND G''�f- �-'T, qlL <br />PROVISIONS OF LAWS AN� ORUINANCES GOVERNINO 7- .:!�E OF <br />WORK WILL BE COMPIETED WITH WHETHER SPECIFIEL !FcIN OR <br />NOT. THE ORANTINO OF A PERMIT DOES NOT PRESU�/.E f0 OIVE <br />AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br />OTHER STATE OR LOCAL LAW REOULATINO CONSTRUCTION OR THE <br />PERFORMANCE OF CONSTflUCTION. THAT I AM AUTHORIZED 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 t8.27 RCW AND 296200 WAC. <br />X�� �' ���� ;� -�g -93 <br />BION�IUf1E D��E <br />TYPE OF EOUIPMENT FEE <br />AIC—NFiNDLG UNITS—H.P. � <br />FORCED AIR SYSTEMS—B.T.U. M E.A. � <br />UNIT FIEATERS—B.T.U. M i <br />CLOTHES DRYERS ' <br />VENTILATION FAN � <br />RANOEHOOD ' <br />WATER HEATER ' <br />W000 STOVE � <br />METAL FIREPLACE (WOOD BURNING) ' <br />FIREPLACE INSERT • � _ <br />HEAT PUMP ' <br />GAS PIPIN6 � <br />EXHAUSTFAN ' <br />. ' <br />i <br />---T— <br />� <br />_ ' <br />---�--�--r— <br />i <br />SUB TOTAL S ' <br />PEFiMIT S � <br />TOTALFEE E ; _ <br />SiDESETBACK PLANC/HJEF NNUMBE-R7 <br />'/ �J ��l <br />vncnNrsite ' FEES <br />❑ VES ❑ NO gU�LDIN6 <br />ORWNILY MO.pOWfllIN0UNi16 <br />°"0VP PLUMBINO . <br />BASEMEN� MECHANICAL <br />o ves ❑ No <br />HEI6HT LIMITATION AODITIONAI PLAN CHECK <br />OTHER <br />STATE BUILDING SURCHARGE <br />cirr oF eve <br />LOCAL SAI <br />TAX CODE IS <br />PUBIIC WORKS <br />TOTAL <br />RECEIPT NO. <br />. <br />