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APPLICATIO" FOR CONSTRUCTI'N PERMIT <br />TO BE COMPLETED IN BLACK INK —PLEASE PRINT <br />BUILDING DEPARTMENT HEATING SYSTEM: ❑ GAS ❑ ELECTRIC ❑ __. <br />259-8810 <br />Li DEMOLITION ❑ COMBINATION Cj BUILDING i7 MECHANICAL ❑ PLUMBING ❑ SIGN <br />MAIL ADDRESS PHONE <br />OW En/ 5%r3r'��2� �(� G/lo lI PL ZIP -,2 <br />TENANT MAIL ADDRESS CITY ZIP PHON <br />,Sbne /inchv�' l�%D(� (pS �2 SE Sytvh�mis�i (it/F /`�dSd 76S� <br />ARCHITE OR DESIGNER MAIL ADDRESS CITY ZIP PHONE <br />GENERAL CONTRACTOR MAIL ADDRESS CITY ZIP PHONE STATE LICENSE# <br />MECHANICAL CONTRACTOR MAIL ADDRESS CITY ZIP PHONE STATE LICENSE <br />MAIL ADDREGCITY ZIP <br />/ <br />4G ! VAf/$$ K o'. NF) io L1 l Sf±�.S/ IL7� <br />PRICE OF WORK <br />Q3j STATE LICENSE # <br />DESCRIBE WCRK AND SQUARE FOOTAGE INVOLVED <br />CONTACT PERSON AND PHONE NO. <br />PjLLtnhiLwj- <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br />APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALI. <br />PHUVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br />WORK WILL BE COMPLETED WITH WHETHER PAPFCIFIED HEREIN OR <br />NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br />AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br />OTHER STATE OR LOCAL LAW REGULATING 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 STATE <br />CONTRACTORS LAW 18.27 RCW AND 296.200 WAG. <br />/ /� �� / r <br />i/p E I <br />SI URE DATE <br />PROPOSED USE OF UILOING <br />,On <br />LEGAL DESCRIPTION OF PROPERTY (SHOWN BELOW OR ATTACH TWO COPIES) <br />LOT BLOCK OF <br />PARCEL TAX I.D. NUMBER <br />CONSTRUCTION LOAN LENDER. ADDRESS, TELEPHONE NUMBER <br />PROJECCIT.{A OR//��C�'AQQQ'��QQQ J^y)[ � <br />\i `%SU 1 `A)g SE �vg£i *aoa <br />J` i <br />CITY BUSINESS LICENSE NO <br />PLUMBING <br />MECHANICAL <br />HO. <br />TYPE OF FIXTURE OR ITEM <br />FEE <br />NO. <br />TYPE OF EQUIPMENT <br />FEE <br />WATER CLOSET (TOILET) <br />' <br />A/C—AIHNDLG UNITS—H.P. <br />' <br />BATHTUB <br />FORCED AIR SYSTEMS—B.T.U. M E.A. <br />LAVATORY (WASH BASIN) <br />UNIT HEATERS—B.T.U. M <br />SHOWER <br />CLOTHES DRYERS <br />' <br />KITCHEN SINK 8 DISP <br />VENTILATION FAN <br />DISHWASHER <br />RANGE HOOD <br />' <br />LAUNDRY TRAY <br />WATER HEATER <br />CLOTHES WASHER <br />I <br />WOOD STOVE <br />URINAL <br />METAL FIREPLACE (WOOD BURNING) <br />' <br />DRINKING FOUNTAIN <br />FIREPLACE INSERT <br />FLOOR DRAIN <br />BACKFLOW PREVENTERS <br />HEAT PUMP <br />GAS PIPING <br />' <br />_ <br />ROOF DRAINS—RAINLEADERS <br />' <br />EXHAUST FAN <br />' <br />SINK (SERVICE —BAR, ETC.) <br />I <br />I <br />I <br />' <br />' <br />I <br />I <br />' <br />SUBTOTAL $ <br />' <br />SUBTOTAL $ <br />' <br />PERMIT $ <br />ao <br />PERMIT $ <br />i <br />TOTAL FEE $ <br />TOTAL FEE $ <br />' <br />rvn vrrm r- uan <br />vF•A_#- <br />RECEIPT NO. <br />FRONT SETBACK <br />REAR SETBACK <br />SIDE SETBACK <br />PLAN CHE'MBE <br />FEE <br />USE ZONE <br />LOTAREA <br />VACANT SITE <br />FEES <br />VALUATION <br />FEE <br />BUILDING <br />❑ YES ❑ NC <br />TYPE OF CONST. <br />NO. OF STORIES <br />OCCUPANCY <br />NO OTOAEU NGUNItS <br />LRWP <br />PLUMBING <br />' <br />MECHANICAL <br />SIZE OF BLDti <br />FIRE BPRINKLERSREO'D <br />BASEMENT <br />❑ YES ❑ NO <br />; <br />ADDITIONAL PLAN CHECK <br />OCCUPANCY LOAD <br />FIRE ALARM RED <br />HEIGHT LIMITATION <br />OTHER <br />REASON <br />STATE BUILDING SURCHARGE <br />PUBLIC WORKS <br />' <br />INTAKE BY <br />PLANS APPROVED BY=TAXCODE <br />TOTAL <br />�� co <br />DATE <br />