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TO BE COMPLETED IN BLACK INK—PLEASE PRINT <br /> BUILDING DEPARTMENT HEATING SYSTEM: ❑GAS �ELECTRIC � <br /> 259•6810 <br /> ; ' DEMOLITION J COMBINATION i I BUILDING �MECHANICAL �PLUMBING i7 SIGN <br /> 0�` '� / MqKqODPE55 PHON;, "/ � <br /> .�7/��0 /LXe�ii.f/�P � .'�7�s ��-119�� .SE J�f�c,ui /` 4'�ofi7 �'Sry 9� 7 <br /> TENRNT �, /1,�pILRnDpflE55 dTY 2f}�i' FHONE <br /> ARCHITEGTOflOESIGNER / M�qppRES����� ���ry �ZIp ��� pHONE <br /> GENERALLONTRACTOR MRILADDRE55 CITV ZIP PHONE STATELICENSE� <br /> MECH�NICALCONTRpCTOR MqILADDRE55 CITV ZIP PHONE STRTELICENSE• <br /> PLOMBINGCdJTR�CTOR M41L DRES CITY ZI PHONE STATEUCENSE/ <br /> E .�/ /.�-� � /� UK 7J�•9 <br /> CONTRAGT PRICE OF WORK ���� ���� <br /> OESCRIBE WORK pND SOUARE FOOTAGE INVOLVED CONTALT PE N A HO E NO <br /> Q�� <br /> �cutn..� J <br /> I HEREBY CERTIFV THAT I HAVE READ AND EXAMINED THIS <br /> PROPOSED USE OF BUILDING APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT.ALL <br /> PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br /> LEGRLDESCRIPTIONOFPqOPERTY�SHOVMBELOWORATTACHTWOCOPIES� WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br /> �or BLOCK oF NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br /> AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANV <br /> OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br /> PERFORMANCE OF CONSTRUCTION.THAT 1 AM AUTHORI2ED BV THE <br /> OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br /> PRRCELTA%ID.NUMBER APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> CONTRACTORS LA 18.27 RCW AND 296.200 WAC. <br /> CONSTRUCTION LORN LENDER.f.DDRE55,TELEPHONE NUMBER <br /> PROJECT ADDF�E '���'' �/��� <br /> /� icw o�ie <br /> / O T��� GfYBU5ME55LRFNS[NO <br /> PLUMBING MECHANICAL <br /> N0. TYPE OF flXTURE OR ITEM FEE NO. TYPE OF EQUIPMENT FEE <br /> WATEfl CLOSET(TOILET) A/C—A/HN�LG UNITS—H.P. , <br /> BATHTUB FORCED AIR SYSTEMS—B.T.U. M E.A. <br /> LAVATORY(WqSH BASIN) � UNIT HEATERS—B.T.U. M ; <br /> SHOWER � CLOTHES DRYERS � <br /> KITCHEN SINK 8 DISP VENTILATION FAN � <br /> DISHWASHER � RANGE HOOD , <br /> LAUNDRYTRAY ' WATER HEATER � <br /> CLOTHES WASHER � WOOD STOVE ; <br /> URINAL ' METAL FIREPLACE(WOOD BURN�NG) <br /> DRINKING FOUNTAIN ; FIREPLACE INSERT <br /> FLOOR DRAIN HEAT PUMP , <br /> BACKFLOW PREVENTERS ; GAS PIPING <br /> ROOF DRAINS—RAINLEADERS � EXHAUST FAN ; <br /> SINK(SERVICE—BAR,ETC.) � <br /> � � <br /> � <br /> � � <br /> SUB TOTAL $ ; SUB TOTAL $ � — <br /> PERMIT $ �(j , PERMIT $ <br /> TOTAL FEE $ ,S — TOTAL FEE $ � � � <br /> FOR OFFICE USE ONLY: � J� <br /> FRONTSETBACK RE�RSET611CK SIDESETBACK PLANCHE KNUMBER FEE RECEIPTNO. <br /> �/(p 7O <br /> USEZONE LOTAREA VACANTSITE FEES VAWATION PEE <br /> ❑ YES ❑ NO BUILDING ' <br /> iYPEOiCONSi. NOAFSTORIES � <br /> OCNMNCY NOMVN[iliN4114115 <br /> �pWP PLUMBING i <br /> i <br /> SIZEOFBLDG. FIflESPRINKLER5RE0'D BASEMENT � <br /> ❑ YES ❑ N� MECHANICAL <br /> OCCUPANCY IOAD FIRE ALAqM REOD HEIGHTLIMITATION ADDITIONAL PLAN CHECK � <br /> REASON OTHER � <br /> � <br /> STATE BUILDING SURCHARGE � <br /> INTAKE BV PLqNS�PPRpVED BV CITY OF EYEHETT PUBLIC WORKS i <br /> LOCAL SALES � <br /> OATE TAII CODE IS 3105 TOTAI ; <br />