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APPLICATIO' ' FOR CONSTRUCTI'`N PERMIT � <br /> TO BE COMPLETED IN BLACK INK—PLEASE pRINT <br /> BUILDING DEPARTMENT HEA7iNG SYSTEM: ❑GAS 0 ELEC7RIC U <br /> 259•8810 <br /> ❑ DEMOLITION [l COMBINATION CI BUILDIN(3 ❑ MECHANICAL ❑PLUMBING f I SIGN <br /> �R MAIL�O�RE55 dTY ZIP PHONE <br /> �.h�Y Se�ber `18/9G1�'�ev Cl�c �����'e7f 9�r?C_3 Zs"`�-/,;2C7 � <br /> TEN�NT M�IL�ODRE55 �� Cltt ZIP PHONE <br /> SC+M � <br /> ARCMI7ELTORDESIGNER MAILR�DRESS CITY 21P PMONE <br /> OENERAL CONTR�CiOR M�IL ADORESS CITY ZIP PHONE SiQE UCENSE I <br /> MECHANICAL CONTRAGTOR MI11L�DORESS CITY 21P PNONE S7ATE IICENSE� <br /> J L�r — <br /> PLUMBIN6CONTR�C'OR M�IL�O�RE55 CITV ZIP VIIONE STAiE LICENSE/ <br /> CONT ��TPRICEOFWORN <br /> d , "° -- <br /> DESCRIBE WORK AN�SOU�RE FOOTAGE INVOLVED CONT�CT PERSON ANO PNONE NO. <br /> 'ns � — <br /> i HEREBY CERTIFV THAT I HAVE READ ANO EXAMINED THIS <br /> PflOPOSED USEc uC�ryp APPLICATION AND KNOW 1HE SAME TO BE THUE AND CORRECT.ALL <br /> )� K PROVISIONS OF LAWS AND OPDINANCES GOVERNING THIS TVPE OF <br /> LEO�LDESCHIPTIONOFPflOPER�715NOWNBEIOWORATULHTWOLOPIES� WORK WILL BE COMFiETED WITH WHETHER SPECIFIED HEREIN OF <br /> NOT. THE GRANTIN(i OF A PERMIT DOES NOT PHESUME TO OIVE <br /> �or BLO�:K or AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br /> OTHEF STATE OR LOCAL LAW RE6ULATING CONSTRUCTION OR THE . <br /> PEHFORMANCE OF CONSTRUCTION.THAT I AM AUTHORIZED BY THE � � '� <br /> OWNER OF THIS PROPERTV TO PERFORM THE WORK FOR WHICH <br /> APPLICATION IS MADE AND I COMPLV WITH THE STATE <br /> VARCEL TA%10.NUMBEP CONTRACTORS LAW 18.27 RCW AND 296.200 WAC. <br /> LONSiPUCTION lWN LENDEN,ADDRE55.TELEPHONE NUMBER � /^ , / <br /> x �.[...�'.�"'1 /U -.� - `j`/ <br /> PIIQIECT ADDRE88 saru�un o�rt <br /> —�e - arreuswcss�cExsEw <br /> YLUM�INO MECNANICAL <br /> N0. TYPE OF fl%TUNE OR ITEM FEE NO. TYPE OF EOU�PMENT FEE <br /> WATER CLOSE?(TOILET) � A/C—A'HNDLG UNITS—H.P. � <br /> BATHTUB ; FORCED AIF SYSTEMS—B.T.U. M E.A. ' <br /> LAVATORY(WASH BASIN) � UNIT HEATERS—B.T.U. M � <br /> SHOWER ' CLOTHESDRVERS ' <br /> KITCHEN SINK 8 DISP � VENTILATION FAN � <br /> DISHWASNER � RANGE HOOD ' <br /> UUNDRY TRAV ; WATER HEATER <br /> CLOTHES WASHER � WOOD STOVE � <br /> UHINAL ' METAL FIREPLACE(WOOD BURNINO) ' <br /> DRINKINO FOUNTAIN � FIREPLACE INSERT �_. <br /> FLOOR DRAIN � HEAT PUMP ' <br /> BACKFLOW PREVENTERS � GAS PIP�NO _ <br /> ROOF DRAINS—RAINLEADERS � EXHAUST FAN � <br /> SINK(SERVICE—BAR.ETC.) � <br /> � <br /> � T <br /> � 1 <br /> SUBTQTAL S ' SUBTOTAL S 'OU <br /> PERMIT E PERMIT S /S�OD <br /> TOTAL FEE S ' TOTAL FEE $ 30' 00 <br /> FOR OFFICE USE ONLY: yS 7'3 3 <br /> FNONTSETB�CR RE�RSETB�CR SIDESETBRGK PLANCNECNNUMBFN FEE RECEIPTNO. <br /> USE ZONE LOT�FEA VAGANi SITE FEES VALUATION FEE <br /> : i YES ❑ NO BUILDING <br /> iYPf Of CONSl. NOAP STOFIES oauveNn No d oWtwhG uHrta <br /> taav PLUMBINO <br /> SIZE OF BL00. FIRE SPRINNLERS REOD B�SE6IENT MECHANICAL � <br /> ! 1 YES f� NO � <br /> OLCUPANGVLOAD FIRE�URMREO� NEIGHTLIMI1�ilON ADD�tIONALPLANCMECK � <br /> OTHER i <br /> ---r-- <br /> REA60N � <br /> STAiE BUILDINO SURCHARGE � <br /> INTAKE BY PUIIS FPPROVED BV CITY OF EYENETT PUBLIC WORNS � <br /> LOCALSALES <br /> DATE TAX CODE IS 3105 TOTAL ; <br />