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APPLICATI� FOR CONSTRUCT�N P�RMIT � <br /> TO 5E COMPLETED IN BLACK INK—PLEASE PHINT <br /> BUILDIMGDEPARTMENT HEATINGSYSTEM: � aAS ❑ELECTRIC O 1 �FLN S�oU� _ <br /> 259-8810 <br /> C� DEMOLITON i�! COMBINATION ❑ BUILDING ❑MECHANICAL ❑PLUMBING ❑ SIGN <br /> OWNEfl I.ULLADDRE55 �IIY IIP Pr^M'E <br /> ��t l,ue�trlan as-,p�;.�� N�rQr�-/ �8�i �s9sic�, _ <br /> NANI T , M1RA�OFESS Clb IIP PNpNE <br /> �ON1E / I � � I i . <br /> ANCNRRiOflDESIG4E0 MAILA�OFF55 GIiY ZIP � �PINWE � <br /> Yk-s S3 '�t� s����] 1 ' , <br /> uENE0.LLGp1iN� T MAILAO�PRS CIiY ZIV � �IlplE � Si1TELKEM$E/ <br /> ' Oric./= �Ll�/J1= 2. . , r ' . <br /> MELH/J11GtLpItM iON M,1ilA� S CIIY IIV plqN[ STATEIICENSE• <br /> ��o �-r. usa�%_r� <br /> vWMBINOt iP�C10P IMIL�DDFESS Lltt IIP P�qNE SiRELICENSE� <br /> �k r- ks l�r 2 <br /> LON! ACiPPICEOFW /M p ,�-}� <br /> O�Lu 4 VJ 7���'�r�l. <br /> �ESLRIBEW011 A�OG��R[FW1�.fUN�VED �ONi�Ci�EPSON.WDPbONEtb <br /> / � <br /> � b� <br /> I NEREBV CERTIFV THAT I HAVE READ AND EXAMINEU THIS <br /> onoaoseo use or unmr+e APPLICATION AND KNOW TME SAME TO BE TRUE ANO CORRECi ALL <br /> -��� FROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS NPE OF <br /> iecuoescnirrrmcr vnormn�sNarvrvec�owonertncNrvrocovicsi WORK WILL BE COMPLE7ED IVITH WHETHER SPECIFIED HEREIN OR <br /> NOT.THE GRANTING OF A PEflM1T DOES NOT PRESUME TO GIVE <br /> �o*/ M�a:K oF AUTMORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br /> /-J�i� /�D�`� OTHER STATE OR LOCAL LAW REGULqTING WNSTRUCTION OR THE <br /> — PERFORMANCE OF CONSTRl1CT104.THAT I AM AUTMORIZEO 6Y THE <br /> OWNER OF THIS PROPERTV TO PFflFORM THE WORK FOH WHICH <br /> vnacc�rneiorvuueen � / APPLIC TION IS MADE AND I COMPLY WITH THE STATE <br /> ����JS'Y —O JJ—���J��_ CONT ORSL RCWAND'<96200WAC. <br /> CONS1flUCiIPY LO�N LENDEN,A�DPE55.TELEPIICNE NOMBEN <br /> � 1:r.'��; /: '�JI r � � �7���7� <br /> PHOJECT ADDBESS ��_r� � sn��im� — c.e <br /> ��� aio� -f- �,,.�,,,��-,t�=E� - <br /> PLUMBING MECH�NICAL <br /> NO. TYPE OF FI%TUflE Ofl REM FEE NO. T/PE OF EOUIPMEiJT FEE <br /> WATER CLOSET�TOILET� A��NHNDLG UNITS—M.7. <br /> 7� BATHTUB FORCFDAIRSVSTEMS—B.T.II. M E.A. <br /> 1 �qyqTORV(1YASH BASIN� UNIT HEATEPS—B.T.U. M <br /> SHOWER CLOTMESDRYERS <br /> / KITCHE.'�SINN 8 DISP VENTILATION FAN <br /> OISHWASHEP / qANGE HOOD <br /> LAUNDRV TRAV WATER HEATER <br /> / CLOTHES WASMER WOOO STOVE <br /> UFiINAI METALFIREPLACE�WOODBURNING� �pU <br /> DflINNING FOUNTAIN FIREPLACE INSERT <br />� FLOOR DRAIN HEAT PUMP <br /> BACNFLOW PREVENTERS GAS PIPING <br /> ROOF DRAINS—RAINLEADERS � E%HAUST FAN <br /> SINK�SERVICE—BAP,EiC.� � � <br /> —T II <br /> SUBTOTAI $ SUBTOTAL $ <br /> PERMIT $ PERMIT 5 <br /> _ TOTALFEE 5 TOTALFEE E <br /> FOH OFFICE USE ONLY: �p u�n U i�-�.,.J .j(/(f�� <br /> FPONtSEiB�C� NEAFSELBAf' SiLE5Ei0�LR 'n PUNCNECRNUMBEP iEE PECEIvj� <br /> � µ,c�� Zo 3�Z � + /o� Zsr. Ct'3:2 ---�"�-�� J 7C 32-- <br /> usczaie w�anenq vec<rvrsne FEES VALU�TON FEE <br /> 2'Z �/Zo r� yE5 (�NO BUILOING <br /> rvttC�coxs� r+cwsroni[s ores.rn wnomwwwns ��Z �.S � ' � <br /> �_(� �'.�,� I � PLUMBING ��DJ <br /> .1-_1- <br /> SIIEOLOIxy lIRESnpINNlE115NEOD 6ASE4ENI <br /> I6I•t `�� i.�! VE$ / MEGNANICAL CD ' �� <br /> p YNO <br /> UCGUPANGYLO � Rt1F�UPMRE00 MEIGNiLIM:tA�VN d��ITIONALPIANCNECK n � <br /> A A /J� �� <br /> �2_ OTHEri I.-:�/, <br /> PGSON <br /> STATE BULL�iNG SURCHARGE � <br /> ix�ucE er xnr�s�waweoev CIiY UF EYENETT PUBLIC WOflNS � �� <br /> J M LOCAL S�LES <br /> o.,e �� C�y TAI CODE 1S 3105 mr�� 7 � ��, <br />