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APPLICATIC'1 FOR CONSTRUCT'`�N PERMIT � <br />TO BE COMPLETED IN BLACK INK—PLEASE PRINT <br />BUILDING DEPARTMENT HEATING SYSTEM: V GAS f J ELECTRIC ❑ <br />259•8810 <br />f] DEMOLITION I I COMBINATION i i BUILDING I i MECHANICAL i i PLUMBING CI SIGN <br />Q�Ep M�I��ODRE55 <br />CRY ZIP P1qNE � <br />�ffr� lf� �']�1l�15o1,i 7/b-9�(n157 5� Ri*Bv¢ii 48a0$ 347- l3lo I <br />TENANT M�II�DOFE55 <br />GITV 21P PNpryE <br />iPo�r u�.TNe�rcw ���-9vtzi si. sE Bv�iz�i r�g �8 �3y�_ r 36 r <br />•RCNITECTOpDE51GNEH M�ILADDRESS ��ty 21P ��H�E <br />2ngear ,�53Nnsav 7i�-�� srs �r�.�-rr �s�-cs� ::d�_,�, � <br />MEGNIINICQGONiq�CTOR M <br />4 t Dr/w= 6vl �D �ArG' <br />PWMBINGCONTRACTOq M <br />LONTR�CT PRICE OF WpqK <br />� <br />�ESCRIBE WOFk I1N0 SIXMRE F00T1 <br />�i83 Sy� r-r�g,— <br />PROPOSED USEIOF 9UILOINO <br />G <br />IEO�L OESCRIPiION Of PROPI <br />�oT z- o � s a��� <br />�DDRE55 <br />'o'1G.U� <br />n+vaveo <br />[•'.i <br />!� I - — <br />•, . <br />�� � P�NCELT�%10 NUMBER <br />: i . ' ► �2So5=�-Of3 -Do <br />• ' CONSTNUCTIONLO�NLENDER.�UDRESS,TELEPMpNE <br />' 'T�ACNl��LS�'2�€A('T /1NIDicI <br />. � onn�crr �nneene <br />OR <br />KITCHEN ;�iNK <br />DRINKIN6 FOUNTAIN <br />FLOOR ORAIN <br />BACKFLOW PREVENI <br />ROOF DRAINC�RAIN <br />SUB TO <br />PERMIT <br />TOTAL F <br />FOR OFFICE USE ONLY: <br />fRONTSETB�CK / RE�RSEiB/�C% <br />s <br />USE 20NE I.OT ARE� <br />IYPFOiCONST. NODFSTORIES <br />� <br />SIZE OF BLUO FIRE SPRINNlERS RE00 <br />�?Z O <br />OCCUPANCY LOAO FIRE �URM REO�� <br />INTANEBV PlAN61wPR VEDBY <br />o�r O /,� /a <br />CAPIES� <br />S$�� <br />FEE <br />CITY ZIP <br />8 �$}FA g �'f <br />CITV z�p <br />8� <br />CITV pIP <br />CON7�CT PERSON �ND PHONE NO <br />�n.cnac • <br />LICENSE � <br />STATE IICENSE / <br />. . . _ �. , k....._...� . i �z� ,. <br />I HEREEV CERTIFY THAT I HAVE READ AND EXAMINED THIS <br />APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />PROVISIONS OF LAWS AND ORDiNANCES GOVERNING THIS TYPE OF <br />WORK WILL BE COMPLETED WITH WHETHER SPECIFlEU HEREIN OR <br />NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br />AUTHORITV TO VIOLATE OR CANCEL THE PROVISIONS OF ANV <br />OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OH THE <br />PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHOqIZED BY THE <br />OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br />APPLICATION IS MADE AND I COMPLV WITH THE STATE <br />CONTRACTOFS lAW 18.27 RCW ANO 296200 WAC, <br />FORCED AIR SYSTEMS—B.T.U. M <br />UNIT HEATERS—B.T.U. M <br />CLOTHES DRVERS <br />VENTILATION FAN <br />RANGEHOOD <br />WAT[R HEATER <br />WOOD STOVE <br />METAL FIREPLA E IWOO� 6l1RNINf; <br />PIPING <br />1US7FAN <br />SUBTO <br />PERMIT <br />SIOESETBACR / PL�NCHECNN BER FEE <br />/�3 /�� / S <br />V�C�NTSITE FEES VALUATIOI <br />' VE3 i i NO BUILDINO S S S� <br />acuwwc. rwporrtiiiwcux�rs <br />cnwo p�UMBINO <br />BASEMENT � MECMANICAL <br />i i YES j/ NO <br />NEI6HTLIMIT�TION ADDITIONALPUNCHECK <br />Z// OTMEF <br />STATE BUILDING SURCHARGE <br />CITY OF EYERETf pUALIC WOFKS <br />LOCALSALES <br />TAX CODE IS 3105 TOTAL <br />