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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 f] ELECTRIC ❑ //� <br />259-8810 <br />�► DEMOLITION ❑ COMBINATION ❑ BUILDING ❑ MECHANICAL ❑ PLUMBING ❑ SIGN <br />�i�`�T J,V7'6k5JATc�,�nearsc x S%p�3 � pY ziP PHONE <br />AMIL ADDRESS <br />PIKKJE <br />.i1/oNE <br />�RCHITECTORDESIONF.R IMILADDNESS CITV ZIo PNpNe � <br />�.�� ,✓o kJ.d <br />/6EN+ERALCONTB�CTON MAIUODRESS GTV � ZIP PIiONE iTATF.UCENSE� <br />S�o%DO�A,foEr�c s�io-�39''.%�✓F S•F .S�/eHomi4li U71� SloK-R'711�,�,�LtQf�X�l�,^,_ <br />MECNANICALCONTMCTOR MAILADDRESS CITV ZIP P��(,y�E STATE4C'NS_1 <br />CO`RIiAC I PIiICE OF WOPK <br />oF Bunnn+a <br />l.OT1�L.m— BLO�K � OF <br />Y.—'—�. !l - - ` ' �� ^ �� <br />PARCEL TA%I.D. NUMBER • <br />ya�i -��a-�oi - <br />CONSTRlICT10N LOAN LENDEF.11DD11E55� <br />LAVATORV <br />KITCHEN SINK 8 <br />DISHWASHER <br />CLOTHES WASHER <br />URINAL <br />FLOOR DRAIN <br />BACKFLOW PREVENTERS <br />SINK <br />FOR OFFlCE USE ONLY: <br />U5EZONE <br />TYPE OF CONST. <br />BV <br />PERMIT <br />TOTAL FEE <br />LOT AREA <br />NO.OF STORIES <br />FIRE SPflINKLERS HEO'D <br />FIPE �V.ARM PE�'0 <br />PlANS �PPROVED BY <br />D�TE <br />CITY <br />FEE <br />SIDE SETBACK <br />V�C�NT SITE <br />❑ YES ❑ NO <br />aeurµer rro.aoweuixcuxrts <br />GRWP <br />BMSEMENT <br />❑ YES ❑ �O <br />HEIGHT LIMITATION <br />CITY OF EYENETT <br />LOCAL SALES <br />TAX CODE IS 3105 <br />.�. "—."'_"_'""'._..___. ___ <br />ZIP PHON_ ,i6T�UrF!lii:• <br />PERSON <br />� HEREBY CERTIFY THAT I HAVE READ AND ExAMINED THIS <br />APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br />WORK WILL BE COMPLETEO WITH WHETHER SPECIFIED HEREIN OR <br />NOT. THE GRANTING OF A PERMIT DOES NOT PpESUME TO GIVE <br />AUTHORITY TO VIOLATE OH CqNCEI THE PROVISIONS OF ANV <br />OTHER STATE OR LOCAL I^�: pEIiULATING CONSTRUCTION OR THE <br />PERFORMANCE OF CO�.STRUCTION. THAT I AM AUTHOFi12ED BY THE <br />OWNER OF THIS PR(:PEflTY TO ?ERFORM THE WORK FOR WHICH <br />APPLICATION IS M DE ANO I COMPLY WITH THE STATE <br />CONTqACTORF U1 827 RCVi AND 296.200 WAC. <br />���"� �/, /� <br />� h <br />s <br />cmeUSwEBsICFrsErq. <br />..I�.�� i �'1 � 3.: i �'.illi..�I3:i� �� <br />FORCED AIH SYSTEM�-B.T.U. M E.A. <br />UNIT HEATERS--B.T.U. M <br />CLOTHES DRYERS <br />RANGEHOOD <br />WATER HEATE <br />METAL FIREPLACE <br />FIREPLACE INSER' <br />GAS PIPING <br />EXHAUST F� <br />TOTAL FEE S <br />PLANCXEQ�//�R .I FEE <br />Y <br />BUILDING i <br />i <br />PLUMBING � <br />i <br />MECHANICAL � <br />i <br />ADDITIONAL PLAN CHECK � <br />Oi4ER � <br />i <br />STATE BUIL�ING SURCHARuE i <br />i <br />PUBLIC WORNS � <br />TOTAL i <br />