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APPLICATIC AFOR CONSTRUCT")N PERMIT <br />TO BE COMPLETED IN BLACK INK —PLEASE PRINT <br />BUILDING DEPARTMENT — <br />259-8810 <br />jd DEMOLITION COMBINATION <br />OWNER MAR ADDRESS <br />HEATING SYSTEM: U GAS U ELECTRIC U <br />So BUILDING ❑ MECHANICAL vPLUMBING <br />CITY ZIP PHONE <br />CITY ZIP - - PHONE <br />SIGN <br />CITY <br />ZIP <br />PHONE <br />ARCHITECT OR DESIGNER <br />MAIL ADDRESS <br />6RAC <br />El;; <br />CITY <br />Z.IP <br />PHONE <br />STATE LICENSE I <br />GENERAL LDNTRACTD <br />GENERAL <br />ADDRESS <br />G►-rY <br />CRy <br />ZIP <br />PHONE <br />STATE LICENSER <br />MECHANICAL CONTRACTOR <br />MAIL ADDRESS <br />CITY <br />Zip <br />PHONE <br />STATE LICENSE ii <br />PLUMBING CONTRACTOR <br />M\ItJIDDRE55 <br />CONTRACT PRICE/�O-F�yW.O�,RN�/ <br />DESCRIBE WORK AND B UARE FOOtAGE INVOLVED <br />CONTACT PERSON AND PHONE NO. <br />/"J f.{/vI' (/T/w <br />A �✓V �(y���/ <br />-�EEy��pL��.T��EL.,w�ls <br />G A'' <br />I HEREBY CERTIFY THAT 1 HAVE READ AND EXAMINED THIS <br />APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />PROPOSED USE OF euIEON+�`jA1�-`¢FI-i{� <br />PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br />NOR THELL BE COMPLETED WITH GRANTIING OF A ERMITyDOES NOT PRHETHER IFIED ESUME TREIN O GIVE <br />LEGA DESCRIPTION TYIS�ELL ATTACH TWO GOPIE51 <br />OF <br />AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br />LOT BLOCK <br />OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br />PERFORMANCE OF 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 THE STATE <br />CONTRACTO 6 LAW 18.D RCW AND 296.200 WAC. <br />PARCEL TAXI D NUMBER <br />/ L <br />..JNSTRUCTIONLOAN <br />CO LENDF. R.ADDRESS. TELEPHONE NUMBER <br />ST.N J <br />PROJECT ADORES 3v = <br />CI BUT NF5511LFN IY1 <br />ECHANICAL <br />PLUMBING <br />TYPE OF FIXTURE OR ITEM <br />FEE <br />NO. <br />TYPE OF EQUIPMENT <br />FEE <br />NO. <br />1 <br />A'C—AIHNDLG UNITS—H.P. <br />_ <br />WATER CLOSET (TOILET, <br />-- <br />' <br />FORCED AIR SYSTEMS—B.T.U. M E.A. <br />BATHTUB <br />UNIT HEATERS—B.T.U. M <br />LAVATORY (WASH BASINI <br />1 <br />CLOTHES DRYERS <br />SHOWER <br />i <br />VENTILATION FAN <br />KITCHEN SINK 8 DISP <br />RANGE HOOD <br />DISHWASHER <br />' <br />WATER HEATER <br />LAUNDRY TRAY <br />I <br />WOOD STOVE <br />�— <br />CLOTHES WASHER <br />METAL FIREPLACE (WOOD BURNING) <br />URINAL <br />DRINKING FOUNTAIN <br />1 <br />FIREPLACE INSERT <br />HEAT PUMP <br />FLOOR DRAIN <br />GAS PIPING <br />— <br />13ACKFLOW PREVENTERS <br />OF DRAINS—RAINLEADERS <br />EXHAUST FAN <br />SINK (SERVICE —BAR, ETC.) <br />I <br />i <br />r— <br />SUB TOTAL $ <br />SUBTOTAL $ <br />PERMIT $ <br />- <br />PERMIT $ <br />— <br />TOTAL FEE $ <br />TOTAL FEE $ <br />FOR OFFICE USE ONLY: <br />FRONT SETBACK REAR: <br />SIDE <br />USE ZONE <br />LEI^^ <br />-- <br />❑ YES ❑ NO <br />— <br />BUILDING <br />PLUMBING <br />MECHANICAL <br />TYPE OF CONST. <br />NO OF STORIES <br />Occu>AMT <br />GIMP <br />le PFWlnvGUV5 <br />SIZE OF BLDG, <br />FIRE SPRINKLERS RED D <br />BASEMENT <br />_ <br />YES NO <br />ADDITIONAL PLAN CHECK <br />OCCUPANCY LOAD <br />FIRE ALARM REl0 <br />HEIGHT LIMITATION <br />OTHER <br />STATE BUILDING SURCHARGE <br />PUBUCWORKS <br />REASON <br />INTAKEBY <br />BY <br />CITY OF E�IS <br />FPL�ANS�;NPPROVED <br />LOCAL <br />TAX CODETOTAL <br />FEE <br />im <br />i <br />H <br />