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APPLICATiO'�9 FOR CONSTRUCT!�1N PERMIT �✓� <br /> TO BE COMPLET�D IN BLACK INK—PLEASe PRINT <br /> BUILDING DEPARTMENT HEATING SYSTEM: ❑GAS �ELECTRIC U- <br /> 259-8810 <br /> O DEMOLITION ❑ COMBINATlON ❑ BUILDING ❑MECHANICAL ❑ PLUMBING �� SIGN <br /> OWNER MAILADDRE55 �ITY 21P PHONE / � <br /> r1 �l 2�f��KL �, �%-�` ��' 9�'u� <br /> N T MAILAD� SS GITY IP PHONE <br /> �i�-� .�.a.v,� ��a3 ��` s�s� y�1�.�os 33 y-�� <br /> ARC IiECTORDE5IGNE-RI M�AIL.ADDPE55 �/ CIiY II �21P �/PHO�NE7b ) 'j <br /> �/J/V 1�fC� 1 !�/� �I�/.d'�� /V G Z'-�C/i I I�L H/// /J � STATE��/ `b �L / <br /> GENERAL CONT i GTO MAII AD�R 55 CITY <br /> SI6'�"�l� <br /> MECYANICALGONTHACTOR M�ILMDRESS CIiY 21P PMONE 5 IICENSE� <br /> LUMBINGCONTH�C70R MAILADDFE55 GITY 21P PHONE STATEIICENSEt. <br /> � <br /> � <br /> C TNACi PR6E OF WORK <br /> DESCRIBE WORK AND SOU�AE FOOTAGE INVOLVED LONTACT PERSON AND PHONE N0. <br /> � �A�AI J _ <br /> —��r—� <br /> I HEREdV CERTIFY THAT I HAVE READ AND EXAMINED THIS <br /> vaoro �se oF e oiNc APPUCATION AND KNOW THE SAME TO BE TRUE AND CORRECT.ALL <br /> PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br /> L ALDESLRIPiONOfPROPERP'ISHOWNNCL?1VORATTACMTWOCOPIES� WORK WILI. BE COMPLETED WITH WHETHER SPECIFIED HEFEIN OR <br /> NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br /> �oT eiocK oc AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br /> OTHER STATE OR LOCAL LAVJ REGULATING CONSTRUCTION OR THE <br /> PERFORMANCE^�CONSTRUCTION.THAT 1 AM AUTHORIZEC BY THE <br /> OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br /> APPLICATION IS MADE AND i COMPLY WITH THE S7qTE <br /> PARCELTA%ID.NUMBEP CONTRACTORSLAW . CWAND29620�WAC. <br /> CONSTRUCTION LENDEF. OG�iES^y�ELEPMONENUMBER 'I � �, <br /> H�-- <br /> . PR ECT ESS � rou.n o��e <br /> � cirveuswcs ucEH:�rro - <br /> P UMBING MECHANICAL <br /> N0. TYPE OF FlI(TURE OR ITEM FEE N0. TYPE OF EOUIPMENT FEE <br /> WATER CLOSET(TOILET) AIC—A/HNDLG UNITS—H.P. � <br /> BATHTUB ; FORCED AIR SYSTEMS—B.T.U. M E.A. � <br /> LAVATOF.Y(WASH BASIN) UNIT HEATERS—B.T.U. M � <br /> SHOWER ' CLOTHES DRYERS � " <br /> ICITCHEN SINK 8 DISP � I VENTILATION FAN ; <br /> � UISHN/ASHER RANGE HOOD <br /> LAUNDRY TRAY ; WATER HE4TER <br /> CLOTHES WASHER � WOOD STOVE � <br /> URINAL ; METAL FIREPLACE(WOOD BURNING) ' <br /> DRINKING FOUNTAIN � FIREPIACE INSERT � <br /> FLIIOR DRAIN � HEAT PUMP � <br /> BACKFIOW PREVENTEFS I GAS PIPING ; <br /> ROOF DRAINS—RAINLEAUERS � F.XHAUST FAN � <br /> SINK(SERVICE—BAR,ETC.) ; ' <br /> � <br /> � � <br /> � <br /> � � <br /> SUB TOTAL $ ; SUB TOTAI $ ' <br /> PERMIT S � PERMIT $ � <br /> TOTALFEE $ ' TOTALFEE $ ' <br /> FOR OFFICE USE ONLY: <br /> FRONT SETBRCN REAR SETBRCK SIDE SETBACK i'LAN CHEC 1.10�0 FEE ^� HECEIPTf�O./�C <br /> i ✓ <br /> O ` ff <br /> use zor+e n LOT AREA VACA:�T SRE FEES VALUATION FEE <br /> c 2 `��' V �l YES ❑ NO BUILDING � f � � � <br /> TVPFOFCON51. NO.OFSTORIES OCtun�xc� xaaoJ?LLixGuxrts i <br /> G°1UP PLUMBIYG � <br /> ---T— <br /> SIZEOFBILM.. FIRESPPINKLERSNE00 BASFAIENi MECHANICAL � <br /> ❑ YES ❑ NO � <br /> OCCUPANCY LOA� FIR=�LARM REO'D HEIGHT IIMITATION ADUITIONAL PLAN CHECK � <br /> _ <br /> � <br /> __ OTHER i <br /> RFASON <br /> STATEBWLOINGSURCHIIRGL �� � <br /> i <br /> i <br /> MTAKEB� PUNSR PROVEDBY CITYOFEVEflETT PUBLICWOFBS � <br /> �nh LOCAI.SALfS <br /> D�iE '� -a� -5 S TAX COOE IS 3105 roTn� Z ��,7' <br /> , <br />