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APPLICATIO.4 FOR CONSTRUCT.JN PERMIT <br />TO BE COMPLETED IN BLACK INK -PLEASE PRINT <br />'\ <br />BUILDING DEPARTMENT <br />259-8810 <br />DEMOLITION <br />IV <br />HEATING SYSTEM:) GAS ❑ELECTRIC ❑ <br />COMBINATION BUILDING <br />PLUMBING SIGN <br />GAINER MAlLADDIAESS Cln ZIP VIE <br />•y <br />YELL lvrROw16 —g -,/ arm. Q%QCE7T /��V z.-M- Sio/ <br />TENANT MAIL A:IDPESS b1V ZIP PHONE <br />ARCHITECT OR DESIGNER MAX ADDRESS CITY ZIP PHONE <br />GENERAL CONTRACTOR MAXADDRESS CRY ZIP PNONE STATELCENSCF <br />MECHA`Ng�0.P',LdZTON MA"R A�D�DRESS LRY ZIP pNONC STATE LICENSE <br />a�psM/�ILt� �i7OZ (Pi�SPI/1/Cii �S !VZp/ ;337W S //// D"OL. <br />PLUMBNGCCNTBACTCR MAl ADDRESS CITY ZIP PHONE STATE LICENSE <br />(. i NEW ADDITION )(ALTERATION REPAIR DEMOLITION WOODSTOVEIFRPL INSERT BUILDING RELOCATION <br />.��y.,� <br />CONTRACT PRICEOF K A'Lc!:� <br />CONTACT ELY.^✓ 353-3,JLfli/ <br />DESCRIBE AIORK AND SQUARE FOOTAGE IN VED <br />PROPOSED USE OF BUILD {L �� <br />( <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br />APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT ALL <br />PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br />WORK WILL BE COMPLETED WITH WHETHER SPECIFIED 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 />[EWLDESCRIpTIONOFPROAE Tr)SHOWN BEIOWOP ATTALNLWRLWIE51 <br />Lot BLOCK o' <br />PRWELT AOyDwgE�/SfS <br />PLUMBING <br />MECHANICAL <br />NO. <br />TYPE OF FIXTURE OR REM <br />FEE <br />NO. <br />TYPE OF EQUIPMENT <br />FEE <br />WATER CLOSET (TOILET) <br />AIC-AIHNDLG UNITS-H.P. <br />BATHTUB <br />_ <br />FORCED AIR SYSTEMS-B.T.U. M E.A. <br />LWATORY(WASH BASIN) <br />UNIT HEATERS-B.T.U. M <br />SHOWER <br />CL OTHES DRYERS <br />KITCHEN SINK 6 DISP <br />VENTILATION FAN <br />DISHWASHER <br />RANGE HOOD <br />LAUNDRY TRAY <br />WATER HEATER <br />CLOTHES WASHER <br />WOOD STOVE <br />URINAL <br />ME FAL FIREPLACE 8 CHIMNEY <br />DRINKING FOUNTAIN <br />FIREPLACE INSERT <br />FLOOR DRAIN <br />HEAT PUMP <br />BACKFLOW PREVENTERS <br />Z <br />GAS PIPING <br />F.00F DRAINS-RAINLEADERS <br />EXHAUSTFAN <br />i <br />SINK (SERVICE -BAR, ETC.) <br />ELIB TOTAL S <br />SUB TOTAL S <br />PERMIT S <br />PERMIT S <br />TOTAL FEE S <br />TOTAL FEE $ <br />FOR OFFICE USE ONLY: <br />FRONT SETBACK <br />REAR SETBACK <br />SIDE SETBACK <br />PLANCNO \: lY � <br />9 <br />FFC <br />PECFiPI NO <br />USEZONE <br />TOT AREA <br />VACAFif SRF <br />FEES <br />VALUATION <br />FEE <br />BUILDING <br />— -- <br />nnacaxTs.uLDNAALE <br />TrvFacoxsT UTuu <br />omAATc. Ao worrtuBFMnL <br />SAOV <br />PLUMBING <br />SIZE OF BLDG. <br />NO OF STORIES <br />BASEMENT <br />MECHANICAL <br />— <br />ADDITIONAL PLAN CHECK <br />I.Y.CUPNICYLWO FIRESHINKIERSREOD HEIGHTLZTATKIN <br />REASpIfOR ygMIQE119 <br />SPRINKLER <br />STATE BUILDING SURCHARGE <br />—T <br />MAKE BY <br />PLANSA"WVED BY <br />CITY UEEVEIIETT <br />LOCAL SALES <br />TAX CODE IS 3105 <br />PUBLIC V10RN5 <br />TOTAL <br />