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4 <br /> � �i APPLICATI�rV FOR CONSTRUCY.�N PERMIT � ' <br /> G � <br /> TO BE COMPLETED IN BLACK INK—PLEASE PRINT <br /> � HEATING SYSTEM' U GAS ❑ELECTRIC ❑ <br /> r'��� BUILDING DEPARTMENT <br /> 259-8810 <br /> � � * I DEMOLITION COMBINATION k BUILDING X MECHANICAL x PLUMBING i � SIGN ��� <br /> � (�J T � �OWNEH MALLADDRE55 CIiY ZIP PHONE i <br /> � ,2 5� - �7,F/L <br /> 'i`..'i�� a a�L I s L�' � �c ' z' sr ��, .�-fF <br /> TENANT MAILA�DPESS CITY PP PHONE <br /> L��� �qCMITECTOFDESIGNER MAILAG�NESS CITY ZIP PHONE <br /> '� "� <br /> ��� <br /> � GENERALCONTNACTOfl MAILa00RE55 CITY ZIP PMONE STFTEIICENSEY <br /> � � S„o �..���< �iFlSu 3�,irF7 ,P�p�o-iofr� � <br /> R�UA�SS�N� �41��P/S 7U� ror�Ci��P �� � Z�P pHONE SiATELICENSEI <br /> �M MECHUlICALCONTRACTOR Mr111.ADDRE55 CITY -- � <br /> W�Q� � � PLUMBINGCONTMCTOR MAILAODFE55 CITV 21P PHONE STATELICENS[M <br /> �y� <br /> ClASS OF WORK <br /> '�'� i -I NEW i7 ADDITION � ALTERATIUN . �. REPAIR ; '', D MOLI710N , ��. WOODSTOVE/FRPLINSERT � BUILDINGRELOCATION <br /> 1„� /IK A��A CONTALTPERSONANDPNONENO. <br /> �w�y CONTR�GT PPICE OF WORK �Q / /C�� /� � OO QO <br /> py�G �ESCRIBEWORNANOSOUAREi00TFGEINVOLVED , <br /> O W /�� u- T�6 ePsar G/orF , AIP�/WhfN Li�:s d G.�e <br /> _--- �� �� . PYfOPOSEDUSEOFBUIL01N3 I HEFEBV CERTIFY THAT I HAVE READ AND EXAMINED THIS <br /> P //�� APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT.ALL <br /> � PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS NPE OF <br /> LEGALOESCRIPTIONOFP OPERN�SHOWNBELOWORATfAC11FWFGOPIES! yyORK WILL BE GOMPLETED WITH WNETHER SPECIFIED HEfiEIN OR <br /> � �oi /,2,7� BLOCN ySSI oF � '2 NOT. THE GRAIJTWG OF A PERMIT DOES NOT PRESUME TO GIVE <br /> � /� AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br /> � p� .3B , Le�S �� Oc/�- S� OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE i <br /> PERFORMANCE OF CONSTRUCTION.THAT I AM AUTHQRRED BY THE I <br /> 1 OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br /> APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> i CONTRACTORS LAW 1827 RCW AND 296200 WAC. <br /> � <br /> X �'��2��/� /az-�� � <br /> S�GN�i11fVE DAiE <br /> ` PROJECTADOFE55 � <br /> / - GiV Ou5iNE55lIC[NSF x0 I <br /> (I PLUMBING MECHANICAL � <br /> I C�� � NO. TYPE OF FIXTURE OR ITEM FEE NO. TYPE OF EOUIPMENT FEE . <br /> NC—NHNDLG UNITS—H.P. I <br /> � ' � � / WATER CLOSET(TOILET) FOFCED AIR SYSTEMS—B.T.U. M E.A. � <br /> I BATHTUB � UNIT HEATERS—B.T.U. M . <br /> �� '—�� , / LAVATORY(WASH BASW) � <br /> ' L�I SHOWER / CLOTHESDRYERS I <br /> KITCHEN SINK P.DISP VENTILATION FAN I <br /> ' RANGEHOOD <br /> � DISHWASHER i <br /> � � �� LAUNDRYTRAY WATERHEATER <br /> .��I ��� � � CIOTHESWASHER WOODSTOVE i <br /> URINAL METAL FIREPLACE&CHIMNEY <br /> - �, �� DRINKING FOUNTAIN i FIREPLACE INSERT � _ � <br /> � FLOOR DRAIN HEAT PUMP ' <br /> - BACKFLOW PREVENTERS / GAS PIPING ware�R I�TR ( <br /> ,I �� � E%HAUST FAN <br /> , ROOF DRAINS—RAINLEADERS � I <br /> SINK(SERVICE—BAR,ETC.) � <br /> (. �-1�' ! <br /> I SUB TOTAL $ '; � SUB TOTAL S � i '�, <br /> �1� PERMiT 5 PERMIT S I i, <br /> �' � TOTAL FEE 5 TOTAL FEE S <br /> FOR OFFICE USE ONLY: I <br /> FRONTSETBFCK REARSETOACH SIpESETBACH PLANCHEf.KN�W�F� FEE PECEIPTNO. <br /> 5 `��� � <br /> USE20NE LOTARER VACANTSITE FEES VALUATION �E � I <br /> BUILUING /V _ i � <br /> IYPE Of CONiS.ALLC1YABlE iYPE 0i COqS*ACtUFL Ottuvaxcv �io ai Va¢uFf u"ut5 —� n/� <br /> cawv � PLUMBING GV � ' <br /> SREOFBLDG. NO.OFSWFIES BTSEMENT MECHANICAL .V �� <br /> \ <br /> OCCIIPANGY LOAD PIRE SPRNKLERS REO�� NEIGHT LIMITATIOIJ ADDI�IONAL PLAN CHECK ��(/ <br /> i <br /> SPRINKLEP � <br /> -- �'-- <br /> REASON FOR SPRINKlERS � <br /> STATE BUILDING SURCHARGE <br /> iNTANEBV PLANSAPPROVEDBV CITYOFEVEREIT PUBLICWORK$ <br /> LOCALSALES , <br /> TAX COOE IS 3105 rora� 2,j`�2 ;bU <br />