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APPLICATIC~7 FOR CONSTRUCT'`1N PERMIT � <br />TO BE COMPLETED IN BLACK INK—PLEASE PRINT <br />HEATING SYSTEM: GAS ❑ ELECTRIC ❑ <br />BUILDING DEPARTMENT <br />259-8810 <br />❑ DEMOLITION pCI COMBINATION ❑ BUILDING LJ MECHANICAL ❑ PLUMBING ❑ SIGN <br />ONWEA . MAILAUORESS CITY ZIP PHONE <br />C�TY ZIP PHONE <br />�P MITECTORDESIGNEfl IAAILADDRESS CITY ZIP PMONE <br />, �=5 �n. �'�/i;. �?<c�7 �/7,aonSc?- �»ooE.`rr� �a 9fio�< <.?o6-yf�l"-Y3y`i <br />GENERALCO RPCTOR MAIIADDPE55 CITv ZIP PHONE STATELICENSEN <br />��TQ �(7��A�•vcA�i'o.� �t,�p aio���l7��Se"Dau4/i 98oz. �J'BS�YJY�L06co�,r/S'9� <br />MECHANICAI CONTRACTOR MAIL AO�RE55 CITY 21P PHONE STATE UCENSE � <br />PLUM8INGCONTRA�TOR MAILAODREa°. CITY ZIP PHONE STATELICENSEN <br />CONTRACT PPICE O� WORN <br />�ZL 7� � <br />OESCRIBE WOPN AND SOUARE FOOTAGE INVOLVED <br />C��. ��-� ��f r���., �2 y s-o � <br />�.�-,.,G �QJ.�4� <br />PROPOSEDUS OFBUILDING <br />r� _�_ ,��� <br />LEGAID RIPTIONOFPROPERTY� OWNBELOWOPATTACHTN <br />. LOT� BLOCK -- OF —��� <br />PRPCELTA%I.O.NUMBER <br />CONSTFUCTIONLOANLENDER, <br />/ . / � i <br />(r Y L / '. / /O' ' -V ! \ J 1 4 <br />PLUMBING <br />O. TYPE OF flXTURE OR REM <br />. WATER CLOSET (TOI�E� <br />BATHTUB / <br />' LAVATORY (WASH BASIN) / <br />SHOWER <br />� KITCHEN SINK & DISP i <br />DISHWASHEfl / <br />LAUNDRYTFAY / <br />CLOTHES WASHER <br />URINAL <br />DRINKING FOUNTAIN <br />FLJOR DRAIN <br />BACKFLOW PREVENTERS <br />ROOF DRAINS—RAI�LEADERS <br />FOR OFFICE USE ONLY: <br />FRONT�TBRCK! REA� <br />� <br />� �J <br />iVPE OF CONST. <br />� <br />SIZE OF BLDG. <br />REASON <br />INTAKE BY <br />LOT AREA <br />/ <br />0 <br />� <br />� <br />SUB TOTAL $ ; <br />PERMIT $ � <br />TOTALFEE $ , <br />� <br />FIRE SPRINNLERS REO'D <br />—��"--- <br />FIRE AIARM REO-D <br />A� � <br />PLANS �PPiZOVED BY <br />Jr <br />DFTE ��/�/(�� <br />CONTACT PEfl50N AND PHONE NO. <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br />APPLICATION AND KNOW THE SAME TO BE TRUE AND COflRECT. 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 ANY <br />OTHER ST.4TE OR LOCAL LAW 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 COMPLY WITH THE STATE <br />CONTRACTORS LAW 18.27 RCW AND 296200 WAC. <br />�s � �' C�i �. 9�o�p.3 <br />SIGN�T E �A1E <br />N0. TYPE OF <br />AI�FUHNOLG UNf <br />1 FORCED AIR SYST <br />T.U. M <br />VENTILATION FAN ; <br />RANGEHOOD / � <br />WATER HEATER i ' <br />WOOD STOVE � <br />METAL FIREPLACE (WOOD BURN�NG) � <br />FIREPLACE INSERT . � <br />HEAT PUMP � <br />GAS PIPING //i� ' <br />EXHAUST FAN Ac// � <br />SIDE SETBACN PLAN CHECK NUMBER <br />/5� Z <br />VACANT S� FEES <br />❑ VES ❑ NO gUaoiNG <br />acur�xcr uaovvx[wNcuxns <br />(Jp°� PLUMBING <br />N' <br />BASEMENt MECHANICAL <br />❑ YES �LI�O <br />HEIG'HT LIMITATION ADDITIONAL PLAN CHECK <br />!/<J ' <br />OTHER <br />STATE BUILDING SURCHARGE <br />CITY OF EYEflETT PUBLIC WORKS <br />LOCALSALES <br />TA7( CODE IS 3105 TOTAL <br />TOTAL FEE $ <br />„ <br />