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APPLICATIO� FOR CONSTRUCT�N PERMIT � <br />S/ � TO BE COMPLETED IN BLACK INK—PLEASE PRINT <br />l. <br />BUILDING DEPARTMENT � HEATING SYSTEM: J GAS J ELECTRIC J <br />259•8810 <br />, � DEMOUTION x COMBINATION �f" BUILDING MECHANICAL �k:'PLUMBING SIGN <br />OIYNER hINL�D�RE55 CITV ZiP PNONE <br />... _ . _ � _./_ � , , _ ., �v.,,. .� � �/. .✓ _r-- �.�� .�.-- <br />ARGHITECT OR OESIGNER <br />S.�n�r,_.'a�� <br />� GENERALCONTRqLTOR <br />AD�RESS <br />MaIL AODRESS <br />MAI� R 55 <br />MECNANIGALGONTRAG70N Id�II��ORESS <br />PWIdCINGCONIR�GIOR MAILqDDRE55 <br />CONTRAGT PRICE Of WORN ` <br />� <br />DESCRIBE WORN ANU SOUAR[ fOOT�GE INVOIVED <br />��v S� �j - <br />�iD�ilS �� i y� �O�/�e � �.t/ KrX <br />PRO�POSEDUSEOFBUIL�ING %O FIPOf/1 1 '� NP�� � <br />' ,b <br />IEGALJESGRIPTION PROPERTY�SHOWN�ELOWORATiALHTWOCOPIES� <br />�or— o�ocK oF <br />PRRCELTA%I� NUMfiER <br />GONSTRUGTION I.OAN LENDER. AODRESS. TELEPMONE NUMBER <br />NO. TVPE OF FIXTURE OR Il <br />WATER CLOSET (TOILET) <br />BATHTUB <br />LAVATORY (WASH BASIN) <br />SHOWER <br />KITCHEN SINK & DISi' <br />DISHWASHER _ <br />LAUNDRYTRAY <br />CLOTHES WASHER <br />URINAL <br />DRINKING FOUNTAIN <br />FLOOR DHAIN <br />BACKFLOW PREVENTERS <br />ROOF DRAINS—RAINLEADERS <br />SUB TOTAL $ <br />PERMIT $ <br />TOTAL FEE $ <br />FOR OFFICE USE ONLY: <br />fRONiSETBFGK BEARSE7BACN <br />USE ZONE LOi ME� <br />IVPEOFCONSi NO OF STORIES <br />SIZEOFBLD� FlRESPR�NKLERSRE00 <br />OCCUPANCYLOA� FlRGALARMRW'D <br />RCnsoN <br />RJIRM! (1V �LAN54PPROVEDBY <br />onr[ <br />SIDE SEi��CK <br />CRY <br />GITV <br />QiV <br />Zip PIIONE <br />ZIP PMONE <br />O `J�/ % <br />STATE LICENSE R <br />CITY 21P PHONE STATELICENSE� <br />CITV 21P PMONE STATE LICENSE � <br />PEfl50N AND PHONE NO <br />r�o�r G�os��IZ.i S� <br />i HEREBY 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 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 LAW REGULATING CONSTRUCTION OR THE <br />PERFORAIANCE OF CONSTRUCTION. THAT I AM AUTHORI2ED BY THE <br />OWNER OF THIS PROPERTV TO PERFORM THE WORK FOR WHICH <br />APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />CONTRACTORS LAW 78.2i RCW AND 296.200 WAC. <br />`,�� �� i S- nj.3 <br />x - <br />SiGrv4unc e�iE <br />CRVOU9�N[551iCFN5Y 11U <br />MECHANICAL _ <br />AIC—A�HNDLG UNITS—H.P. <br />FORCED AIR SYSTE6IS—B.T.U. M <br />UNIT HEATERS—B.T.U. M <br />CLOTHES DRYERS <br />VENTILATION FAN <br />WATER HEATER <br />WOOD STOVE <br />� METAL FIREPLACE (WOCD BURNING) <br />FIREPLP.CE INSERT <br />HEAT PUMP <br />; GAS PIPMG <br />EXHAUSTFAN <br />0 <br />SUBTOTAL <br />PERMIT <br />TOTAL FEE <br />NUMBER f[L I R[CEiPTNO. <br />-.� YES ���. NO BWLDING <br />osu���,rv xoanvrtwxcuw:s <br />ePoun pLUMBING <br />BASEMENT MECHANICPL <br />.� ' VES I,'. NO <br />HEiGHT uMITATiON ADDITIONAL PLAN CH[CK <br />OTHER_ <br />STATF OUILDING SUf�CHARGE <br />CITY OF EYEflETT Pueuc wo�Ks <br />LOCALSALES <br />TAX CODE IS 3105 T�rA� <br />