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APPLICATiCI�I FOR CONSTRUCT''1N <br />TO BE COMPLETED IN BLACK INK—PLEASE PRINT <br />BUILDING DEPARTMENT � HEATING SYSTEM: ❑ GAS O ELECTRIC ❑���� I <br />259-8810 <br />❑ DEMOLITION ❑ COMBINATION �LDING ❑ MECFIANICAL ❑ PLUMBINQ ❑ SiC:N <br />�Ep MAILADORE55 r.m 2iP cww� ' <br />G'T�e�ff'.rcl�aCiww/7, /�o �i►�..ha►t;e.✓ �l ar'r/�'ltc 9�/09 . ..V ... Z�'�6 —28'f—GY/� <br />�ENEMLCONTlUGTOR�ILADD�i$$ CRY ZIP � PHI,Wc STATELILElLSE• <br />AACT(M MAIL ADDHESS <br />��� <br />:�oFNon !� 3� � S�% <br />. O'O' <br />�(IIHDSOU EFOOTA�f RVOWED <br />L�ldi' /ve <br />� �'/�sJ'Jf'� lli►e <br />��` 1�t`�° 5°.Ft. <br />oFeuao�o . <br />an <br />�,, u_ oes/cnirraN� vnoremr �s�(ovm ee�ow on ��Ti 1wo a' <br />�o�—�— e�aac �— oF ,�L�.� <br />�'r.E�ie� ?�,di��� <br />���'7/- G7? - O�7 .. . oo a� <br />BATHTUB <br />KITCHEN SINK 8 DISP <br />DISHWASHER <br />LAUNDRYTpAY <br />CIOTHES WASHER <br />URINAL <br />DRINKING FOUNTAIN <br />ROI,F <br />FOR OFFlCE USE ONLY: <br />FqONTSEIB/�CK REMSETBACK <br />USEZOHE <br />i <br />� TYffOFCONSr. <br />� �q�oPr <br />$I�/�e% <br />� occuP � Lf <br />N p <br />REASON <br />} INTANE BV <br />TOTAL <br />NO.OF STOflIES <br />FIHE SPPINNLERS REO'0 <br />No <br />OATE <br />9 <br />BV <br />FEE <br />a <br />21P <br />CONTACT <br />5TATE LICENSE 1 <br />I HEREBY CERTIFY THAT I HAVE REAU AND EXAMINED THIS <br />APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />PROVISIONS OF LAWS AND JRDINANCES QOVERNINCi THIS TVPE OF <br />WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEHEIN OR <br />NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO OIVE <br />AUTHORITV TO VIOLATE OR CANCEL THE- PROVISIONS OF ANY <br />OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OP THE <br />PERFORMANCE C� CONSTfiUCTION. THAT I AM AUTHORIZED BY THE <br />OWNER OF THI> PROPERTY TO PERFORM THE WORK FOR WHICH <br />APPLICATION IS MADE AND I COMPLV WITH THE STATE <br />CONTFACTORS LAW 1827 RCW 96 200 WAC. /. <br />Ss'�� rYl��stJ!' �r� <br />�vf �r�i�ift�i. /� <br />e o � ' <br />FORCEDAIRSYSTEM�B.T.U. M E.A. <br />UNIT HEATERS--B.T.U. M <br />CLOTHES DRYERS <br />VENTILATION FAN <br />RANGEHOOD <br />WATER HEATER <br />WOOD STOVE <br />METAL FIREPLACE (WOOD BURNING) <br />FIREPLACE INSERT <br />HEAT PUMP <br />GAS PIPING <br />SIUESc'TBACK PUNCHECNNUMBEfl _� FEE <br />�ia n <br />VACANT SITE FEE$ <br />❑ YES ❑ NO Bui�olNo <br />au;vu�cr ra.amnunwimits <br />�p�P PLUMBING <br />BASEMENT MECHANICAL <br />❑ VES CR'NO <br />HEN3HTUMIT�TION ADDIT'�NALPLANCHECK <br />OTHER <br />STATE BUILDING SURCHARGE <br />CITY OF EYERETf PUBLIC WORKS <br />LOCAL SALES <br />TAX CODE 18 3105 ror�� <br />PERMIT S <br />TOTAL FEE $ <br />FECEIPTNO. <br />