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� <br /> APPLICATION rOR CONSTRUCTIC J PERMIT � <br /> TO BE COMPLETED IN l3LACK INK�LEASE PRINT <br /> BUILD�NG DEPARTMENT HEATING SYSTEM: GAS ❑ELECTRIC ❑ <br /> 259-8810 <br /> I 1 DEMOLITION I_I COMBINA710N BUI!DING !MECHANICAL �PLUMBING SIGN <br /> �E9 MIIRADDRE55 LITV ZIP PHONE <br /> J� _`�,�,r�-���,,,�. �p-� c-,rR FrcnGrt� 5'82,01 �,S`� —a�sl�_ <br /> TE—N/TT M�ILADDRESS CITV ZIP P�pryE <br /> ARCMITECTORDESIGNER MAIIMORESS CITY Zlp pHpNE <br /> GENEflALCONiR�CTOR AIAILADDRESS CITY ZIP PMONE STATELICENSE� <br /> MECNANICµCONTRACTOR M�K�DOHE55 CITV ZIP PHO�'c ST�TELICENSE• <br /> PLUMBMaCANTA�1C^tt�fl MAILADDRES$ CITY ZIP PHONE STATELICENSE• <br /> � YI� <br /> CUSS OF WORN <br /> I�_l NEW f i ADDITION I I ALTERATION � 1 REPAIR I I DEMOLITION I-i WOODSTOVE/FRPLINSERT i. I BUILDINGRELOCATION <br /> CONT�CT PERSON AND PMONE NO. <br /> CONTMCT PRICE OF WO/iK <br /> DESCR6E WONK AND SOUIIFE FOOTAGE ttNOLVEO <br /> PpOPOSEDUSEOFBUI�DMG � HEREBV CERTIFY THAT I HAVE READ AND E%AMINED THIS <br /> � �1 � � APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT.ALL <br /> � LEdLL DESCRIPTqN OF PROPERTV� BELOW'9 ATT�CN F q pOP1ES� PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br /> . � �1 WORK WILL BE COMPLETED WITH WHETHtR SPECIFIED HEREIN OR <br /> �or etocic .y32 oF � NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br /> ' AUThORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br /> � OTHER STATE OR LOCAL LAW REGUUITING CONSTRUCTION 09 THE <br /> PERFORMANCE OF CONSTRUCTIGN.THAT I AM AUTHORIZED BY THE <br /> �� OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br /> �� APPLICATION IS MADE AND I COMPL� WITH THE STATE <br /> ' CONTRACTOAS UW iB.27 RCW AND 296200 WAC. <br /> ��� PROJECT ADDAE$$ �aH Un ���� � <br /> o�h <br /> CITV OUSMES4lICENSE NO <br /> . PLUMBMKi MECMAfNCAL <br /> , N0. TIPE OF FlXTURE OR ITEM FEE NO. TYPE OF EQUIPMENT fEE <br /> �� WATER CLOSET(TOILET) � NC—AMNDLG UNITS—H.P. � <br /> ' BATHTUB ; FORCED AIR SYSTEMS--B.T.U. M E.A. � <br /> �, LAVATORY(WASH BASM) � UNIT HEATERS--B.tU. M ; <br /> � SHOWER � CLOTHES DRYERS � <br /> � i <br /> ' KITCHEN SINK 8 DISP ; VENTILATION FAN ; <br /> DISHWASHER � RAN6E HOOD � <br /> LAUNDRYTRAY ; WATER HEATER � <br /> , CLOTHES WASHER WOOD STOVE ; <br /> URINAL � METAL FIREPLACE 8 CHIMNEY � <br /> DRINKING FOUNTAIN ; FIREPLACE INSERT ; <br /> ' FLOOR DRAIN � HEAT f'UMP � <br /> � <br /> BACKFLOW PREVENTERS ; GAS PIPING ; <br /> ROOF ORAINS--RAINLEADERS � EXHAUST FAN <br /> SINK(SEHVICE—BAR,ETC.) ; � <br /> � � � <br /> � , <br /> � � <br /> SUB TOTAL $ ; SUB TOTAL S ' <br /> PERMIT E � PERMIT S � <br /> TOTAL FEE E ' TOTAL FEE S ' <br /> FOR OFflCE USE ONLY: <br /> FRONTSETB�CK REARSETB�CK SIDESETBRCK PLRNCNECNNUMBE FEE RECBpTNO. <br /> USEZONE LOTARE� J�CANTSITE FEES VALUATION FEE <br /> BUILDING <br /> 1VPE Of CONTS.�I IOWABLE ME OF LONSi.�CTUAL OccUr�N[r HO a�mv[u�NG UNns i <br /> GRO�° � PLUMBING ' <br /> SIZEOFBLDG. NO.OFSTORIES BnSEMENT MECHANICAL � <br /> OCCUPANCYLO�O FIRESPRNKLERSFEO'[1 MEIGHTLIMITATION A�DITIONALPLANCHECK � <br /> � <br /> SPRINKLER � <br /> i <br /> REASON FOR SPRINKlERS <br /> STATE BUILDING SURCHARGE i <br /> INTAIfE BV PLANS APPROVED BY CITY OF EYEHETT PUBLIC WORKS � <br /> LOCAL SALES - � <br /> TA)I CODE IS 3105 TOTAL � <br />