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APPLICATIC�1 FOR CONSTRUCT��N PERMIT � <br />TO BE COMPLETED IN BLACK INK—PLEASE PRINT <br />HEATING SYSTEM: Q GAS ❑ ELECTRIC O <br />BUILDING DEPARTMENT — <br />259-8810 <br />�7 DEMOLITION ❑ COMBINATION ❑ BUILDING Z MECHANICAL oNE jQ.PLUMBING ❑ SI <br />MAIL ADURE55 ��T� <br />OWNEfl �� y'I f- ��r� Q q �.� f <br />Ab .-+VNAIY�JN I •�� .����T �ULECLIL ZIP , PNONE <br />MAII ADORE55 ��ry <br />TENANT _ <br />GENEHAL <br />MAIL <br />ADORESS <br />CpN7RACT PRICE OF WORN <br />DESCRIBE WORK AND SOUARE FOOT�GE INVOIVED <br />PqOPOSED USE OF BWLDING <br />LEGAL DESGRIPTION OF PROPERTV (SHL NN BELOW OR hTTACM TWOCOPIES) <br />LOT— BLOLK OF <br />PAflCELTP"ID.NI'MBEP <br />CONSTRUCTION LOAN LENUER. ADDRESS. <br />PpOJECT ADDRESS � � /a� <br />`-t <br />TRAY <br />DRAIN <br />SINK <br />FOR OFFICE USE ONLY� <br />. FRONTSETBACK REARSETOACN <br />USE ZONE l0T AREA <br />TYPEOFCONST NO.OFSTORIE <br />pEA50N <br />LOAD <br />TOTAL S <br />�AIT 5 <br />FIRe SPPINKLENS PEO'D <br />OATE <br />ev <br />CITV Ziv <br />CITY ZIP <br />CITV ZIP <br />GTV ZIP <br />�HONE STATE UCENSE Y <br />PHONE STATE LICENSE M <br />CON7ACT PEFSON AND PHONE NO. <br />I HEREBY CERTIFY THAT I HAVE READ APJD EXAMINED THIS <br />APPLICATION AND KNOW THE SAME TO BE TFUE AND CORRECT. 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 STATE OR LOCAL LA:Y flEGULATING CONSTRUC710N OR THE <br />PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br />OWNER OF THIS PROPERTY TO PERFORM THE WOFK FOR WHICH <br />APPLICATIGN IS MADE AND I COMPLY WITH THE STATE <br />CONTRACTORS LAW 1827 RCW AND 296200 WAC. <br />OF <br />AIR <br />VENTILATION FAN <br />RANGEHOOD <br />WATER HEAiER <br />WOOD STOVE <br />METALFIREPLAC <br />FIREPLACE INSEI <br />HEAT PUMP <br />GAS PIPING <br />EXHAUSTFAN <br />VACANT SITE <br />❑ YES n NO BUILDING <br />o¢uvA�r rvoaow[u�xcuxrts <br />cuwo pLUMBING <br />BnSEMENt MECHANICAL <br />❑ YES ❑ NO �� <br />HEIGH7 LIMITA710N ADDIT101JAL PIAN CHFCK <br />OTHER <br />STATE BUII.OING SURCHARGE <br />CITY OF EYEHETT PUBLIC WORKS <br />LOCAL SALES TOTAL <br />TAX CODE IS 3105 <br />FEE <br />M E.A. <br />TOTAL <br />Ej <br />FEE <br />�p <br />0 <br />� <br />7 <br />� <br />I <br />