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APPLICATI("Y FOR CONS'CRUCT""�N PERMIT � <br />TO BE COMPLETED IN BLACK INK--PLEASE PRINT <br />HEATING SYSTEM: ❑ GAS ❑ ELECTRIC ❑ <br />BUILDING DEPARTMENT <br />259•8810 <br />O DEMOLITION ❑ COMBINATION ❑ BUILDING ❑ MECHANICAL ❑ PLUMBING ❑ SIGN <br />OWNER MAILAqD� SS CITY 21P P NE <br />1-1 'e•k� �.•�w.L^�••,ct 31oC`1h�A�e1�E- C�r `l�?o �3`f —Z1�`� <br />TENANi .A��LAD�BE55 GITY ZIP PHONE <br />SF.+��- pt h�OvA <br />AFCNRECTORDESIGNER IMI�nCDHESS CITY ZIP PNONE <br />GENERALClX1TRRCTOR MAILADDflESS QTV ZIP PHOHE STATEIICENSE• <br />S�.a ws Qbo� c <br />MECH/J11CAL40NTRACTON MAILnODRE55 CfTV ZIP PMONE SiATEUCENSE� <br />PLUMBING CONTPACTOF <br />LONTFACT PRIGE OF WORK <br />DCSCNIBE WORK �ND SWPRE FOOi�GE �NVMVE� <br />PROPOSED USE OF BURDING <br />IEGAt DESCNIPTION OF PROPERTV (SHONt! BELOW OR �TTACH TWO COPIES) <br />LOT BLOLK OF — <br />PA^CELTA%LD.NUMBER <br />COMSTRUCTqN LWN lENOEF. ��DRE55. <br />N0. <br />WATER CLOSET(TOIL <br />9ATHTUP <br />LAVATORY' (WASH iiA; <br />SHOWER <br />KITCHEN SINK 8 DISP <br />DISHWASHER <br />LAUNDRYTRAY <br />CIOTHES WASHER <br />ORINKING FOUNTAIN <br />FLOOR DRAIN <br />PACKFLOW PREVENTERS <br />ROOF LrtAINS--RAINLFAC <br />SINK (SERVICE—BAH. ETC <br />FOR QFFICE USE OWLY: <br />FPONTSETBACN FERRSETBnGK <br />USE20N� IOTAREA <br />TVPE Of CON51 <br />SRE OF BIOG. <br />REASON <br />INiAKE BY <br />NUNBER <br />SUB TOTAL 3 <br />PEAMIT S <br />TOTAL FEE $ <br />N0. OF STORIES <br />FIRE SPRINKLERS REO'D <br />FIRE RLARM REO D <br />PUNS APPROVED Bv <br />onre <br />CITY ZIP <br />FEE <br />PHONE STATELICENSE� <br />CONTRCT PERSON AND PMDNE NO. <br />i HEflEBY CEflTIFY THAT I H0.VE READ AND EXAMINED THIS <br />APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />PROVISIONS OF LAWS AND ORDINANCES GOVERNIN� THIS TYPE OF <br />WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br />NUT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br />AUTHORITY TO VIULATE OR CANCEL THE FROVISIONS OF ANY <br />OTHER STATE OR LOCAI LAW REGULATING CONSTRUCTION OR THE <br />PERFORMANCE OF CONSTRUCTION. THAT 1 AM AUTHORIZED BY THE <br />OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br />APPUGATION IS MADE AND I COMPLV WITH TH' STATE <br />CONTRACTORS LAW 18.27 RCW AND 296200 WAC. <br />` �/j � (�/N� �I ��/�%/ <br />6iGHI.IUBE O�TE � � <br />GIiY BOSnI[SS l ICENSE N0. <br />MECMANICAL <br />N0. TYPE OF EOUIPMENT FEE <br />A/�A/HNDLG UNITS—H P. � <br />FORC�D AIR SYSTEMS—B.T.U. M E.A. <br />UNIT HEATERS—B.T.U. M � <br />T <br />CLOTHES DRYERS ' <br />VENTILATION FAN ; <br />WATER�IEATER <br />WOOD STOVE <br />METAL FIREPLACE i <br />FIREPLACE IP'SERT <br />HEAT PUMP <br />GAS PIPING <br />E%HAUSTFAN <br />SI�ESETBRCK PLANCHECKNVMBEP FEE <br />�iy�/ <br />VACANT SI7E FEES <br />❑ YES ❑ NO BUILDING <br />OCN>WCY NOIXVMLL�NGONIIS <br />�"ppP PWMBING <br />BeSEMEnr MECHANICAL <br />❑ YES ❑ NO <br />HEIGHT LIMITATION A�DITIONAI PLAN CNECK <br />_ OTHER <br />STATE BUIIDING SURCHARGE <br />CITY OF EYE:�ETT PUBLIC WORKS <br />LOCAL SALES <br />TAX GOUEIS 3105 TOTAI. <br />SUB TOTAL $ <br />PERMIT 5 <br />TOTAL FEE $ <br />