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APPLICAT���`] FOR CONSTRUCT^)N PERMIT` � <br /> TO DE COMPLETED IN BIACK INK—PLEASE PRINT <br /> BUILDING DEPARTMENT I�EAT�NG SYSTEM: 'J GAS ❑ELFCTRIC ]_ <br /> . 259-8810 <br /> : I UEMOLIT104 �COMBINATION ' 1 BUILDING I MECHANICAL "I PLUMBING ; ' SIGN <br /> 01%`!ER MFILAWFESi C17V ZIP PRORE <br /> .SS,�ro,�,� P,0 eox �y E�e�,etfc:.�t- �yzo� �s-� 'Y.3,SY <br /> �E YT MMLPDDRES$ CITY $IP PIION[ <br /> �' �'�'"�.%r'.Pty .��'zv C'o�6r E.�'-ti�f' 2�v/ asTl• 45d� <br /> ARCIIiECiORDESiGNEn MAILAD�RESS CiTV <br /> 21P PHUNE <br /> T/.:t.Y ti9'�sae�,trEs _4'Q�S�l�ny S�" SEdt�i�° (.�/�- �.�ob —(cd209s',�/ <br /> GE(N`EH4L CONTRqLTOR �) MAIL AD�PE55 T C`ITV�� zIP PHONE STnTE UCENSE� <br /> .�/W/YI�L � /��K/ TiK/� <br /> :'EC`NA�NICALLCC�TqACTOfl IAAILAOORESS CIT� I�p PHOYE SJpTELILENSE� <br /> u„//4 <br /> PLUMpING LONTP�CiOR MRIL�ODHE55 CITY ZIP PIIONE SiATE LICENSE• <br /> � / <br /> COfJTRACI PFICE CF^WCnRN <br /> ���� i 4TL�� <br /> DESGRIB�5011 FOOTA EINVO E� WN7A TPFRSCNANDPHC4ENO <br /> Gsoo ��,'��ov� �'.er slc��1�- �s� 5��5}� <br /> I HEREBY CERTIFY THAT I HAVE FEAO AND EXAMINF.D THIS <br /> PF�o�vn�o uSECF BUligy+�!(J�' �/y/�P� APPLICATION AND KNOW THE SAME TO BE TRUE AND COPRECT.ALL <br /> u`� �� ��� PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS NPE OF <br /> LEGALO[SCFIPTIONOFPROVEflTVISHOWNBELOWOPAttACNTWOCOPIES� WORK WII.L RE COMPLETED WITH WHETHER SPEGFIED HEREIN OR <br /> NOT. THE GFANTING OF A PFRMIT DOES NOT Pi7E5UME TO GIVE <br /> tor /BLOCH/ oF qUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br /> �� Nt tA OTHEP. STATE OR LOCAL LAW REGULATING CONSTRUCTIO^!OH THE <br /> PERFORAIANCL OP 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 1HE STATE <br /> PARCEL rpz i NUMOF CONTRACTORS LAW 18.27 RCW AND 296.200 WAC. <br /> /f <br /> CONSTRUCTION IOAN LEN�ER,nDDRE55.TELEP40NE NUM6ER /J y� � ��{' � � <br /> /�%��si� ��/ �j - /b -9� <br /> �t_t�,LfL6 ti�irize�� <br /> PROJECT ADDRESS s�eN.mne o�re <br /> � azs �/6� �,.�a�s��Ess��«�.��� <br /> PLUMBING MECHANICAL <br /> N0. TYPE OF FIXTURE OH ITEM FEE NU. TVPE OF EOUIPMENT FEE <br /> WATER CLOSET(TOILET) � AIC—ArHNDLG UNITS—H.P. ; <br /> BATHTUB ; FORCED AIR SVSTEMS—B.T.U. M E.A. <br /> LAVATORY I�VASH BASIN) � UNIT HEATERS—B.T.U. M ; <br /> SHOWER � CLOTHES DRYERS <br /> KITCHCN SINK 8 DISP VENTILATION FAN ' <br /> DISHWASHER RANGE HOOD <br /> LAUNDRY TRAV WATER HEATEq <br /> CLOTHES WASHEFi WOOD STOVE ; <br /> URINAL AIETAL FIREPLACE(WOOD BURNING) <br /> DRINKING FOUNTAIN � FIREPLACE INSER7 ; <br /> FLOOR DRAIN � HEAI'PUMP � <br /> BACKFLOW PREVENTEPS I GAS PIPING <br /> ROOF DHAINS—RAINLEADERS EXHAUST FAN � <br /> SINK(SEtiVICE—BAR,ETC.) <br /> _ <br /> � ; <br /> � <br /> � <br /> .`iU8 TOTAL S ; SUB TOTAL $ <br /> PCRMIT 5 � PERMIT $ � <br /> 'OTAL FEE S ' TOTAL FEE $ � <br /> FOR OFFICE USE ONLY: ��� ,Cig' _ <br /> fRONTSETBACK REARSFT90.CN SI�ESETOACr: PLANCHEGKNOMEER � FE /� RfCEI TNO. <br /> t�(v8(n �30- � �05�1/(0 <br /> usezone iotaaen VRCANTSITE FEES VALUATION FEE <br /> C YES ❑ NO BUILDING '7� -- –� �/ � <br /> 7Yi'E OKON57 NO.OF STOFIES aNP�vtr 40 0�o02wNGUArts <br /> cao.:r pLUMBING <br /> TC- I ti� 5 z ,e' <br /> S2E OF BICG. FIRE SPRINKLERS RE00 9ASEMEIlT�Z LEHLTiy MECNANICAL <br /> (�� '-r� � 7( YES :-� NO , <br /> OCCUPANC�l04D FIFE�LAPMr_REO'D HEIGHT UAUTr1TI0N ADDITIONAL PLAN CHECK � <br /> —I� Frk= �T J. � YP.S OTH[R <br /> REASON <br /> t'��j l�(�i��E �'^,�� STATE JUILDING SURfI1AqGE ; �� <br /> !NTAN[bV PLANSAPP�ipVEDOY CITYOFEVERE7T PUBLICWORKS i <br /> �+"� LOCALSALES <br /> onre (P Z i - TAX CODE IS 3105 TOTAL �Ji'3 �C�� <br />�� <br />