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r <br />APPLIGATIQN FOF� CONS"iRUCT�AN PEF�MIT � <br />TO BE C�MPLETED IN BLACK INK—PLEASE PRIh � <br />BUILDING DEPARTMENT '— <br />259-8810 <br />C I DEMOUTION ❑ COMBINATION <br />OW�iEO <br />n.� <br />ARGNITELT <br />HEATING SYSTEM: f�GAS IJ ELECTRIC IJ <br />L MAIL A�UiiESS ,t <br />I• SGI�UL^ IS�v J'C)K/��1�, <br />MA�L AODRESS <br />RUESIGNEF MAILAODRESS <br />JTFlAQOIR /� MAiI A�DR45SJ. <br />-SGf1UG/C. �iea�� 0 �\ ��i��(_� <br />CONiflACTOR M�IL4DD�iES7 <br />.a y�/ r <br />;:-,,.:,., �.wia„ . ..✓-�,:».:'.�.' <br />CONTRACTPRICEOFWORK � <br />DESCRI9E wOPM N AND SOI:PRE f�TA�E <br />�Ww_ ��'f"D�7i�f <br />APOPOSE� E OF BUILDING „/ � <br />,.i � 7a..n , <br />IEG�L �ESCRIPTI 04 oFlOPERTY �5111 <br />�nr� BLOCK — <br />� <br />I�BUILDING Ii�MECHANICAL <br />LO W OF� A�T�1AC�f�. T(W 0 COqPIE51 <br />OF —/�—"—�L- <br />PARCELinai.u.nornocn <br />CCNSTRl1C: �ON LOAN LEN�EP. PDDRESS. TELEPHONE NUMBEFl <br />PROJECT ADDRESS ,/� <br />� �����–�7/" <br />PLUMBING <br />��p, TYPE OF FD <br />� WATER CLOSET (TC <br />KITCHEN SINK & DISP <br />DISHWASHER <br />LAUNDRY TP,AY <br />CLOTHES WASHER <br />URINAL <br />ORIIJKIhG FOUNTAIN <br />FLOOR DRAIN <br />BACKFLOW PFEVENI <br />ROOF DRAINS—RAIN <br />FOR OFFICE USE ONLY: <br />7VP�E O�F COIISI. <br />_�V �N <br />i i e�; °sf <br />flGA50N <br />OR ITEM <br />SUB <br />r s <br />FEE 5 <br />GITY <br />Sn � Fr, c� <br />CITY <br />CI7Y <br />GIiY <br />SAa . r.ij1 <br />CITY <br />� ,_ <br />I-1 SIGN <br />, <br />l <br />21P rn�nc <br />21P PHONE <br />Zp. PHONE +��TE IICENSE � <br />>�.;,�; z�u-u8�7 RA I u Ns oGS M 1 <br />Z�p oi�pNE ST ELIGENSE� <br />sa3� 7s���ioi (�'6�FR;F; ;�o�c� <br />Z�p PHONE STATEUCENSEs <br />9Qa>� �Sa•�i�� SEu�rr ��:� l30 <br />CONTACT PERSON nNU rnurve rvv <br />I�L�l���-_Sc.)zc.�iF' 33�/-0�/% <br />I HEREBY CERTIFY'iHAT I HAVE READ AND EXA�,iWCD THIS <br />APPLICATION AND KNOW THE SAME TO BE TRUE AND CORNECT. ALL <br />PROVISIONS OF LAWS AND QRDINANCES GOVERNING THIS TYPE 0� <br />WOFK WILL BE COMPLETEDrWITH WHETHER SPECIFIED HEREIN OF <br />NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br />AUTHORITY TO VIOLATE QR CANCEL THE PFOVISIONS OF ANY <br />OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR T'1E <br />PERFOFiMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY i HE <br />OWNER OF THIS PROPERTY TO PEFFORM THE WORK FOR WHICH <br />APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />CONTRACTORS lAW 1827 RCW AND 296.200 WhC. <br />MECHANICAL <br />FEE N0. TYPE OF EOUIPN7SNT <br />� AIC—A/HNDLG UNITS—H.P. <br />( FORCED AIR SYSTEMS—B.T.U. <br />UNITHGAT,ERS—B.T.U. M <br />� � CLOTHES DRYERS <br />VE^1TILATION FAN <br />� �� RANGEHOOD <br />—� <br />� � WATER HEATER <br />, WOOD STOVE <br />� METAL FIREPLACE (WOOD BUP <br />; FIREPLACEINSERT <br />HEAT PUMP <br />; � GAS PIPING <br />—� •�,. EXHAUST FAN <br />PL4N CMEGK <br />LOiRREA VACANiS�TE r��� _� <br />'�'' ❑ YES 17 NO BUILOINu <br />NO.OFSTORIE$ IXNvp!;Cv 400�OnLLUMG�`UR <br />cnouv PLU1dBING <br />F'f1ESP��EO'0 DASEhjNT M[CHANICAL <br />NU ❑ ves ��o <br />FIAE �LNRM REO'0 HEIGI/T UfdITFtIU% <br />ADOITIONAL PLAN CHECK <br />�u ? " OTHER <br />STATE OUIIDWG SURCHAqGE <br />INTAMEBY r�::��cnsar,uv�oor � ��7'(OrFVERf:7"t' ruoucv:��nK; <br />J1-} � LQCQL $i+L'e' — <br />1P.: CODe IS :f , roTai--- <br />— r,nTi � Z/llv �`I" --` <br />FEE <br />M E.A. <br />� <br />--,— <br />i <br />� <br />SUBTOTAL 5 I <br />PERMIT S <br />—f— <br />'OTAL FEE $ <br />I � � <br />fiECEIPi NO. <br />, "I _ -�, y �v��=1 <br />VALUATION FEE <br />. _ • � ip� — <br />�) � <br />���'�G <br />� i <br />