Laserfiche WebLink
APPLICATI���1 FOR CONSTRUCT`�N PERMIT � <br />TO BE CC .APLETED IN BLACK INK—PLEASE PRINT <br />HEATING SYSTEM: � GAS ❑ ELECTRIC U <br />BUILDING DEPARTMENT <br />259-8870 <br />f7 DEMOLITION ❑ COMBitJATION ❑ BUILDING ❑ MECHANICAL [7 PLUMBING I I SIGN <br />OWNEfl M�ILMDRESS CITY ZIP PNONE <br />��r� .y.�,ri/lY .�'�9 tri�r,►.v.tf e�� �zoi zsg-.�6 <br />TEN�WT AUILADDPESS Llfv 21P PHONE <br />ARCMITEGTOfiDESIGNER MAILADDRE55 CITY ZIP PHOME <br />GENEMLCONTMCTOB MAILADDRESS CITY ZIV PNONE STATEUCENSEt <br />M�IL/�DDNE55 CITY 21P PHONE STATELILEHSE� <br />MEGWWMd1LGd1TXACTOR _ �._ _ ..`� .." _" '..�w i� n i L� <br />l0T <br />1MIL <br />PRICE OF WOPK <br />euaou+o <br />INVOIVED <br />PPOPERTY ISHOWN BEIOW OR <br />�p�K OF — <br />PARCELTN(ID.NUMBER <br />CONSTRUCTION <br />6 DISP <br />UR�NAL <br />FOR OFFICE USE ONLY: <br />Fi10Ni5ETB11LK REAR: <br />USE ZONE l0T AF <br />irrE a caxsr. NO °F <br />SIZEOFBl.06. FIRESI <br />OCWPANCYLOAD FIREAI <br />REASON <br />INTANE BY <br />PUNS <br />OAtE <br />NUMBER <br />TWO GOP�ES) <br />S <br />S <br />yAC/JIT SITE <br />❑ VES <br />acuwu�cr <br />cnaP <br />❑ YES <br />CONTALT PERSON AND PNONE N0. <br />1 HEREBY CERTIFY THAT 1 HAVE READ AND E%AMINED THIS <br />ppPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />PROVISIONS OF LAWS AND ORDINANCES GOYEHNING THIS TYPE OF <br />WORK WILL BE COMPLETED WITH WMETHER SPECIFIED HEREIN OR <br />NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br />AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br />OTHER STATE OR LOCAL UW REGULATING CONSTRUCTION OR THE <br />PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br />OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br />APPLICATION IS MADE AND I COMPLV WITH THE STATE <br />CONTpACTORS LAW 1827 RCW AND 296200 WAC. <br />Y�z��/� 6-/3- 9� <br />5 rJ�E WiE — <br />VENTILATION FAN <br />RANGEHOOD <br />WATER HEATER <br />WOODSTOVE <br />METALFIREPLACE( <br />FIREPiACE INSERT <br />HEAT PUMP <br />� (fi (J <br />FEES <br />❑ NO Bl11LDING <br />p p pwFlpN4 uNrtS <br />PLUMBING <br />MECHANICAL <br />(] NO <br />GTION ADDITIONAL PUN CHECK <br />OTHER <br />STATE BUILDING SURCHAFlGE <br />iF EYEHETT PUBLIC WORKS <br />�L SALES <br />mF iS 3105 ror�� <br />