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� <br />APPLICATIOrI FOR CONSTRUCTrt�N PERMIT � <br />TO BE COMPLETED IN BLACK INK—PLEAS�5 PRINT <br />�t�cx V'-annY.�' � C. — ��l - I �( � <br />(L <br />I HEATING SYSTEM: $ <br />BUILDING DEPARTMENT <br />259-8810 <br />Cl DEMOUTION L7 C06:91NATION I' BUILDING <br />ARGHITECTORDESIGNER MAILPDDRESS <br />GENERRLCONTRACTOR MAILADDRESS <br />❑ ELECTRIC ❑ <br />� y�'S f� � Src�,7�,a <br />CITY ZIP PHONE <br />CITV ZIP PHONE <br />CITY ZIP FMONE <br />} Y ZIP PHONE <br />ti -�°�tS P.�.�P� �� <br />CITY ZIP PHONE <br />; , PLUMBING f 1 SIGN <br />STATE LICENSE+1 <br />L_ <br />STATE LICENSE N <br />� <br />CUSS OF WOFK <br />�NEW ( 1 ADDITION i_ I ALTERATION i I REPAIR I I DEMOUTION �I : WOODSTOVE/FRPL INSERT I I BUILDING RELOCATION <br />� � I CONTACT PEFSON AND PHONE NO. - <br />CONTRACTPRICEOFWORK OO <br />PROPOSED USE OF BUI�LD_II� f_�� � � <br />��� <br />LEGAL QDESCRIPTION OF PROPEfl/T�Y ��S,N�O�W�N 3ELOW OR ATTQACH FOUFi CAP�ES) <br />LOT O�� BLOCK lllJV OF O O� <br />�� <br />r�uMeiNc <br />p. TYPE OF FIXTi <br />WATER CLOSET (TOIL <br />BATHTUB <br />LAVATORY (WASH BA: <br />SHOWER <br />KITCHEN SINK & DISP <br />DISHWASHER <br />LAUNDRYTRAY <br />URINAL <br />DRINKING FOUNTAIN <br />FLOOR DRAIN <br />6ACKFLOW PREVENTERS <br />ROOF DRAINS—RAINLEAC <br />SINK ISERVICE—BAR, ETC <br />OR ITEM <br />SUB TOTAI $ <br />PERMIT S <br />FOR OFFICE USE ONLY: <br />FRONTSETBACK flEARSETBACK <br />USEZONE LOTAREA <br />1YPE OF CONTS. ALLOWABLE 7YPE OF CONST. FCTUAL <br />SIZEOFBLOG. NO.OFSTORIES <br />OCCUPANCV LOAD FIRE SPRNKLERS NE( <br />flEASON FOH SPRINKLERS <br />INTAKEBY PUNSAPPROVEDBY <br />i HEREBY CERTII'Y THAT I HAVE READ AND EXAMINED THIS <br />APPLICATION AND I<NOW THE SAME TO BE TRUE AND CORRECT. AI.L <br />PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br />WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OFi <br />NOT. THE GRANTIIJG OF A PERMIT DOES NOT PRESUME TO GIVE <br />AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br />OTHER STATE OR I.00AL LAW REGULATING CONSTRUCTION OR ThiE <br />PERFORMANCE OF f,ONSTRUCTION. THAT I AM AUTHORIZED BY THE <br />OWNER OF THIS F'ROPERTY TO PERFORM THE WORK FOR WHICH <br />APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />CONTRACTORS L�'d�-4B.47�AC�ND 296200 WAC. <br />��,�'C�.��z 7/<g/9y <br />SIGNRiUPE OATE <br />FEE NO. TYPE OF EDUIPMENT FEE <br />� A/C—lVHNDL.G UNITS—H.P. <br />;� FORCED AIR SYSTEMS—B.T.U. M E.A. <br />� UNIT HEATEFiS--B.T.U. M <br />' CLOTHES DFIYERS <br />; VENTILATIOPI FAN <br />� RANGEHOOD <br />; / WATER HEA1'ER <br />� WOOD STOVE <br />' METAL FIREi'LACE & CHIMNEY <br />� FIREPLACE INSERT <br />� HEAT PUMP <br />; GAS PIPING <br />� EXHAUSTFAN <br />SUB TOTAL <br />PLAN CNECK NUNqEH � FEE � REGEIPT NO. <br />VACANTSITE FEES _ <br />BUILDING <br />OtGUPPNGY NO Of VNEIIiNGUNi15 - <br />enouv � pLUM81NG <br />BASEMEN7 MECHANICAL <br />HEIGHT LIMITATION ADDITIONAL PLAN CHECK <br />SPRINKLER <br />STATE BUILDING SURCHARGE <br />CITY OF EYEHETT PUBLIC WORKS <br />LOCAL SALES <br />TAX CO�E IS 3105 �TA� <br />