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�4PPLICATIQ. �+I FOR CONSTRUCY�N PERMIT �✓� <br />� TO BE COMPLETED IN BLACK INK—PLEASE PRINT <br />I HEATING SYSTEM: � �AS ❑ ELECTRIC ❑ � <br />BUILD!NG DEPARTMENT <br />259-8810 <br />❑ DEMOLITION ❑ COMBINATION ❑ BUILDING O MECHANICAL ❑ PLUMBING ❑ SIGN <br />OWNER MAILADDFE55 CITV ZIP PHONE 'S�II <br />CRA�G� P`�ELgEGK 75770LD QEDMaNll R.D ��i �EDMON9 WA 98052 <br />TENAN7' MAILADDRESS CI7V ZIP PHONE <br />ov�tNE� <br />ARCHITECTORDESIGNER MRILAOORESS CIN ZIF PHONE <br />owt NE¢- <br />GENERA.L C1ONTRACTOR MAIL AUURESS CITY ZIP PMONE STATE LICENSE � <br />D�N�� <br />MECHANICALCONTRACTOF MAILADDRESS QTV ZIP PHONE STATELICENSEA <br />Ov�[NtR.- <br />PWM9MGC(NJTRACTOR MAILADDRFSS CITV ZIP PHONE STATELICENSEk <br />C TRACT PRICE OF WORK <br />� 2 I 5a so o � I 5%D-5 <br />DE�CRIBE WOPK AND SOUAFE FOOTAGE INVOLVED <br />CoNST�ucT NEW 31ao sq_Fr. <br />SIN6l.� PP��"II�Y DW�t-�1N�L- _ <br />PROPOSED USE OF BUIL�ING <br />p�ete�.iA�L oc.LupA�ntc,Y <br />LEUAL DESQRIPTIGN OF PROPERTV (SHOIYN BELOW OR ATfACH TWO CGPIFS� <br />�or � " — BLOCK OF — <br />�bWDEe MI�.�. HIGHI.I�NDS <br />Dlvlslo�l �. <br />PARCEITA%I.U.NUMBEF <br />CONSTRl1CTION LOAN LENOEF, ADUfle55. TELEPHONE NUMBER <br />PROJECT ARDR�S� �. �— f I C/i 1 <br />NO. TYPE OF <br />3 WATER CLOSET <br />BATHTUB <br />LAVATQRY (WASI <br />^ URiNAL <br />� DRINKING FOl <br />� FLOOR DRAIN <br />BACKFLOW PI <br />SINK <br />CONTACTPERSONANDPHONENO. �rj/�IG <br />�r/'� <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br />APPLICATION AD;O KNOW THE SAME TO BE TRUE AND CORRECT. �1LL <br />PROVISIONS 0��� LAWS AND ORDINANCES GOVERNING THIS TYPE 7F <br />WORK WILL BE �'O"piETED WITH WHETHER SPECIFIED HEREIN Ofi <br />NOT. THE GR.4'� ' OF A PERMIT DOES NOT PRESUME TO GIVE <br />AUTHORITY i��� .'ILATE OR CANCEL THE PROVISIO(JS OF ANY <br />OTHF.R STATE' i'..00AL LAW REGULATING CONSTRUCTION OR THE <br />PERFORMANC: OF CONSTqUCTION. THAT I AM AUTHORIZED BY THE <br />OWNER OF THi� PROPERTY TO PERFORM THE WORK FOR WHICH <br />APPLICATION IS MADE AND I COMPLY WITH TH[ STATE <br />CONTRACTORS LAW 78.27 CW AOND�96.2U�AC. , ' <br />� � � <br />� <br />e <br />0 <br />OF <br />FORCED AIR SYSTEMS—B.T.U. <br />UNIT HEATERS—B.T.U. M <br />CLOTHES DRYERS <br />8 DISP � � •— VENTILATION FAN <br />� .► RANGEHOOD <br />� ; WATER HEATER <br />HER � — WOOD STOVE <br />� — METAL FIPFpLACE <br />SUB TOTAL $ � <br />PERMIT $ ' <br />TOTAL PEE $ I <br />FOR aFFICE USE ONLY: <br />FflGNT SETC �CK �7y REAR SE7BACK <br />rf..� I -31' ^7 r � <br />� � <br />ttPE OF CCN51. <br />SIZE O� <br />'f t �ig <br />(.b� <� <br />OCCUPAINCVLOAD <br />EASON � <br />\KE BV <br />LOT 4REA <br />NO.O STORIES <br />FIRE SPRINNLERS REO'D <br />FIRE ALARM FE� <br />No <br />PLANSAP ROvEDBY <br />►1 <br />�v <br />onre �n! fG�Q <br />SIDE SETBACK � <br />7.5�- IS <br />�C7 YES ❑ NO <br />suv�wcr xoaoweweeuxrts <br />qp�nv <br />�•.J � <br />9JLMCIY 1 <br />❑ YES NO <br />EIGM7 LIMITATION <br />I <br />CITY OF <br />TAX CODE IS 3105 <br />— HEAT PUM�° <br />GAS PIPING <br />i EXHAUSTFAN <br />PLAN <br />euaoin�c <br />PLUMBING <br />MECHANICAL <br />ADDITIONAL PU1N CHECK <br />OTHER <br />STATE BUILDING SUFiCHARGE <br />PUBLIC WORKS <br />TOTAL <br />M E.A. <br />TOTAL S <br />NIT $ � <br />1L FEE $ ' <br />�__ <br />/3 <br />�5� FiECEIP��� �J <br />JATIO" FEE <br />i 3y� sa ' <br />�c <br />//� (U Ci <br />' �7 <br />� �—�� <br />�. ���/ <br />