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A <br />APPLICATIC'1 FOR CONSTRUCT'J1N PERMIT � <br />TO BE COMPLETED IN BLACK INK—PLEASE PRINT <br />I HEATING SYSTEM: U GAS �ELECTRIC ❑ _ � <br />BUILDING DEPARTMENT <br />259•8810 <br />I] DEMOLITION Cl COMBINATION i I BUILDING L 1 MECHANICAL CI PLUMBING f i SIGN <br />OWNEP MAI A ESS CITY 21P PMONE <br />RAL'PN "BLac.KN01� 730 URAND AVC. �/L'2�7'T- WR �i02U1 Z$�-Oy�I�% <br />TENANT <br />MAIL <br />CITY ZIP PMONE <br />r���„j,�j�p,� � _��G!{E�H/�K..CONST2�-I�GTict�l _.._ <br />`� <br />GENEPALCONTRACTOR MAILADDRESS CITY ZIP • PHONE STATELICENSE+1 <br />C�eMAiC C.nNST• I N Cr. `7'5 2� Or.YMi�i c_ V i�rl"I�2. gtQ .G EDhlo 1� . I�IA � 26 <br />MECNRNICALCONTflACTOR MAILADDRE55 .� CITY ZIP PHONE 5�y E E� <br />"AiCK�loWARA!SoN`�blF�• fv�o23-21� SW •L�/NNNK�;a `TSo�%3lDI�l�N<�C;%GRu U lIONI�I <br />'LUMBING CONTRACTOR MRIL PODRESS <br />�,-r�s—Pwm��►yc� t�F5: <br />CONTRACT PRIC�F WORN � <br />a_ ; <br />DESCRIBE WORK AND SOUARE FOOTAGE INVpLVEI <br />'� �I�--�2�1"�-'� <br />��011�lr '� <br />� �, <br />PqOPO'SEvD JUSE OCF BUILDING <br />��..(� � � <br />L�GA� DESCRIPTION OF PROPEPTY <br />LOT BLOCK — <br />21P PHONE STATE LICENSE t <br />� ...i .���a.• ._�l �J�_ �.�r A�wr� <br />CON. ACT PERS( �N AND PMONE NO. <br />� <br />� , � � <br />BELOW OR ATTACH T40 COPIES� <br />— OF <br />PARLEL TA%I.D. Nl1MBER <br />1a2�o5- t- cao� - <br />CONSTRUCTION LO�N LENDER. A�DPESS. TELEPH <br />;Ll <br />WATER CLOSET (TOILI <br />BATHTUB <br />LAVATORY�WASH BA� <br />SHOWER <br />KITCHEN SINK & DISP <br />DISHWASHER <br />LAUNDRYTRAY <br />CLOTHES WASHER <br />URINAL <br />DRINKING FOUNTAIN <br />FLOOR DRAIN <br />ROOF <br />OR <br />FOR OFFICE USE ONLY: <br />FRONf SETB— RCN � REAR SF�j�C� <br />uir G <br />USEZ E � LOTARcA <br />� � <br />rvx n[ cnust NO. OF STORIES <br />SiZE OF <br />INTANE <br />NUMBER <br />0 <br />TOTAL $ <br />FIPE SPRINNLEFiS REO'D <br />FIRE AL��EO➢ <br />N� <br />PlANSAP R�EDBV <br />DpTE /, � � /Ra� <br />SIDE <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 GOVERNING THIS TYPE OF <br />WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br />NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO G�VE <br />AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br />OTHER STATE ('9 LOCAL LAW REGULATING CONSTflUCTION OR THE <br />PERFORMANC'_ OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br />OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br />APPLICAT.JN IS MADE AND I COMPLY WITH THE STATE <br />CONTRACTOR i LAW 1827 RCW AND 296.200 WAC. <br />� , n .„ ,I � _ � � � <br />NO. <br />PI.RN <br />NC—NHNDLG UNITS—i� � <br />FORCED AIR SYSTEMS—B.1.U. M E.A. <br />UNIT HEATEPS—B.T.U. M <br />CLOTHES DRYERS <br />VENT�LATION FAN <br />RANGEHOOD <br />WATER HEATER <br />WOOD STOVE <br />HEAT PUMP <br />\'4CFNT SITE reea <br />,� YES ❑ NO BUILDING � <br />IXCu&vtr NOIXVMLLINGUniiS <br />���,2 PLUMBING � ��Z <br />J <br />BnSEMENi MECHANICAL <br />❑ YES ?� NO <br />HEIGHT �IMITA 'W J ADDITIONAL PLAN CHECH <br />� <br />OTHER <br />S7ATE BUILDING SURCNARGE <br />CITY OF EYEflETT PUBLIC WORKS <br />LOCALSALES <br />TAl( CODE IS 3105 TOTAL <br />SUB TOTAL 3 <br />PERMIT $ <br />TOTAL FEE $ <br />�� <br />� <br />X <br />B <br />