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, <br />APPLICATIO.. FOR CONSTRUCTI _,N PERMIT � � <br />TO BE COMPLETED IN BLACK INK—PLEASE PRINT <br />BUILDING DEPARTMENT '— <br />259•8810 <br />I l DEMOLITION i_] COMBINATION <br />��uN�p MAILADDRESJ <br />HEATING SYSTEM: ❑ GAS ❑ ELECTRIC ❑ <br />Cl BUILDING L7MECHANICAL <br />`�TY "" 339- S�/� <br />Fa�- <br />ARCHRECTOFDESIGNER MAILF�OfiESs -"' <br />GENERALCONTPACTOR MAILA�DRESS <br />LITV ?IP PNONE STATE LICENSE � <br />MAIL <br />G+O�NTFACT PR�CE OF WORK � <br />/ O pQca�ta <br />DESCRIBE WORK �ND SOUARE FOOTAGE INVOLVE� <br />PROPOSED USE OF BUI�DING <br />5 r �2 <br />LEG/�L OESCRIPTION OF PROPEriTY �SNOWN BELOW OH ATTALH TWO COPIES) <br />LOT— BLOCK OF <br />P�RCELT�XIO.NUMBER <br />N <br />iINK 8 <br />iER <br />TRAY <br />FOR OFFlCE USE ONLY: <br />FRONTSEiBACK REAR: <br />USE20NE <br />TYPE OL CON51. <br />SIZE OF BLOG. <br />OCCUVANCYI <br />REASON <br />:NTANE BY <br />LOT �flEA <br />FIRE SPHINKLERS REO'D <br />OATE <br />Ej <br />QTV ZIP <br />PHONE <br />LJ <br />LONTACT PERSON AND PNONE NO. <br />Ci SIGN <br />I.-���r��� -� ��°6L36��-�a�o <br />i HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br />APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. AlL <br />PROVISIONS OF LAWS AND ORDINANCES r,OVERNING THIS 7YPE OF <br />NOT. THELGRA T�ING OF A PERMITJDOES NOT PRIE UME TO GI�VE <br />OTHER STATE OR LOCAL LAW EGULATING CONSTRIUCT ON OH THE <br />PERFORMANCE OF CONSTRUCTION. THAT i AM AUTHORIZED BY THE <br />OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br />APP� �CATION IS MADE AND I COMPLY WITH THE STATE <br />CONTFiACTORS LAW 1827 RCW AND 296.200 WAC. <br />HEA! <br />� <br />FAN <br />VAC�NT SITE <br />❑ 1� r N� BUILDING <br />ocav�xtv r�oo�urnuxcux�s <br />eaw° pLUMBING <br />BASEMENT MECHA�lICNL <br />G �ES ❑ NO <br />NEIGNT LIMITATION RDDITIONAL PLAN CHECK <br />OTHER <br />STATE BUILDING SURCHARGE <br />CITY OF EYEHETT PUBLIC WORKS <br />LOCAL SALES <br />TAX CODEIS 3105 Torn� <br />FEE <br />� <br />� <br />d <br />0 <br />� <br />� <br />