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APPLiCATIQ'' FOR CO►N�TRUCT�N PERMIT � <br />TO BE COMPLETED IN BLACK INK—PLEASE PRINT <br />BUILDING DEPARTMENT L <br />259-8810 <br />❑ DEMOLITION ❑ COMBINATION <br />HEATING SYSTEM: � G�1S ❑ ELECTRIC ❑ <br />f 1 BUILDING <br />MAI�ADDRESS � CITY <br />' ir.�f �di./ic� a.ic <br />rnurve <br />y n <br />Cl PLUMBING ❑ SIGN <br />._..^^• mn��novntas GITY ZIP PHONE <br />ARCHITECTORDESIGNEP MAILADDRESS CITY ZIP PHONE <br />GENERAL CONTRACTOR MAIL ADDRE55 CITV ZIP PHONE STATE UCENSE • <br />�MECH NICALCONT�R�/� �TOR MAILADDRESS CIIY ZIP P fOj� E STATELICENSEI <br />_ZL�/roNCi .•'•� lf�SZZ.i/• F��,�A,��1�fs%��j '�-�..�.f,l�Lif/� 4�1'i7Z7J1�''i�SI,B:�'Z <br />f IUMBING CONTRAGTOR �MqIL ADDflE55 CIN 7TZIP PHONE STATE �ICENSF e <br />CONTRACT PRICE OF WOflK <br />//� � <br />DESCRIBE WOflK ANO SOUARE FOOTAGE INVOLVEU <br />PROPp$ED USE OF BUILDING <br />LE WL DESCRIPTION OF PROPERTY ISHOWN BELOW OR ATTACM TWO COPIES) <br />� LOT BLOCK OF <br />�, P�RCEI.TA%I.D, <br />562�c <br />. �ONSTRUCTION <br />OP fll(TURE OR ITEM <br />WATER <br />SHOWER <br />KITCHEN SINK 8 DISP <br />DISHWASHER <br />LAUNDRYTRAY <br />CLOTHES WASHER <br />UFINAL <br />DRINKING FOUNTAIN <br />FLOOR DRAIN <br />BACKFLOW PREVENT <br />FOR OFFICE USE ONLY: <br />FRONTSET&1CK REAq SET <br />USEZONE LOTAREA <br />TYPE OF CONST <br />SRE OF BLDG. <br />OCCUPANCYLOA� <br />RE�SON <br />INTAKE BY <br />SUB <br />FIRE SPRINKLERS FEO'D <br />FIRE AIARM NEO'D <br />onte <br />ev <br />FEE $ <br />CONTACT PERSON ANO PMONE NO. <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 60VERNIN6 THIS TYPE OF <br />WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br />NOT. THE GRANT�NG OF A PERMIT DOES NOT PRESUME TO GIVE <br />AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br />OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br />PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BV THE <br />OWN�R OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br />APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />CONTRACTORS LAW 1827 RCW AND 296,200 WAC. <br />'��5��' �.�/q�!' <br />5 �A �DAiE <br />� <br />A/C—A/HNDLG UNITS--H.P. <br />FORCED AIR SYSTEMS—B.T. M E.A. <br />UNIT HEATERS—B.T.U. M <br />CLOTHES DRYERS <br />VENTILATION FAN <br />RANGEHOOD <br />WATER HEATER <br />WOOD STUVF. <br />METAL FIREPLACE (WOOD BURNING) <br />FIREPLACE INSERT <br />HEAT PUMP <br />GAS PIPING <br />EXHAUSTFAN <br />SIUE SETBACK PLAN CHECN NUMBER <br />VRCANT �ITE FEES <br />L� 1"eS ❑ NO pUILDING <br />OCCII>MCv NOIXOWFlIM6uNIi5 <br />cxav p�UMBING <br />BASEMEN7 MECHANICAL <br />�7 YES G NO — <br />NEIGHT uMITA7iON ADDITIONAL PLAN CHECK <br />OTHER <br />STATE BUILDING SURCHARGE <br />CITY OF EYEflETT PUBLIC WORKS <br />LOCALSALES <br />TAX CODEIS 3105 Tor�� <br />PERMIT $ ; <br />TUTAL FEE $ <br />. RECEIPTNO, <br />VALUATON FEE <br />: <br />- 1 <br />I <br />i <br />—� <br />i <br />� <br />� <br />� <br />