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APPLICATIO^ FOl3 CONSTRUCT�"N PERM�T � <br />TO BE COMPLETED IN BLACK INK—PLE4.SE PRINT <br />BUI�DING DEPARTMLNT � HEATING SYSTEM: �GAS ❑ ELECTRIC ] <br />259•8810 <br />❑ DEMOLITION I] COMBINATION ; 1 BUILDING �MECHANICAL ❑ Pl.UMBING ❑ SIGN <br />OYMEP MAILADDPE55 CITV ZIP PHONE <br />D�C1 �A)� CUraiJ i�J4dpN SO/�F 5 L/ S/v cveaCn-' 98Zo Z ��:L 3S9 v- <br />TENANT MAILAODRESS �ITY 21P PF�NE <br />ORDESIGNER MRILADORE55 <br />CITY ZIP <br />GENERALCONTRAC�OR MAILADDRESS CIiV ZIP PNOHE STATEUCENSEt <br />�tJQoPrf GONt��h. �i�.L 7�77� 96ti.�vc GJ CBHON¢C _ �!6'02b 1lf •D�i7 (— �UPl��//o ON <br />IAEGNANICALGONTFACTOR Mpil R��RE55 CITV 21P PMOhE STRTE L�CENSF. • <br />PLUTABINGCONTR�CTOH MaILAD�RESS GTv 21P PNONE SUTELI�ENSEII <br />fdiTRACT °RICE OF WpRK <br />��L? / � ti <br />DESCRIBE WORK r1ND SIX�>RE FOOT�GE INVOLYED <br />PROPOSED USE OF (fUILD�VG <br />LEG1L DESCPIPTiON OF PROPERI ° �SNJWN BELOK' OR FTTAP" MO f DPi[5� <br />LOT — BIOLK O: <br />PARCELTAXI.O.NUMBER <br />CONSTROCTqNIO�NLEND[R,RDDRESS,TELEPNONENUMBER <br />PHOJECTADDRES��� S � � <br />PLUMBING <br />NO. - YPE OF Fl1(TURE OR ITEM <br />WATER CLOSET (TOILEn <br />BATHTUB <br />LPVATORY (WASH BASIN) <br />SHOWER <br />KITCHEN SINK 8 DISP � <br />_ DISHWASHER <br />IAUNDRYTR.4Y <br />CLOTHES WASHER <br />URINAL <br />DRINKING FOUt:TAIN <br />FLOOR DRAIN <br />SUB TOTAL $ <br />PERMIT $ <br />TOTALFEE $ <br />FOR OFFICE USE ONLY: <br />FRONTSETBACK PEARSETBAGK <br />USE2dJE LOTFREA <br />lYFEOiCONSi NODFSTORIES <br />512E OF BLDG. FIRE 5!'RINKLEPS REO'� <br />OLGUPANCYLOAD <br />REASON <br />FIFE r1LARM REO'0 <br />PLANSAPPROVEDBV <br />oare <br />VACRNT SITE <br />❑ YES �] NO BUILDING <br />xo n ewruixc uri*s <br />CONTFCT PEFSON AND PHONE N0. <br />I HEREBY CERTIFV 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 />W�RK `NILL BE COMPLFTED WITH WHETHER SPECIFIED HEREIIJ OR <br />NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br />i,UTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANV <br />OTHER STATE OR LOCAL LAW RFGULATING CONSTRUCTION OR THE <br />PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br />OWNER OF THIS PROPFRTY TO PERFORM THE i�rORK FOR WHICH <br />APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />CONTRACTORS LAW 1827 RCW AND 296.200 WAC. <br />x �94- vGt��, � � • 9. q3 <br />SiGNAIU OAIE <br />ti�r eusNEss IiCEMse rq <br />UNIT HEATERS—B.T.U. M <br />CLOTHES DFiYcRS <br />VENTILATION FAN <br />RANGtHOOD <br />WATER HEATC-R <br />WO00 STOVE <br />METAL FIREPLACE (WOOD <br />FIREPLACE INSERT <br />am�exa I <br />LPWP <br />BRSEMENT <br />❑ YES C: NO <br />HEIGHT LIIAITRTION <br />CITY OF EYERET7 <br />IOCAL SALES <br />TAX CODE IS 3105 <br />PLUM6ING <br />MECHANICAL <br />ADDITIONAL PLAN CHECK <br />OTHER <br />STATE BWLDING SUFCHARGE <br />PUBUC WORNE <br />ro�a� <br />T.U. M E.A. <br />SUB TOTAL 5 _yv ; . <br />PERMIT $ � <br />TOTALFEE $ �–! <br />FECEIPT NO. <br />