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APPLICATIC'"l FOR GOfNSTRUCT")N PERMIT <br />� �'O BE COMPLETED IN BLACK INK—PLEASE PRINT �rr I�rr <br />� HEATIIJG SYSI'EM: 'J GAS U ELECTRiC J _ <br /> BUILDING DEPARTMENT _ <br /> 259-8810 <br /> DEMOLITION �( COMBINATION BUILDING MECHANICAL PLUMBING SIGN <br /> OWNER mnar,on�ess � cirv zia r�,ioNe <br /> �.G�D GnJ/w�io� u.- ol'/00 7 4 7��D,.,s�' �v_�,ll �+�G� R20 L( S/f1 S=y�3�/�/ <br /> r� <br /> TEN4NT MUt�55 CILV �W PiIONE <br /> ANCNRECi0B�E51GNER lAAILAUDRESS Cliv ZiP PMONE <br /> 1 GKA �l/i.r S•�•u <br /> OBlEFl CONTFACTOR IdNLPilGAE55 CI7V ZIP PHOIlE Si4fELICENSEp <br />' ��n�n��o Rncro�� Gs�co�2iDD7 �lJ��S�It'i7dTwl�t/A�Z�j$DZC �/ffSE�f.j�/� GTDOGOGC/J s,�N <br />� <br /> PWMBINGWN?pqCTOR MAILALuR[SS CIiV TIP PNONL STAiELICENSEa <br /> CU,SS l�F WORK <br /> x NEW ADpITION � ' ALTeRATION . REPAIR . DEMOLITIG' WOODSTOVE/FRPL INSERT ' � BUILDING RELOCATION <br />� � CC 950N AN/D�P'HONE NO. <br /> CONTR�CT PR�C[OF WOPK �J�'` /�.J C `(Jf L�gr`U�(,� <br /> DESCRI�E WORKAND SOU�FE FOOIAGE INVOLVED � <br /> Cn„�d�-v�- a 9aa o� �da�,c <br /> PfiOPOSEDUSEOFBUILDING i HEREBY CERTIFY THAT I HAVE READ AND EXAMINED TNI.; <br /> S%„ � � �����, APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT.AL� <br />�� �ecn� SCflIPTIONOFPROPE V(SI/OWNBELOWOFATTACNFOURCOPIES) PROVISIONSOFLAWSANDORDINANCESGOVERNINGTHISTYPEOF <br /> /I WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN Ofl <br /> I �or_� o�ocK ___ oF 6wcGf/nv / NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br /> /� , � AUTHORITY TU VIOLATE OR CANCEI THE PROVISIONS OF ANY <br /> /b7 r /`' OTHER STATE OR LOCAL LAW flEGULATING 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 /> - APPLICATION IS MADE AND I COMPLY WITH THE FTATE <br /> CONTRACIORS LAW 1827 RCW AND 296200 WAC. <br /> X U / -� .iY.�. �/z �/ ��Z y <br /> PROJECTAOOpESS SiGmnwaE �� oAiE <br /> s?�� ����` �=l"�� ��_J <br /> cnv ouswEss i�cEHSE Ho. <br /> PLUMBING MFCHANICAL <br /> N0. TYPE OF FIXTURE OR ITEM FEE NO. TYPE OF EOUIPMENT FEE <br /> WA7ER CLOSET(TUILET) � A/C—A/HNDLG UNITS—H.P. ; <br /> BATHTUB ; FORCEU AIR SYSTEMS—B.T.U. M E.A. <br /> LAVATORY(WASH BASIN) UNIT HEATERS—B.T.U. P.1 ; <br /> SHOWER 1 CLOTHES DRYERS —T— <br /> � KIT:HE�SINK 8 DISP ; VENTILATION FAN ' <br /> 1 DISHWASHER RANGE FIOOD T— <br /> � LAUNDRV TRAY ; WATER FIEATEF � <br /> �_ CLOTHES WASHER � WOOD S'fOVE ' <br /> URINAL ! METAL FIREPLACE&CHIMNEY � <br /> DRINKING FOUNTAIN FIREP',ACE INSERT ' <br /> FLOOR DRAIN � HEAT PUMP � <br /> BACKFLOW PREVENTERS f� GAS PIPING ' <br /> FlOOF DRAINS—RAINLEADERS EXHAUST FAN <br /> SINK(SERVICE—BAR,ETC.) ; � <br /> � ; <br /> I T <br /> I <br /> SUB TO7'AL $ SUB TOTAL $ ' <br /> _ FERMIT 5 PERMIT $ � <br /> TOTAL FEE S TOTAL FEE 5 <br /> FOR OFFICE USE ONLY: � �79, � <br /> FHONT SETBACH / qF�R SETBACK/ SIDE SETB � PLAN CNECK NUMBEfl FEE _ RECEIPT NO. . <br /> /�� .�S "L _S� ��1� 7 5�', �J:, !;� ���/(��� <br /> usezor+e �ornqen vncnN ire FEES VALUATION FEE � <br /> � `S �Q��L _ BUIL�ING � i - q.� �Oc(� �cJ <br /> iYPEO�CONiSALLOWA�LE iYPEOLC@�S7.ACiIIAI ouuva�wr uoorovi¢uucwurs <br /> nou= � <br /> 'I� �'l� .3 PLUMBING ��� !OO <br /> SIZEOFBLDG. Y, NO.OFSTOiilES �ASEMENT �.1ECHANICAL //!� �OCI <br /> 2`l31 5(' <br /> 2cx+ SF 6,4F Z J �— <br /> oCcuanNCv�ono FwesPnrvK�E�saeo�o NEIGMiLRdITATION ADDI7;ONALPLANCHECK ' <br /> / _ � �``' <br /> ����L��A � <br /> nEnSONFORsaaiNr'.�ERS �� � SPRINNLER � <br /> i <br /> STATE BUILDING SURCHARGE � i!�J <br /> INTAKEOY PLANSFP{'ROJEDDY CITYOFEVEREiI PUBLICWORKS �%„7 i (�O <br /> ,JI"+ LOCALSALES <br /> � . - �. TAX CO�E IS 3105 TOTAL ��c/ " � � <br /> � i J��- <br /> - � <br />