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� r7 1 APPLICATIO: FOR CONSTRUCT�N PERMIT � <br /> TO BE COMPLETED IN BLACK INK—PLEASE PRINT <br /> , HEATING SYSTEM: ❑GAS ❑ELECTRIC CJ <br /> BUILD�NG DEPARTMENT <br /> 259-8810 <br /> DEMOLITION COMBINATION BUILDING MECHANICAL PLUMBIN(3 SION <br /> p�E MAIL�UDPE55 CIiY ZIP PNONE <br /> v!'�< 7�� 3.t�o �8.,. �ver2� �JP.�e 1 <br /> TEN�NT M�IL ADDRE55 CITY IIP PHONE <br /> �dr ,!'s fJ! � <br /> AqCHITEGTORDE5IGNEP M�IL�DDRE55� CITY ZIP PHONE <br /> OENER GONTPACTOR M�IL��DNE55 LITY ZIP PHONE 6TATE IICENSE/ <br /> � 7� O L�fitre � <br /> MECN/JlICAL C ITRAGTOH MAII AO�RESS CI7Y ZIP PHONE ST�TE IILENSE/ y <br /> �tinc.ic.e� �fy �e , 36o! /�ier�i✓�� 9��ar/ ar}-�a � /y/;',c��?K/.�" <br /> UMBM�CONTR�GiOR MAIL�DORESS CITY ZIF PHONE SiATELICENSE• f <br /> cuss or vroaK <br /> I i NEW I i ADDITION � �� ALTEFATION REPAIR DEMOLITION � WOODSTOVE/FRPL INSERT � �. BUILDING RELOCATION <br /> CON7�CT PERSOJN�ND PHONE O Q <br /> LONTR�CT VRICE OF WnRN ,� s d 9'G VC o �s `� �rf �,�� � <br /> OESLNIBE W011N�{�+D SOUARE fOOTAGE INVO�VED G� <br /> v� T �e� � �[. �v✓n�tet �I�,�s• <br /> PROPOSEDUSEOFBUILUINO --T I HEREBV CERTIFV THn! I HAVE flEAD AND EXAMINED THIS <br /> APPLICATION AND KNOW THE SAME TO BE TRUE AND COFRECT.ALL <br /> LE(L1L DESCRIPTION OF PROPEHTY�SMOWN BELOW OR�TT�CM FWP COPIESI PRUVISIONS OF LAWS AND OADINANCES GOVERNINO THIS TYPE OF <br /> WORK WILL BE COMPLETEG WITH WHETHER SPECIFIED HEREIN OR <br /> �or aiaK ov NOT. THE GRANTINO OF A PERMIT COES NOT PRESUME TO GIVE <br /> / AUTHORITV TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br /> �� �I /G P�S� V v OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br /> ,[ PERFORMANCE OF CONSTRUCTION.THAT I AM AUTHORIZED BY THE <br /> � vC��' �/ �G� 9�,re i OWNER OF THIS PROPERTV TO PERFORM THE WORK FOR WHICH <br /> ' APPLICATION 1� MADE AND I COMPLY WITH THE STATE <br /> CONTRACTO '.AW 1827 RCW AND 296.200 WAC. <br /> , w--.-� �s� 1 /y�q/ <br /> PR0.IECT�DDHFSS / saH�t E o�rE T <br /> 14 G 1 vCr Sory' v� <br /> CirrBU5M�F5lliCENSF un <br /> K��ppp MECHANICAL • <br /> N0. ?tl/E Oi fll(TURE OII ITEM FEE NO. TVPE OF EOUIPMENT PEE <br /> WATER CLOSET(TOILET) � NC—NHNDLG UNITS—H.P. � <br /> BATHTUB ' FORCED AIR SYSTEMS—B.T.U. M E.A. ' <br /> LAVATORV(WASH BASIN) � UNIT HEATERS—B.T.U. M i <br /> SHOWER ' CLOTHESDRVERS � <br /> KITCHEN SINK 8 DISP � VENTIlATION FAN ; <br /> � DISHWASHER � RANGE HOOD � <br /> LAUNDRV TRAV ; WATER HEATEH ' <br /> CLOTHES WASHER � WOODSTOVE � <br /> URINAL METAL FIREPLACE 8 CHIMNEV � <br /> DRINKING FOUNTAIN , FIREPLACE INSERT � <br /> FLOOR DRAIN � HEAT PUMP � _ <br /> BACKFLOW PREVENTERS GAS PIPING � <br /> pOOF DRAINS—RAINLEADERS � E%HAUS7 FAN � <br /> SINK(SERVICE—BAR,ETC.) 1 �� �'' w � <br /> � <br /> , � <br /> SUB TOTAL E ' SUB TOTAL S �'O I <br /> PERMIT S PERMIT S 1 � <br /> TOTAL FEE E ' TOTAL FEE E ' <br /> FOR OFFICE USE ONLY: <br /> FRONTSETBALK NE�RSE70ACN 51DESETB�CK PLANCMECBNUMBER FEE FECEIPTNO. <br /> 3s' <br /> USCZONE �OTAREA VACANTSITE FEES YALUATION FEE <br /> BUILDINO � <br /> fYVfOftONfS.AILOWliBLF 1YPFOftONSi.�CilUl o[ao�ucv xoaoWFwNGuxin i <br /> cnao pLUMBING i <br /> SQEOFBLDO. NO.OFS70RIE5 BASEMENT MECHANICAL �J � � <br /> OCLUPANCYLOAD FIRFSPflNNLEPSREO'D NEI6HTLIMITATION A�DITIONAIPUNCHECK � <br /> SPFINNLER � <br /> PEASON FOfl SPRINKIERS <br /> STATE BUILDINCi SURCMARGE i <br /> INT�NE BY PlANS�PPROVED BY CITY OF EYERETT PUBLIC WORNS i <br /> LOCAL8ALE8 � <br /> TAII CODE IS 3105 TOTAL s ;G- <br />