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APPLICATIC�'1 F�OR CONSTRUCT"-1N PERMIT , ;� <br />TO BE COMPLETED IN BLACK INK-PLEASE PRINT �n <br />BUILDING DEPARTMENT HEATING SYSTEM: GAS i] ELECTRIC �7 <br />259-8810 <br />i 1 DEMOLITION ❑ COMBINATION I_l BUILDING �MECHANICAL 1 PLUMBING ❑ SIGN <br />�OWNE M/RAp ESS ITV � ZIP PMONE ^���� ���� <br />���Cs \ � �,d3.1[' � �c�ti�1���� 1 f�1 � �, �� � �! <br />TFNANT A�A��ADDRESS CiIY 21P PNON[ <br />ARLHITECT OR <br />MAIL ADORE55 <br />MRIL AODFE55 <br />�ESCRIBE WORN AND SOUARE FOO7RGE INVOLVED <br />T.\ \\-4f1\\ I�ill ll <br />PROPOSED U:'�E OF BUILDING <br />LEGAL DESCRIPTIpN OF PROPI <br />Lpi dLOCK <br />QTV <br />�:in <br />CTv <br />GIIY <br />BELOW OR �TTACH TWO COPIES) <br />— OF <br />PARCEL7A%I.D.NUMBER <br />GONSTPUCiIONLOANLENOER.AD�RESS.TELEPHONE <br />OR ITEM <br />BATHTUB <br />LAVATORY(WASH BA: <br />SHOWER <br />KITCHEN SINK 8 DISP <br />CLOTHES WASHER <br />URINAL <br />DRINKING FOUNTAIN <br />ROOF <br />SINK 1 <br />� TOTAL <br />FOR OFFICE USE ONLY: <br />FRCf1TSETB�CK REARSETBACK <br />I15E ZONE LOT RREF <br />iYPEOfCONSi. NO.OFSTORIES <br />SRE OF 81 DG. FPE SPRINNLERS RW'D <br />OCGUPr1NCV L04D FNE �LARIA FEOD <br />REASON <br />INTAKE BY <br />onre <br />BY <br />ZIP <br />Zlp <br />21P <br />PNONE <br />PMONE <br />PMONE <br />PMONE <br />CONTAGT PERSON AND PNONE N0. <br />STRTE L�GENSE � <br />STqTE IICENSc � <br />STATE LICENSE t <br />i HEREAY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br />APPLIGA�TION AND KNOW THE SAME TO BE TRUE AND CORRE�L ALL <br />PROVISIONS OF LAWS AND OADINANCES GOVERNING THIS TYPE OF <br />WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEflEIN OR <br />NOT. THE G�ANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br />AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br />OTHER STATE OR LOCAL LAW i±EGULATING CONSTRUCTiON OR THE <br />PERFORMANCE OF CON.^,TRUCTION. THAT I AM AUTHORIZED BY �HE <br />OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHi:'H <br />APPLICATION IS MADE AND I COMPLY WITH THE STA�E <br />CONTRACTORS LAW 18.27 RCW AND 296.200 WAC. <br />x�_'tiiJ ��r�!'erka-'�y� 7i�� <br />SqNUURE D�iE <br />FEE N0. TYPE OF EOUIP� <br />A/C—NHNDLG UNITS—H.F <br />� FORCED AIR SYSTEMS-8 <br />i UNIT HEATERS—B.T.U. M <br />� CLOTHES �AYERS <br />VENTIL4TION FAN <br />RANGEHOOD <br />WATER HEATER _ <br />WOOD STOVE <br />. METAL FIREPLACC- IW000 <br />HEAT PUMP <br />GAS PIPING <br />EXHAUSTFAN <br />5 <br />SIOESETBACN PLANCHECKNUMEER FEE <br />VACANT SITE FEES <br />❑ YES i-: NO BUILDNG <br />acu��ucr waoroxhuixr.uwrs <br />c«nuc p�UMBING <br />BASEMENT MECHANICAL <br />;-i YES -1 NO <br />MEIGNTUMIiAiICV ADDITONALPLANCHECK <br />OTHEIi <br />STA1E BUILDING SURCHARGE <br />CITY OF EYERETf PUBLIC WORKS <br />LOCAL'3ALES <br />TAX CODf: IS 3105 roui. <br />M <br />SUB TOTAL S <br />PERMIT $ <br />TOTALFEE $ <br />