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"4` APPLIGATIAN FOR CONSTRUCTI4N P�f3M17" � <br />TO BE CUMPLETED IN BLACK INK—PLEASE PRIh � � <br />HEATING SYSTEM: GAS IJ ELECTHIC U � <br />BUILDING DEPARTMENT <br />259-8810 <br />I I DEMOLITION I1 COMBINATION f�(BUILDING IN'MECHANICAL ��LUMBING Il SIGN <br />OWNER MAILAODRE55 <br />RA loii- ScI'luo� lSl�o 1•�JKAi <br />TENANT MnIIADOFE55 <br />ARCHITECTOR�ESiGNER MNLADDR[SS <br />G[NERALCONTRACTOfi fAAILADDRE55 <br />�e i„!J_S._I,..�/c /56 (-a /L1��� <br />'LUMBING CONTRACTOR <br />r7 ;� <br />li..-ivi :Atl.r % -, <br />CONTAACT PRICE OF WOflK <br />DESCRIBE WORK AND SOUA' <br />M�IL IDCFE55 <br />s na�-t <br />MAIL ADOflE55 <br />r._ ir���_ <br />INVOLVED <br />� <br />PROPOSGO E OF BUILDING .,/ � � � � <br />J <br />' .� c.v 7.�-n .�.. Lr.� a <br />LEGALDESCRIPiI. OFPROPERTV�SHOY �E�OWORFTTACHTWO <br />LOT � BLOCK OF �� <br />S_ fii . Ca�«Xs� <br />PAflCELTA%ID.NUMOER <br />CONSTRUCTIONLOANLENDER,ADDRESS.TELEPHONE <br />/���0 � � � i i � /V � .� � <br />PLUMBING <br />NO. TYPE OF FIXTURE OR ITEM <br />'z, WATER CLOSET (TOILET) <br />� RP.THTUB <br />-L LAVl.?ORY (WASH BASIN) _ <br />SHGW°R <br />KITCHEN SINK 8 DISP <br />� DISHWASHER <br />LAUNDRYTRAY <br />CLOTHES WASHER <br />URINAL <br />DRINKING FOUNTAIN <br />FLOOR DRAIN <br />BACK�LOW PREVENTERS <br />ROOF 7RAINS—RAINLEADERS <br />SINK (SERVICE—BAR, ETC.) <br />SUB TOTAL 5 <br />PERMIT S <br />TOTALFEE $ <br />CITY <br />CIiY <br />�noh. �� <br />qTV <br />��.�,, wn <br />ZIP <br />; y �: <br />.� <br />ZIP <br />21P <br />➢P <br />� <br />ZIP <br />����r <br />i �/- o <br />PMONE <br />PHONE SiA�E LICENSE � <br />�' �_:'J8 RA I S OGS M I <br />h.IONE SI ELICENSE/ <br />7r��,��� (�k'FR:�� �o�c� <br />PHONE STATE LICENSE p <br />(o>ri•%7/7 � �Uc17 � �v� <br />CONTACT PERSON AN� PHONC N0. <br />i HEREDY CERTIFY THAT I HAVE REAO AND eXAMINED THIS <br />APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />PROVISIONS OF LAWS AND OPDINANCES GOVERNING THIS TVPE OF <br />WORK WILL OE COMPLETED WITH WHETHEA SPECIFIED HEREIN OR <br />NOT. THE GRANTING OF A PERMIT DOES NOT PAESUME TO GIVE <br />AUTHORITY TO VIOLATE OR CANCEL TFIE PFOVISIONS OF ANY <br />OTHER STATE OR LOCAL LAW REGULATING CONSTFUCTION OR THE <br />PERFORMANCE OF CONSTRUCTIpN. 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 TFiE STATE <br />CUNTRACTORS LAW 18 27 RCW AND 296200 WAC. <br />v[SSucEr6[rvo <br />ANICAL <br />TYPE OF L�UIPMENT <br />A/C—AIHNDLG UNITS—H.P. <br />FORCED AIR SYSTEMS—B.T.U. M <br />UNIT HEATERS—B.T.U. M _ <br />CLOTHESDFYERS <br />VENTILATION FAN <br />RANGEHUOD <br />WATER H@ATER <br />WOODSTOVE <br />METAL FIREPLACE (WOOD BURNW( <br />FIREPLACE INSERT <br />HEATPUMP <br />GAS PIPING <br />EXHAUSTFAN _ <br />FOR OFFICE USE ONLY: <br />ffiON'. SETBACK REAfl SETOACK - SIDE SETBACN PLAN CN CN N� 8[R <br />� l � Q/%1 � "� <br />USEZONE �� Q�A�EA V ANT TE FEES <br />F t <br />G,e <br />LOAD <br />� <br />INTARE DY <br />i1;�1'ES ❑ NO BUi�DirvG <br />NO OF STORIES accuvpr,tv uo ofMvttuxGUNnS <br />1 `P°1 j , PLUIdBIN(i <br />.7 <br />FIFESPNINKLERSREO'D BASEMENT MECHANICAL <br />ri YES NO <br />FiRE nLANrA REO-D HEIGet LI1dITATION ADDITIONAL PLAN CHECK <br />"-'— Z � � OTHER <br />STATE BUILDING SURCHARGE <br />PLANSAPP@ � EOBV CITY OF �V�:RETT PUBLIC WORKS <br />J � LOCAL S.1LES <br />opTE Z/7/c� S TAX CODE I�• 3105 TOTAL <br />SUB TOTAL $ <br />PERMIT S <br />TOTALFEE 5 <br />— � O ., <br />FEE <br />H <br />