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APPLICATIO' FOR CONSTRUCTt^N PERMIT � <br /> TO BE COMPLETEU IN BLACK INK-PLEASE PRINT <br /> � HEATING SYSTEM: ❑GAS ❑ELECTRIC O <br /> BUILDING DEPARTMENT '- <br /> 259-8810 <br /> ❑ DEMOLITION ❑ COMBINATION I � BUILDING f.,MECHANICAL ❑PLUMBING ❑ SIGN <br /> M�IL�DDRE55 riTY z�P P�`E <br /> �-va+v � SO�G/1y /�� -u�tNf F3D7NLZL 9po,� YPe es90 _ <br /> 7EN�NT �IL�ODRE55 CITV ZIP PMONE <br /> �RCHITECTORDESIGNEN M�RfODRE55 CITV 21P PIqNE <br /> GENERALCONTPA6iOR 1AA�L�DDRE55 CITY ZIP PMONE ST�TEUCENSEI <br /> MECNANICQCONTRIICTOR M�ILAODRE55 GITY 21P PHONE STATELICENSEI <br /> PWMBIN6GGNTRAGTOR MI1IL/�DURESS CITY 21P P�E STAiELICENSE/ <br /> CONTMCT PRICE Of N'�i1N <br /> DESCRIBE VKJi1K�ND SOU�AE FOOT�GE INCOLVED GONUCT PERSON AND PHONE NO. <br /> I HERFBV CERTIPY THAT I HAVE flEAD AND E%AMINED THIS <br /> rrroroseo use ov ew�oirvo APPLICATION AND KNOW THE SAME TO BE TRUE AND GORFECT.ALL <br /> S'`'2 PROVISIONS OF LAWS AND ORDIN4NCES GOVERNINQ THIS TVPE OF <br /> LEMlUESCRIPTIONOFPROPERTVISMOWHBEIOWOHATTl1CHiWOLOPIE51 WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br /> NOT. THE GRANTIN6 OF A PERMIT �OES NOT PflESUME TO (�IVE <br /> �ot BIOCN oc AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br /> OTIIER STATE OR LOCAL LAW REGULATING CONSTRUCTION OH THE <br /> PERFORMANCE OF CONSTRUCTION.THAT I AM AUTHORIZED BY THE <br /> OWNER OF IS PROPERTY TO PERFOHt�A THE WORK FOR WhICH <br /> APPLIC ON IS MADE ND I COMPLY WITH TIiE STATE <br /> PARLEL T�%�D.NUMBER CONTR CTO LAW 1827 W A 98200 WAC. <br /> CONSTRUCTION LO�N IENDER.ADDRES5.1ElEPNJNE NUMBER � ��� <br /> rnaecr�ppqess ° "�` — �"" <br /> �IXp ��� S� c�rveusmcssi�ENu�n . <br /> d <br /> ��� MECHANICAL <br /> ►p, TVPE OF FI%TURE OR ITEM FEE NO. TVPE OF EDUIPGENT �t <br /> WATER CLOSET(TOILEn � A/(rA�'HNDL4 UNITS-H.P. <br /> BATHTUB ' FORCED AIR SVSTEMS-B.iU. M E.A. <br /> UVATOFV(WASH BASIN) UNIT HEATERS-B.T.U. M � <br /> SHOWER _� CLO'fHESORVERS � <br /> KITCHEN SINK 8 DISP I VENTILATION FAN � <br /> pANCiE HOOD ' <br /> DISHWASHER — — WATER HEAIER � <br /> LAUNDHY TRAV � � <br /> CLOTHES WASHER � WOOD STOVE ' <br /> � METAI.FIREPLACE(WOOD BURNIN6) ' <br /> URINAL � <br /> DRINKING FOUNTAIN � FIREPLACE INSERT � <br /> FLOOR DRAIN � HEAT PUMP _ <br /> � <br /> - GAS PIPING � <br /> BACKFLOW PREVENTERS � <br /> ROOF DRAINS-RAINLEADERS � E%HAUST FAN ' <br /> -- —�— <br /> SINK(SERVICE-BAH,ETC.) � - � <br /> � I T <br /> I ! <br /> I <br /> i �—T <br /> _ i <br /> SUB TOTAL $ <br /> SUBTOTAL S ' <br /> PERMIT E � __ PERMIT S -� <br /> TOTAL FEE S TOTAL FEE S ' <br /> FOR OFflCE U8E ONLY: RECEioT ra. <br /> FRONT SETBACN REAH 6ETBALN SIDE SkTB�GN PUM CHECJc,1�I1HBEiJ� FEE —. <br /> /� 7,OT <br /> VALUATION fEE <br /> USE 20NE LOT�RE� V�CAN7 SITE FEES ' <br /> i l YES i7 NO BUILDINO � _ <br /> ����� 1tO.OFSTORIES acuwMr rroaorrtii�xcuxn: — ' <br /> i <br /> �"a'" PWIABINO ' _ <br /> gITEp'BL00 FIRESPRINNlER5RE0'D B�SEMENT MECNANICAL � _ � <br /> ❑ ves n No ; <br /> �ODITIONRL PUN CNECK ' <br /> OCWV/�NCVIOAD FIPEAIAHMREOD HEIOHTUMIT�TION � <br /> OTHEH � — <br /> _ i <br /> RE�� STA7E BUILDING SURCHAR�E ' <br /> INT�I(E BV PI�NS�PPROVED BV CITY OF EYEHETT PUBLIC WORKS � <br /> LOCAL SALES <br /> o�,E TAl(CODE IS 3105 TaT�� <br />