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APPLICATIQ'-' FOR CONSTRUCT'`1N PERMIT � <br />TO BE COMPLETED IN BLACK INK—PLEASE PRINT <br />BUILDING DEPARTMENT HEATING SYSTEM: ❑ GAS ❑ ELECTRIC ❑ —� <br />259•8810 <br />�� DEMOUTION ❑ ' '�MBINATION ❑ BUILDING I�MECHANICAL ❑ PLUMBING ❑ SIGN <br />OWNER MAILADDflESS CITY ZIP pHONE <br />,13�GG CG�� 3/rt Sb7X �T.SeJ �Yi- �iszoi 3�17-5�/7 <br />TENANT MAIL ADDFESS CITY ZIP PHONE <br />ARCHITECTORDESIGNER MAILADDPESS CITY ZIP PHONE <br />GENERALCONTRACTOR MAILADORESS CITY ZIP PHONE STATEUCENSEN <br />MECHANICALCONTFACiOR� MAIIA�DRESS CITY ZIP PHONE STATELICENSEM <br />PLUMBING <br />IL <br />CONTRACT �P.RjIC�E �OF/W�ORK <br />�1'��J <br />�ESCRIBE WORK ANO SOUARE FQ7TAGE INVOLVED <br />� .- J <br />PROPOSED USc OF BUIL,O^ING <br />��r1 <br />IEGAL DESCRIPTION OF PROP! <br />LOT BLOCK <br />CITV <br />(SHOWN BELOW OR ATTACN TWO COPIESI <br />OF <br />PAPCELTA%I.D.NUMBER <br />CONSTflUCTION LOAN LENDEfl, ADDNESS. TELEPHONE NUMBEfl <br />'Z _'.._.... �,�� <br />TYPE OF FIXTURE OR REM <br />UIVATORY(WASH BA; <br />SHOWER <br />KITCHEN SINK & DISP <br />DISHWASHER <br />LAUNDRYTRAY <br />CLOTHES WASHER <br />URINAL <br />DRINKING FOUNTAIN <br />FLOOR ORAIN <br />BACKFLOW PREVENT <br />ROOF DRAINS--RAINL <br />SINK (SERVICE—BAR. <br />FEE <br />PERMIT $ <br />TOTAL FEE 8 <br />FOR OFFICE USE ONLY: <br />FRONTSETBACK R[ARSETBACK <br />use zone <br />7VVEOFCONST <br />REASON <br />INTAKE BY <br />LOTAREA <br />FIRE SPRINKLERS FEO'0 <br />PLANS APPROVED BV <br />DATE <br />SIDE SETBACN <br />ZIP <br />CONTACT PERSON AND PHONE NO. <br />STATE LICENSE N <br />i HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br />APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />PflOVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br />WORK WILL BE COMPI.[?ED WITH WHETHER SPECIFIED HEREIN OR <br />NOT. THE GRANTING UF A PERMIT DQ"S P�OT PRESUME TO GIVE <br />AUTHORITY TO VIOLATE OR GANCEL THE PROVISIONS OF ANY <br />OTHER STATE 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 />APPLICA710N IS MADE AND I COMPLY WITH THE STATE <br />CONTRA�JiORS LAW 18.27 RCW AND 296.200 WAC. <br />A/�AIHNDLG UNITS—H.P. <br />FORCED AIR SYSTEMS-8. <br />UNIT HEATER�B.T.U. M <br />CLOTHES DRYERS <br />VENI'ILATION FAN <br />RANGf HOOD <br />WATER HEATER <br />WOOD STOVE <br />METAL FIREPLACE (WOOD <br />FIREPLACE INSERT <br />HEAT PUMP <br />GAS PI?ING <br />EXHAUSTFAN <br />VACANT SITE FEES <br />❑ YES ❑ NO BUILDING <br />pCLpP,1NCY HO OfW1FLLIHGONItS <br />enouv pLUMBING <br />BASEMENi MECHANICAL <br />❑ YES ❑ NO — <br />HEIGHT IIMITATION ADDITIONAL PLAN CHECK <br />OTHER <br />STATE BUILDING SURCHARGE <br />CITY OF EYEHETT PUBLIC WORKS <br />LOCAL SALES <br />TAX COUE IS 3105 Torn� <br />FEE <br />PERMIT $ �p0 <br />TOTAL FEE $ 'jej ; 60 <br />FEE RECEIPTNO. <br />VAIUATION FEE <br />i <br />1 <br />� <br />i <br />--r— <br />I <br />i <br />i <br />i <br />i <br />i <br />� <br />� <br />