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APPLICATIC�1 FOR CONSTRUCT'"�N PERMIT � <br /> TO BE COMPLETED IN BLACK INK—PLEASE PRINT <br /> BUILDING DEPARTMENT HEATING SYSTEM: ❑GAS ❑ELECTRIC ❑ <br /> 259-8810 <br /> ❑ DEMOLITION ❑ COMBINATION ❑ BUILDING �MECHANICAL ❑PLUMBING ❑ SIGN <br /> OWNER MAILAODFlE55 CITY ZIP PHONE <br /> TENANT MAILADDRESS CITV ZIP PHONE <br /> r-azr�� �A�,� �v�d��e n�n-�►a��v �'v��rr wA <br /> ARGHITECTOBUESIGNER MAILADDRESS LITY ZIP PHONE <br /> � <br /> GENERALCONTRACTOR MAILADDRGSS CITV ZIP PHONE STATELICENSEI <br /> , J'�•�is GRS PD �np�43� Tlsxl►-a A� At9R c/AesG o�?t=p�G.S'fo �T}ntis6AS/(�f/�l <br /> .-� MECHANICALCONTRACTOF MpILA�URESS qTY ZIP PHONE STATELICENSEI <br /> � <br /> PLUMBINGCONTRACTOil MAILAOORE55 CITV ZIP PHONE STATELICENSE� <br /> C{JNTRACT PRICE OF WOflH <br /> S / � <br /> �ESCHIBE WORK AND SOUARE FOOTAGE INVOLVED CONiACT PERSON AND PHONE NO. <br /> N�'W �/� � � � <br /> . I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br /> PPOPOSEDU FBUILOING qPpLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT.ALL <br /> � (��L�/L.Q.N7'� PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br /> LEGALDESCflIPTIONOFPqOPEHTv�SHOWNBELOWORATTACHTWOCOPIES) WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEFEIN OR <br /> NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br /> �or e�ocK aF AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <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 /> PARCEITA%I.�.NUMBEfl CONTflACTORS LAW 18.27 RCW AND 296.200 WAC. <br /> CONSTRUCTION LOAN LENDER,AODflESS.TELEPHONE HUMBEfl <br /> 4 ao� <br /> PRWEC/T1ADDRE H�t e o�re <br /> , �lA♦ i`� � ��,fj�� 'v CIIV USINESSLILENSENO. <br /> _s� <br /> PLUM3ING CHANICAL <br /> NO. TYPE OF F�XTURE OR ITEM FEE 0. TYPE OF EQUIPMENT FEE <br /> j :VATER CLOSET(TOILE� � A/C—A/HNDLG UNITS--H.P. � <br /> BATHTUB ; FORCED A�R SYSTEMS—B.T.U. M E.A. ' <br /> LAVATORY(WASH BASIN) � UNIT HEATERS—B.T.U. M � <br /> SHOWER ' CLOTHESDRYERS � <br /> KITCHEN SINK 8 DISP � VENTILATION FAN ; <br /> DISHWASHER � RANGEHOOD � <br /> LAUNDRYTRAY ; WATERHEATER ' <br /> CLOTHES WASHER � WOODSTOVE � <br /> URINAL ' METAL FIREPLACE(WOOD BURNING) � � <br /> �RINKING FOUNTAIN � FIREPLACE INSERT ; <br /> FLOOR DRAIN � HEAT PUMP � <br /> BACKFLOW PREVENTERS ; GAS PIPING ;_ <br /> ROOF DRAINS—RAINLEADERS � EXHAUST FAN <br /> SINK(SEqVICE--BAR,ETC.) ; � <br /> � � <br /> � � <br /> SUB TOTAL $ ; SUB TOTAL 5 ; <br /> PERMIT $ � PERMIT $ � <br /> TOTAL FEE $ ' TOTAL FEE $ � <br /> FOR OFFICE USE ONLY: <br /> FRONTSET�ACN REAflSETBACN SI�ESETBACN PLANCHECKNl1MBER� FEE RECEIPTNO. <br /> L�.��o/(�� <br /> USE20NE LOTAREA VACANTSITE FEES VALUATION FEE <br /> ❑ YES ❑ NO BUILDIM1G � <br /> i <br /> TYPEOFCONST. NOAFSTOR�ES occUveNtv x0A[mvFwNGUHrtS i � <br /> txouv PLUMBING i <br /> SIZEOFBLDG. FIRESPRINKLERSflEO'D BASEMENT � <br /> MECHANICAL � <br /> ❑ YES ❑ NO � <br /> OCCUPANCV LOAD FIFE ALARM REO'D HEIGHT LIMITATION ADDITIONAL PLAN CHECK � <br /> i <br /> OTHER � <br /> REASON � <br /> , STATE BUILDING SUflCHARGE i <br /> INTPNE BY PLANS APPfiO\'EO BY CITY OF EYEflETT PUBLIC WORKS � <br /> LOCALSALES , <br /> oATE TAX CODE IS 3105 TOTAL ; <br />