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�PPLICATIG� FOR CONSTRUCT �N PERMIT <br /> TO BE COMPLETED IN BLACK INK-PLEASE PRINT � <br /> BUILDING DEPARTMENT HEATING SYSTEM: � GAS ❑ELECTRIC ❑_ <br /> 259-8810 <br /> DEMOLITION COMBINATION BUILDING /ECHANICAL PLUNfBIN i ' SIGN <br /> OWNER MAILAD�FESS CITV ZIP // �' PHONE <br /> �47�15� BURf� /abo3 -io�B.s f �vf.,e�� 9�`�.,� 3s3 -zi9s <br /> TENANT MAILAD�RESS CIiV ZIP PHOhE <br /> ARCHITECiOflDESIGNER MAILADDRESS GTV ZIP PMONE <br /> GENERFL CONTRACTOR ldAIL ADDRE55 CITY 21P PHONE STFTE LICENSE k <br /> ?�fo_mr�s_Frr� rt�z- <br /> MECHANICALCONTRACTOP MAILADDRESS CIiV ZIP PHONE STATELICENSEs <br /> PLUMBIN6 WNTRACTOF MAIL FODFESS CITY ZIP PHONE STATE IICENSE x <br /> C1A55 OF WORK <br /> ; i NEW '. A�DITION �CALTERATION ! � REPAIR ' DEMOLITION WOODSTOVE/FRPL INSERT ��, i BUILDING RELOCATION <br /> CONTACT oER50N�N�PHOHE N0. <br /> CONiRACiPRiCEOFWORH ZSBD �,�,� y�`��� <br /> DESCRIBE WORK AND SOUARE FOOTFGE INVOLVE� <br /> �C�t BIFsfBoR�21� TD.ibRCE b k/R 6�S <br /> PRO?OSEDUSEOFBUILDING I HEREBY CERTIFY THAT I HAVE RE.4D AND EXAMINED THIS <br /> F�C TU GAS IAr�TFKF�i . APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT.ALL <br /> IEGALDESCRIPTIONOFPf70PEiiiV(SHOWNBELO'NORATTACNFOURCOPIES� PROVISIONSOFLAWSANDORDINANCESGOVERNINGTHISTYPEOF <br /> WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br /> LOT_ BLOCK oF NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br /> � AUTHOflITY TO VIOLATE OR CANCEL THE PROVISIONS OF qNY <br /> OTHER STATE OR LOCAL LAW RFGULATING CONSTRUCTION OR THE <br /> PERFORMANCE OF CONSTRUCTION.THAT I AM AUTHORIZED BY THE <br /> OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICii <br /> APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> CONTRACTORS LAW 78.27 RCW AND 296.200 WAC. <br /> � 6�80 DL/ Bat�P' ������ /D�/?�Q3 <br /> PROJECT AOOflESS SiG'+A*uaE � on�E <br /> 3 -/oD�e S . �27� _ <br /> CRY BU9NE55 UCENSI NO. <br /> PLUMBING MECHANICAL � <br /> NO. TYPE OF FIXTURE OR ITEM FEE NO. TYPE OF EOUIPMENT FEE , <br /> . NlATER CLOSET(TOILET) � A'C—A/HNDLG UNITS—H.R �, <br /> , BATHTUB ; FORCED AIR SYSTEMS—B.T.0 M E.A. �i <br /> � LAVATORY(WASH BASIN) � UNIT HEATERS—B.T.U. M ; <br /> SHOWER � CLOTHES DRYEHS <br /> KITCHEN SINK 8 DISP ; VENTILATION FAN ' <br /> � DISHWASHER RANGE HOOD <br /> LAUNDRY TRAY ; WATER HEATER � <br /> CLOTHES WASHER � WOOD STOVE <br /> URINAL ; METAL FIREPLACE&CHIMNEY � <br /> _ DRINKING FOUNTAIN i FIREPLACE INSERT ; <br /> FLOOR DRAIN � HEAT PUMP � <br /> BACKFLOW PREVENTERS ; GAS PIPING ' <br /> � . ROOF DRAINS—RAINLEADERS EXHAUST FAN I <br /> SWK(SERVICE—BAR,ETC.) <br /> � <br /> � <br /> � <br /> SUB TOTAL 5 ; SUB TOTAL 5 ?� — <br /> PERMIT $ � PERMIT $ /5 � <br /> TOTAL FEE $ ; TOTAL FEE S (r� �— <br /> FOR OFFICE USE ONLY: <br /> FRONTSETBACK REARSET9ACK SIDESETBACK PLANCHECKNUMBER FEE RECEIPTNO. <br /> Ua �� <br /> USEZONE LOTAREA VACANTSITE FEES VALUATION FEE <br /> BUILDING � <br /> TYPE OF CONTS.ALLOWABLE iYPE OF CONST.ACNAL otCUCANtr No of oWFwNG W:ns <br /> caouv � PLUMBING <br /> S2EOFBLDG, NO.OFuTORIES BASEMENT MECHANICAI � <br /> L_ <br /> OCCUPANCVLOAJ FIRESPRNKLERSFEO'D HEIGHTLIMIiATION ADDITIONALPLANCHECK i <br /> I SPRINKLER � <br /> REASON FOR SPRINKLERS T <br /> STATE BUILDING SUFiCHARGE i <br /> INTAKEBV FLANSAPPROVEOBY CITYOFEVERF.TT PUBLICWORKS ' <br /> LOCALSALES <br /> TAX COUE IS 3105 TOTAL <br />