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I <br /> , <br /> � <br /> APPLI�AI �ON FO�i GONS'1'RUe.. ��IOi�J PEF$MIT °�`'�`'`� <br /> ;, f , TO BE COMPLETED IN INK—PLEASE PRIN'� � <br /> CITY OF i _ _ I <br /> � �> �y BU�LDING DEPARTMENT � HEATWG SYSTEM: ❑GAS ❑ELECTRIC ❑_ __.. ] j <br /> p �l x 259-6810 <br /> �� H [i� DEMOLITION COMBINATION �BUILDING MECHANICAL PLUMBING SIGN I <br /> OYIYEfl IANLAO�PE55 QiY ZIP PHONE <br /> 3 � H ��tF�l /� s;"�dE,us �9��. �r a( sr L���u:�7` �s.1—/`S�a_ <br /> �e o <br /> F3 .�1 iRIPHi M�ILAUDPE55 CiTY ZIP PIION[ <br /> "i1 H 'il — _ — � <br /> y H nfi��ili[CiGRCCS;G':C❑ MRiLA0DRE55 LITY ZIP PHONE �: <br /> H <br /> x <br /> GErv;'ULGONLBAGTO� ANIL\ODFESS 'i1V ZIP PHONE LiCG�L'En � <br /> o ry+ a 7 as z n� mT�3,s,e�c..��rA. a�ax�,cbr� G�s-�.i s� N�co c.sU xi aN <br /> � 1,-r� /l�ico La /�NNd CoNs 2 / <br /> � CrJ lJ �.�i2NANIC�LCGNTFi�CTOR AIAIIApORESS CITY ZIP PHOtlE ULEKSEt , <br /> �� n�r�.! <br /> z y L� P�NAf3iNG WNiRACIOR IA4ilA�DRE55 CIiY ZiP PHON[ LV.ENSEu <br /> � W <br /> z <br /> H y -- <br /> � y c�nsso�wonrc <br /> �0,� �� NEW ADDITIGN � � ALTERATION REPAIR . DEMOLITION ��. �� WOODSTO'JEiFRPL INSERT L�� 6UIL�)ING RELOCATION <br /> � CONtACT PERSOG ANO PHOtIE hQ � <br /> GC�iRAGTPRIGEO�WORK ��/ �� ��O <br /> y� D'_SCRiBE WOPK�Np 50UARE FOOTAGE VrvGtVE� <br /> h o v, ,QooF-�a7lZyQS- CAd/NcTf <br /> C�l�p REP�i�2— ��' , <br />` pnoPoseoupseoFow�ort�c A�o .a�– I HEREBY CERTIFY THAT I HAVE FEAD AND EXAMINED TR�S <br /> II S FIC APPLICATION AND HNOW THE SAME TO BE TRUE AND CORRECT. ALL <br /> I �een�oescaiauor+oraaoPeArvlsr+owr�oe�avoannncNFouRcoeiesi PROVISIONSOFLAWSANDORDINANCESGOVERNINGTHISTYPEOF <br /> WORK WILL BE COAIPLETED WITH WHETHER SPECIFIED HEREIN Ofl <br /> �or BLOCN oF NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br /> AUTHORITY i0 VIOLATE OR CANCEL THE PRCVISIONS OF ANY <br /> OTHER STATE OF LOCAL LAW REGULATING CONSTRl1CTION OR THE <br /> lil ��� � �, � -- PERFORMANCE OF CCNSTRUCTION.THAT I AM AUTHORI:ED BY THE . <br /> OWNER OF THIS PROPERTY TO PERFORM THE 4VORK FOR WHICH <br /> I � APPLICATION IS MAD� AND I COMPLY WITH THE STATE <br /> I CONTRACTORS LAW 1827 F�W AND 296200 WAC. <br /> SIGNATUREOFCONTR CfORORAUTNORIZE�AGENT �PtE <br />� - /V/G���G ZI D y✓ <br />, <br />� raoiecrneoaess --- _ ---_. <br />. �`_; /^ �/,r� cy. /SJft�,7T �PPLICAfliSClTYpl1S`:ESSUCENSENO.FfIGBl15MES5Nl�M!. <br />' I .0 >I �.�/GILC <br />, ,w PLUMB�NG 1AECHANICAL <br /> � � NO. TYPE OF PIXTURE OF ITEM FEE NO. TYPE OF E�UIPMEN7'_ FEE <br />' � � WAi Efl CLOSET(TOILET) � NC—A�HNDLG UNITS—H.P. ; <br /> �.� SATHTUB ' FOHCE�AIH SYSTEMS—B.T.U. Id E.A. <br /> ��, !I LAVATORV(WASH BASIN) UNIT HEATERS-9.T.U. M _ _�_ <br /> I SHOWER CL0T4ES DRYERS _ <br /> . � _ KITCHEIJ SINK 8 DISP VENTILATION FAN _ <br /> ' �� DISHWASHER RANGE HOOD _ <br /> I !�I LAUNDRY TRAY _ WATER HEATER _ � <br /> CLOTHES WASHER WOOD STOVE _ <br /> � URINAL METAL FIREPLACE 8 CHIMNFV ' <br /> � o DRINKING FOUNTAIN FIREPLACE INSERT _ � <br /> I e '_� _ FLOOR DRAIN HEAT PUMP _ <br /> � BACKFLOW PREVENTcRS GAS PIPING <br /> ROOF DFiAINS—RAINLEADERS EXHAUST FAN <br /> f SINK�SERVICE—BAR,ETC.) <br /> i �1��' — — <br /> I — <br /> T <br /> ��'`� SUB TOTAL $ SUB TOTAL S _ <br /> �� PERMIT 5 PERMIT S _ <br /> � - - TOTAL FEE 5 TOTAL FEI3 $ <br /> FOR OFFICE USE ONLY: <br /> FROHTSEID�CN FIEARSETBACK SiD[SEIBACK PLAIlCHECKNUI.��[!1 FEE PECEiviLO <br /> `__ —. �� <br /> usezoNe LOtAREA VAC�NiSrtE FEES VALUATION FEE , <br /> euaoinc . � yc 7 `- � 3y 'O ` <br /> rvrearwurs.auowaeiF tvreo�mnsrnmun�,. acuvwc+ uommvuw�c�x�,s <br /> eaouv PLUM�ING <br /> � 52EOFBLDG. NO.OFSTOFIES BlSEMENT �,�ECHANICAI � <br /> OCCUPANGYIG�D FIRESPFNNLERSRE09 NEIGNTLIMrtAT10N �DDITIONALPLANCHEL'K <br /> __ OTNER <br /> REASONFORSPfliNKlERS �-- <br /> STATE BUILDING SURCHARGE y i S U <br /> iuukenv ri.n�+snvrr+ow:ouv CITYOFEVEflE77 PUBLiGwoFiKs <br /> LOCALSALES <br />� TAX CODE IS 31U5 TOTAL ,23 3' I S d <br /> ;,. <br />