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�y � APPLICATIG�] FOR CONSTRUCT'"�N PERMIT <br />TO BE COMPLETED IN BLACK IPlK—PLEASE PRINT ��� <br />HEATING SYSTEM: ❑ GAS ❑ ELECTRIC ❑ <br />BUILDING GEPARTMENT <br />259-8810 �� <br />❑ DEMOLITION CI COMBINATION I�HUILDING I i MECHANICAL ❑ PLUMBING U SlGN <br />O�n i.:i 41AILADDFESS CITV ZIP PHONE <br />/�%%� <br />�� <br />IENANT MAILAD�RE55 ' ' CIT1" 21P PHONE <br />S1f i�Gt2-� /� 35vo S rNt.�, d..,..-, o T��( �Lq ��tz� 3 848 -o�L! _ <br />ARCHITECT OR DESIGNER MAIL pODRESS CITV ZIP PHONE <br />pEsiv,.> T�c�� _� "35�78 �%►��x.�� ScJ �rn-,rnr.�,�„av -�i8az3 �'1Z7—�339 <br />GENEFhL GONTHACTOR MAIL AODRESS CITV IP PHONE STATE LICENSE t <br />J�ot�r�i:� �r ri /9.�SG"�ox�.✓u da� rfl�«��i2 �lfi/-I����i21�s t-r-r �Lz/��5 <br />MECHANICALCONTPALTOR MAILADDRE55 CIiY 21P PHONE STATELICENSEI � <br />PLUMBINGCIXJTRACTOR MAILADDFiESS <br />CITY ZIP <br />STATE LICENSE;1 <br />GLASS OF WOPK <br />❑ NEW ❑ ADDITION ❑ ALTERATION LI REPAIR CI DEMOLIT!QN ❑ WOODSTOVE/FRPL INSERT L1 BUILDING RELOCATIC.V <br />I CONTACT PERSON ANO PHOIIE NO. . <br />CONTRACT PRICE OF WOflK <br />OESCRI3E WORK AND SOUa <br />Tr��,:, � T�� <br />G <br />LEGAL DESCRIPTIf1N OF P PI <br />LOT BLOCN <br />PRWECTADDRE55 <br />� ��l7i _ <br />PLUMBING <br />E INVOLVED <br />f <br />OF <br />FIXTUREORITEM I FEE <br />BATHTUB <br />LAVATOfiY (WASH BA; <br />SHOWER <br />KITCHEN SINK & DISP <br />11,UNDRY TRAY <br />CI.OTHES WASHER <br />DRINKING FOUNTAI� <br />FLOOR DRAIN <br />ROOF <br />SINK ( <br />FOR OFFICE USE ONLY: <br />FFONTSETBACK PEARSETBACN <br />USEZONE <br />TYPE OFq C�O�NTS�. ALLOWABIE <br />..IF-1 V <br />SIZE OF BLDG. <br />pC�:CV LtOAD <br />3 (o <br />F'cA$ON FOR SPRINNLEf <br />� <br />INTANE BY <br />AREA <br />SUB70TAL $ <br />PERMIT $ <br />TOTAL rEE $ <br />SIDE SET6AC <br />Vl.CANT SITE <br />iYPE OF CONST. ACTIIRI <br />]L N <br />NO. OF STOPIES <br />FIRE SPflN'LERS REO'D <br />4�� <br />� I�ib-Gt� gt <br />PLANS APPROVEO BY <br />/�/'L JM <br />q87 -U34 z <br />I HEREBY CERTIFY THAT I HAVE AEAD AND EXAMINED THIS <br />APPLICATION AND KNOW THE SAME TO EE TRUE AND CORRECT. ALL <br />PROVISIONS OF LAWS AND ORDINANCES G�DVERNINC.� THIS TYPE UF <br />WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br />NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br />AUTHORITY TO VIOLATE OR CANCEL TtIE PROVISIONS OF ANY <br />OTHER STATE OR LOCAL LAW REGULATINC. CONSTRUCTION OR THE <br />PERFORMANCE OF CONSTRUCTION. THAT � 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 />CONTRACT 1827 RCW AND 296.200 WAC. <br />�— lo z7-� � <br />SIGNATURE oare <br />3Z°``,f�L <br />qTY BOSMESS UGEHSE N0. <br />MECHANICAL <br />NO. TYPE OF EOUIPMEMT <br />� A/�A/HNDLG UNITS—H.P. <br />'� FORCED AIR SYSTEMS—B.T.U. M E.A. <br />� UNIT HEATER�B.T.U. M <br />� CLOTHES DRYEFiS <br />; VENTILATION FAN <br />� RANGEHOOD <br />; WATER HEATER <br />� WOOD STOVE <br />; METAL FIREPLACE 8 CHIMN <br />� FIREPLACE INSERT <br />� HEAT PUMP <br />; GAS PIPING <br />� EXHAUST F <br />NO OF UWEILING UNItS <br />HEIGH�IMITAiION <br />CITY OF EYEflETT <br />LOCALSALES <br />TAX CODE IS 3105 <br />SUB TOTAL $ <br />PERMIT $ <br />TOTALFEE $ <br />P'L7AN CHECK pN�UMBER q F'cE flECEIPT N0. <br />lJ � O ��/ �� <br />BUILDING <br />PLUMBING <br />MECHANICAL <br />ABD4LGAWIPLANCHECK <br />SPRINKLER <br />STATE BUILDING SURCHARGE <br />FUELIC NbRViS <br />TOTAL <br />�� 9 ' <br />,00 <br />i <br />i <br />i <br />i <br />� <br />i <br />a� <br />; <br />T <br />y ,� <br />i <br />i <br />i <br />� <br />T <br />�/� i 3� <br />