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APPLICATI�''Y FOR CONSTRUC7'�7N PERMIT � <br />TO BE COMPLETED IN BLACK INK—PLEASE PRINT <br />BUILDING DEPARTMENT HEATING SYSTEM: ❑ GAS ❑ ELECTRIC ❑ � <br />259-8810 � <br />❑ DEMOLITION ❑ COMBINATION 47 BUILDING ❑ MECHANICAL ❑ PLUMBING ❑ SION <br />OYY/ER MAILMONE55 CITV ZIP PHONE <br />7EWWT IMLAOd1E38 CITY ZIP VINXIE <br />�U D � z_�t_ikc-K �Ar n��E. <br />u�rrecronoE�a,� nuw�uoness cm nr riar+e <br />✓ <br />ae�nw-Tn croa wa �ooness cm nr r�e sr�h ��cer+se � <br />ow�J � Ca,nnn+s LbyrlAaw.Mtl3coG.5 tbs'?.� Ii.w 49 L+Xna�/uia,n r✓a 460 37 7'/�Js55� To`•�N�PPQBq, <br />�cwwirxcarm�c�ioa ' ►u��ooness cm nr rxor+e sr�re��ctnse� <br />r�uierq <br />I I. / " <br />. �. <br />`�[_. <br />i <br />II �u�� rNt i.o. Nw <br />r►� �s <br />�„�� <br />INYOLVED <br />5T/N I <br />F� <br />Q� <br />i1NK 8 DISP <br />iER <br />TRAY <br />URIIIAL <br />DRNKMq FOUNTAIN <br />FLOOR DRAIN <br />BACKFLOW PREVEM <br />FOR OFFICE USE ONLY: <br />morrtsera�ac n�w: <br />imEaoam. <br />( S� OF BLDO. <br />pCqJPANCY U <br />I <br />REABON <br />i <br />� INTIINE BY <br />cm <br />0 <br />� <br />i HEiiEBY CERTIFY THAT I HAVE READ AND EXAMINED THtS <br />APPLICATION AND KNOW iHE SAME TO BE TRUE AND CORRECT. AU <br />PROVISIONS OF UWS AND ORDINANCES OOVERNINfi THIS TVPE GF <br />Twocav�si WORK WILL BE COMPLETED YVITN WHE7HER SPECIFlED HEREI": OR <br />NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO OIVE <br />AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANV <br />OTHER STATE OR LOCAL LAW REODUTINO CONSTRUCTION OR iHE <br />PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORRED BY THE <br />ONMER OF THIS ^FOPERTY TO PERFORM THE WORK FOR WHICH <br />APPLICATION IS MAOE AND I COMPLY WITH THE STATE <br />CONTRACTORS lAW 7827 RCW AND 298200 WAC. <br />FORCED AIR SYSTEMS--B. <br />UNIT HEATERS--B.T.U. M <br />CLOTHES ORVERS <br />VENTIUTION FAN <br />RANGEHOOD <br />WATER HEATER <br />WOODSTOVE <br />METAL FIFEPLACE (WOOD <br />FIREPLACE INSERT <br />HEATPUMP <br />GAS PIPING <br />EXHAUSTFAN <br />im,�q v�cu+rsitE rew <br />❑ VES � � BUILDING <br />ra.ossron�s oawr+c+ waowcuMcunn <br />�° PLUMBING <br />FInE6P1iwKLER5RE0'D b�SENEM MECHkNICAL <br />❑ YES 'J NO <br />FmEUAtWREO'D HEqNiLIMI7AT�ON ADDITIONALPLANCHECK <br />OTHER <br />STATE BUILDIN6 SURCHARGE <br />vur�s,wvrroveo er CITY OF EYENEIT PUBLIC WOfiNS <br />� LOCAL EALES <br />w,� ��, TA1( CODE IS 9105 TOTAL <br />FEE <br />d �3- <br />tl <br />' �D <br />