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APPLICATIO � FOR CONSTRUCTI �N PERMIT � <br />TO BE COMPLETED IN BLACK INK—PLEASE PRINT <br />BUILDING DEPARTMENT HEATING SYSTEM: �,GAS ❑ ELECTRIC ❑ <br />259•8810 <br />❑ DEMOLITION ❑ COMBINATION ❑ BUILDING ❑ MECHANICAL ❑ PLUMBING ❑ SIGN <br />OWNEH M�ILA�DRE55 CITY ZIP 'HONE <br />li��isii,�✓� <-;�rnF l3/ /'�c� Nz �sz�i Z7� - f:3/,' <br />7E�µ{ IMILADDRE55 CITY 21P PHONE <br />�HCNITECTORDESMaNER M�ILADOPE55 GITY 21P PHONE <br />GENERRLGONTAACTOR M�IIADDRE55 CITV ZIP PNONE STATELICENSE• <br />MECHANICAICONTF/iCTOR MAIL�DDRE55 GTY 2iF PHONE STATELICENSE� <br />EU s?�SF SN�n, r.c �/b�Y E�'i.��'✓/� <irx !'/' ET' islu�� 2St-Jiiy FvE/'G SSiL/.I�? <br />PWMBRNiCONTRALTOR MAIIADDPESS CITV ZIP PHONE STATEIICENSE� <br />. fONTRACT PNICE OF WOF/K <br />GGb K— <br />� OESGRIBEWORI(ANDSOUAREFOOT�GEINVOIVEU <br />l <br />PqpPOSED USE OF BUILDMNi <br />IEML OEECPIPTION OF PROPEN7Y (SMOWM BELOW OR ATTRCM TWO CAPIES) <br />LOT BLOCK OF <br />P�RCELYA%I.D.NUM9EN <br />CONSTRUCTION �O� �NDER. ADDNE55, <br />SINK 8 DISP <br />FOR OFFlCE USE ONLY: <br />FRONTSETB�CN PEFRSETBRCK <br />TVPE OF CU! <br />S2E /1F Bl <br />OCCUPM!( <br />REASON <br />INT�KE BY <br />LOT ARER <br />NO. OF STORIES <br />FIRE SPRINKLERS REO'0 <br />FIRE ALAFM HEO D <br />PlANS APPROVEO BY <br />DATE <br />$ <br />$ <br />VqCANT SITE <br />❑ YES ❑ NO <br />OCCUv�NCv NO qVMLIiNGUN�15 <br />GPWO <br />G YES ❑ NO <br />:IGHT LIMITATION <br />CITY OF EYEHETT <br />LOCALSALES <br />TAX CODE IS 3105 <br />CONTACT PERSON pND PHONE NO. <br />�An/ .�. �' <br />i HEREBV CERTIFV THA'� I HAVE READ AND EXAMINED THIS <br />APPLICATION AND KNOW THE SAME TO BE TRUE AND CUflRECT. 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 GIVE <br />AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANV <br />OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br />PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BV THE <br />OWNER OF THIS PROPERTV 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 />C `// ,�/� /�- �� /L� � � <br />SiGN�i E ��� <br />AIR SYSTEMS-B.T.U. <br />DRYERS <br />ION FAN <br />WOOD <br />METAL <br />HEAT PUMP <br />GAS PIPING <br />EXHAUSTFAN <br />PLAN CHECK <br />� <br />BUILDING <br />PLUMBING <br />MECHANICAL <br />AODITIONAL PLAN CHECK <br />OTHER <br />STATE BUILDING SURCHARGE <br />PUBLIC WORKS <br />TOTAL <br />SUB TOTAL $ <br />PERMIT $ <br />TOTALFEE $ <br />