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"a 1 .wpn,un <br />TO " COMPLETED IN INK —PLEASE PRINT <br />,.nY of <br />evere <br />I`LJJI <br />L HEATING SYSTEM;_ ❑ GAS <br />13UILDINr, DEEPP ARTMENT <br />jW ELECTRIC <br />259 8810 <br />I DEMOLITION <br />D( COMBINATION I I BUILDING <br />I I MECHANICAL I I PLUMBING <br />SIGN <br />,NT,LII <br />4Ll-- <br />MAA ADDRESS CITY <br />ZIP rNONe <br />ass -too. <br />wc;-s-- l76u@4pptte4T- <br />ILNA14T <br />JTck_,_1:_3As <br />_-LLYKA.TIFO <br />MAIL ADLIRCSS <br />3�EFdLTA a1Z �N,yaaw <br />--A <br />c11r <br />II,. PHONE <br />cDOIITECT Or, W SIGNER <br />MAX ADDRESS CITY <br />IIP 1,70,E <br />-- <br />,QII nAL dA1IIV1CT011 MAIL ADDRESS CITY 21P PIroNE .ICENSEA <br />26"C A'5oziiol��/ <br />AECIIANICAL CONTAACTOn MAIL ADDRESS GI1V ➢P Poo,,, <br />ICL14SE A <br />I.UMBIN0001,IRACTOR MAK ADWILSS --- CITY IIP PIKBIL LICENSE/ <br />_AormaPc LTn.F3!I. sn1c. �NoNo uTSH .TyP. <br />LASS" WOIIK <br />%Q NEW I I ADDITION f I ALTERATION I I RFUAIR I I _ _. ... <br />--..__.__.. <br />.. ••---���,�.�I "FLuvocln 1 1 UUILUINGHELOCATION <br />'7 � <br />_ONInACT PRr.E OF MILKK_aD /7(� <br />CONTACT PEp50NAND PHONE NO <br />rtSCIUBE WOIIK AND S AIIE FOOTAGE INVOLVED <br />— ,LL�{'d_.LIC�L OTh/Lii`I j -�.pCj <br />AWIEV 135On6 PAMOLE;r- <br />NGrOSLU USE OF BUILDING <br />//J(uLg rAM/�y <br />I HEHEBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br />nfS5i.OriucE <br />APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT, ALL <br />_ <br />�cALGLxnIPt,GNOFrIwPEmYIS,ownBELowonenACNrounCOPIES) <br />PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br />MIT - BLOCK OF <br />WORK WILL BE COMPLETED WITH WI:ETHER SPECIFIED HEREIN OR <br />NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br />LO�QF S IIOe*T PG.A'T- .0 10-oz -6�9Z) <br />AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br />OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br />PERFORMA14CE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br />OF,F012:POn1 O P 1".07--t-, $ AAvp ct <br />OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br />APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />1 / / 1v <br />V 9"A, Lj'TIN IY-n"E *1cAcT:; <br />CONTRACTORS LAW IB.2T RCW AND 296,200 WAC. <br />SIGNAILIEOFCONIRAC ION Oil ALIT ,ONIIE0AGE NT DATE <br />W�T nevc�cc�n.lc�Irr.�c. <br />' %/'%/�i-I►5 <br />_ <br />,IOIICTADOrIESS <br />APPLICANTS CI I Y no51NL55 LICENSE No ANO BUSINESSNAM <br />_PLUMBING <br />MECHANICAL <br />NO. <br />TYPF OF FIXTURE OR ITEM _ <br />FEE <br />N0. <br />TYPE OF EQUIPMENT <br />FEE <br />L <br />WATER CLOSET (TOILET) <br />AA; -A HNDLG UNITS-Ii. P. <br />L, <br />BATHTUB <br />_ <br />FORCED AIR SYSTEMS-B.T.U. M E.A. <br />�- <br />2 <br />LAVATORY (WASH BASIN) <br />I PI I-i"'- <br />HEATERS-D.T.U. M <br />SHOWER <br />' <br />_UNIT <br />CLOTHES DRYERS — <br />/ <br />KITCHEN SINK 8 DISP <br />_ <br />Z <br />_ <br />VENTILATION FAN <br />DISIiWASI1ER <br />/ <br />—__�''- <br />I <br />T <br />-J- <br />RANGE HOOD <br />---�— <br />_�- <br />_LAUNDRY TRAY <br />_ <br />WATER HF:ATEH <br />— <br />-/- <br />CLOTHES WASHER <br />WOOD STOVE <br />- <br />_URINAL <br />_ <br />-�- <br />-�-- <br />METAL FIREPLACE 8 CHIMNEY <br />, <br />DRINKING FOUNTAIN <br />FIREPLACE INSERT <br />HEAT PUMP <br />',-Lb <br />--- <br />-'— <br />FLOOR GRAIN <br />I <br />BPCKFLOW PREVENTERS <br />GAS PIP114G <br />^ <br />ROOF DRAINS-RAINLEADERS <br />'— <br />EXHAUST FAN <br />-�-- <br />-= <br />SINK (SERVICE -BAR, ETC.) <br />-- <br />-- <br />�— <br />__ <br />H5 W <br />_ <br />SUB TOTAL $ <br />PERMIT $ <br />-% <br />PERMIT $ <br />TOTAL FEE S <br />',C6 <br />TOTAL FEE f <br />' <br />-vn Azrm" uDt ONLY: _ <br />146N I SL IpACK <br />20 <br />NEAR SETBACK <br />20 <br />SIDE SETBACK <br />5 <br />PL(V, CIIE K1111ND[I1 <br />Q i . <br />';Elate <br />R <br />/P[DI CU1115 MIMMIi I <br />Tot AREA IQpO <br />vnculT snE --- <br />- FEES - <br />BUILDING <br />PLUMBING <br />TYPE of CBNSI ACTUAL <br />v /�� <br />2AEMENt <br />IIE OFBUJG. <br />NO OF STOMES <br />MF.CI IANICAL <br />cCurANCY LOAp <br />RDE SPRNKI[115 RE00 <br />Yi..QI <br />uHGIR 1'MI1AGIgN <br />7 D I <br />ADDITIONAL PLAN CHECK <br />(;INER <br />LASx1 FON SPNNKLLNS <br />_ <br />S IAl E BUILDING SUNCI IAHLIL <br />,TAME BY Pi ANS APPROVED BY CITY0FCVEMETT_j PUBLICWORKS <br />/ LOCAL SALES <br />TACS O3105 TOTAL <br />-- <br />FEE RECEIPT NO <br />.X"/. 00 1 //ciS /S <br />3 <br />