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APPLICATIC"^l FOR CONSTRUCT'1N PERMIT � <br /> TO BE COMPLETED IN BLACK INK—PLEASE PRINT <br /> BUILDING DEPARTMENT ��TING SYSTEM: ❑GAS ❑ELECTRIC O <br /> 259-8810 <br /> ❑ DEMOLITION L7 COMBINATION ❑ BUILDING ❑MECHANICAL ❑PLUMBING �SIGII <br /> ow�n � M�a�ooness cm ziv rwr� <br /> Sov�r s Gm� ��y N�rrr �►�. �✓�; 9�zB► zv�-N�� <br /> TEIMNT MAIL�DDRE55 GITV 21P PHONE <br /> IIRCMITECTOROESIGNER MAILADDRESS dTY 21P P�IpNE <br /> OEIIEIULCONTMCTOR M�RIIDDRESS GITY ZIP PMONE ST�fELILEN�• <br /> �MD�Cec,� S/GrtJ l7o;P At.�lp A�.eN� S64TTLE Ip�33 5'fZP'7'S7 SNoRES2 //gl� <br /> �cwwic�u coNrn�cron ww woness cm nv a� sr�tE�ctrse r <br /> PLUMBMOCQITR�CttN7 IMGADORESS qTV 21P Pl10NE STATELICENSE• " <br /> . �•�i���r��'_:, <br /> wknucrva�oFwonK �'Oa. rq 'J�r�: ' : <br /> :.';;_. �� <br /> OE9CRlE Y1011K SOWRE FOOT�OE MVOLVE� � CONTACT PERSON AND PHONE N0. uI� r �I tA'/A��Y S� •'..�•H. � ,� �'. <br /> � I l'AL .���2:�-� �, <br /> ..:..y, ..- <br /> /NSTq� ?�o"N �( 2D�o �W Sin.�GcE F,acE St{Z -�'!3 . ,�,��.- <br /> ST•4LL �O'�X/4 O�YV c�NA�c tsK.'t� �„� <br /> � I i HEREBY CERTIFY THAT 1 HAVE READ AND E%AMINED ?MIS ..��. <br /> viaroseo useacw�omc APPLICATION AND KNpW THE SAME Tp BE TRUE AND CORRECT.AlL <br /> ; ___�iTA/L PROVISIONS OF LAWS AND ORDINANCES CAVERNING THIS TYPE OF <br /> I LEMLOE9CRRMMIOFPROPEpTV(SIqW11BElOWOR11TTl1CM7YVOCAPIES� WORK WILL BE CAMPLETED WITM NMETHER SPECIflED HEREIN OR � <br /> � NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO 61VE <br /> . �oT �°rx °F AUTHORITV TO VIOLATE OR C1INCEL THE PROVISIONS OF ANY - - <br /> . OTMEH STATE OR LOCAL lAW REdULATING CONSTRUCTION OR THE ; � � � <br /> � PERFORMANCE OF CONSTRUCTION.THAT I AM AUTHORI2E0 BY THE ` � � = <br /> � OWNER OF THIS PROPEHTY TO PERFORM THE WORK FOR WHICH ti <br /> APPLICATION IS MADE AND 1 COMPLY WITH THE STATE � <br /> � PIIRCEL TAX I D.MIMBER CONTRACTORS LAW 1827 RCW AND 296200 WAC. <br /> CONSTRUCTION LOAN LENOER.ADDIIESS.tELEP110NE NUGBER �r y � <br /> �J//� �_-�+ .�Lr-9f' <br /> MIOJECTADDIIEB! AD/ /7E�t�/T Q� Sq �3 o�t¢ <br /> �t cineusn�ss�cerrsEra. <br /> PLIIAMMO MECNAlNCAL <br /> N0. T�fPE Of RIf7UIlE 011 REM FEE N0. TYPE OF EWNPMENT fEE <br /> I WATER CLOSET(TqLET) � NC—AMNDL6�NITS—H.P. , <br /> � BATHTUB ' FORCED AIR SVSTEMS—B.LU. M E.A. � <br /> LAVATORV(WASH BASIN) � UNIT HEATERS--B.LU. M ; <br /> SHOWER � CLOTHESDRVERS <br /> KITCHEN SINK 8 DISP � ; VENTIUTION FAN ; <br /> ' � DISHWASMER � RANGE MOOD � <br /> LAUNDRY TAAY ; WATER HEATER �� <br /> CLOTHES WASHER � WOOD STOVE ; <br /> �. URINM. ' METAL FIREPLACE(WOOD BURNIN6i � <br /> I DRINKIN(i FOUPRAIN I FIREPLACE INSEHT ' <br /> ' FLOOR DRAIN � HEAT PUMP ��— <br /> �. BACKFLOW PREVENTERS ; GAS PIPING ; <br /> ' ROOF DRAINS—RAINLEADERS � EXHAUST FAN <br /> � SINK(SERVICE—BAR,ETC.) ; <br /> ' <br /> i � � <br /> � <br /> � <br /> � � <br /> SUB TOTAL S ; SUB TO?AL S <br /> � PERMIT S � P R T S � <br /> —�— <br /> TOTAL FEE S ' TOTAL FEE S ' <br /> t FOR OFFICE USE ONLY: <br /> � FRONT6ETBACK RE�RSETBACK SIDESETBACK PUWCNEC $- FE� / �� RECEIPTNO�/� <br /> G , ��y. <br /> . use zarie iy•'r�rv�� v�c,wT site FEES VALUATION FE/E��� <br /> � � N7•S 0 � ❑ YES � BUILOING — 4f/ 1 i _ <br /> 7vPE Of CONSt NO.OF STORIES p�[LPANtv MO O�VNFllM4 UMi15 —�-�'L� <br /> �aWP PLUMBING ' <br /> SIZEOFBLD6. FIRESPRMKLEA£ReOD BASEMENT MECHANICAL —r— <br /> ❑ YES ❑ NO <br /> OCCUPMICYLOAO FIREALARMREO'D HEI TLIMITATION ADDITIONAIPi.ANCHECN j <br /> �l/wllfj OTHER � <br /> RE�SON T <br /> STATE BUILOING SURCHARGE � — <br /> MT�KE BV PLAN PPPOVED BY CITY OF EYENETT PUBLIC WORKS ' <br /> LOCAL 8ALE3 � <br /> DA ��9� �j f TAX CODE 18 3105 TOTAL � <br />