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APPLICATIQ�! FOR CONSTRUCT'�lN PERMIT � <br /> TO BE COMPLETED IN BLACK INK—PLEASE PRINT <br /> BUILDING DEPARTMENT HEATiNG SYSTEM: J GAS �ELECTRIC U � <br /> 259-d810 <br /> DEMOLI110N COMBINATION �( BUILDING MECHANICAL PLUMBING SIGN <br /> OWNER M�iLADDPE55 LIiV 21P PHON[ <br /> i..vvAa�Na t�.,p�zr,w5- �Z�v� C'al,�ae�lic.� E��e�e�,t�a 9ti7� � � a��ISf�R <br /> 1EN�Ni MAiL�DDRE55 CIiV IiP PHONE <br /> Sc�me_ <br /> 1RCHrtEGTOR0E51GNEP MAIl�D�7E55 CILV 2iP PNONE <br /> ��-,'k��e`{t-Co'�D3- IloS�"` �I, �`'J �� — L_vro�iQ�,�.a�dU�`1 �7ti5-rx�7_3 <br /> GENER CONTq�GTOR M�iL�DpRE55 GTY i'�—PNq1E STRTEIiCENSE� <br /> MF.CH�NIG�L CONTRAGTON M�IL��ORE55 q1V ZIP PHONE SUTE l ICENSE� <br /> VWMBMGCON7R�CTOR M�R�ODRE55 CILY .'.IP PHONE ST�TELICENSE� <br /> ��iR�GT PRICE OF y/ORN <br /> 3 oLi <br /> 5 NIBE WORN AND E FOOT�GE INV VE CONT�CT PERSON�NO PIqNE NO <br /> o c. � <br /> -.� < <— _ <br /> < <br /> I HEREBY CERTIFV THAT I HAVE READ ANU E%AMINED THIS <br /> PROPOSEDUSE OF BUIlOING AP�LICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br /> PROVISIONS OF LAWS AND ORDINANCES GOVERNINO THIS TVPE OF <br /> lE6�LDE5CRIPTqNOfPROPEN/TV�S�HOW.N�BEIOWOR�1i�CHTWOCOPIES� WURK WILL BE COMPLETED WITH WHETHEfi SPEGFIED HEREIN OR <br /> �o��7+�� eiocK `p� ov � ��!J�bN -L NOT. THE GRANTING OF A PERMIT DOES NOT PRESUMF TO GIVE <br /> AUTHORITV TO VIOLATE OR CANCEL THE PROVISIONS OF ANV <br /> OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br /> PERFpRMANCE OF CONSTqUCTION.THAT I AM AUTHORIZED BY THE <br /> �I 37 U - (U 3 Z ` O�� - U�O7 �WNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br /> APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> PFRCEI T�x I f1 NUMBER CONTR TORS LAW 18.27 RCW AND 296200 WAC <br /> _____ �!'�.t.4h< �/-�?— ti'`� <br /> CONSTRUCTIONI AN EN R.�DDRESS.TEI.EPMONENUMBEH <br /> ,��01 ���,-�a�iat��ep�tt"r1[�i..q D I ��-1 Z-9`� <br /> �� PROJECT ADORE88 ���� out <br /> C�1vflU9 IiCF Mt) <br /> PLUMBINO MANICAL _ <br /> NO. TVPE OF FIXTURE OR ITEM FEE N0. TYPE OF EOUIPMEM FEE <br /> YIATER CLOSET(TOILET) � NC-A�HNDLG UNITS-H.P. <br /> BATHTUB FORCED AIR SVSTEMS-B.T.U. M E.A. <br /> LAVATORY(WASH BASIN) � UNIT HEATERS-B.T.U. M <br /> SHOWER � CLOTHESDRVERS <br /> KITCHEN SINK 8 DISP � VENTIlATION FAN <br /> DISHWASHER � RANGE HOOD <br /> LAUNDRVTRAV ; WATER HEATER <br /> CLOTHES WASHER � WOOD STOVE <br /> URINAL ' METAL FIREPLACE(WOOD BURNIN�) <br /> ORINKING FOUNTAIN � FIREPLACE INSEHT <br /> FLOOR DHAIN HEAT PUMP <br /> BACKFLOW PREVENTERR ; GAS PIPIN6 <br /> ROOF Of1AINS-RAINLEADERS � E%HAUST FAN �_ <br /> SINK ISEPVICE-BAR,ETC.) I <br /> � <br /> SUB TOTAL S ; SUB TOTAL S <br /> PERMIT S PERMIT 5 <br /> TOTALFEE S TOTALFEE E ' <br /> FOR OFFICE USE ONLY: <br /> FRONTSETBRCM RE�RSETBACK SIOESETBACN PUNCNE MBEP FEE RECEIPTNO <br /> ��/ <br /> use za+c LOT I1RE� V�CANT SIiE FEES VALUATION FEE <br /> f�. VES f�-i NO BUII�ING �O �_'�L�� <br /> fYPFOiGON57 MOOFSTORIES ocru.vncr qnamvtu�M:ux�•s <br /> 01° PLUMBING � <br /> St-�.� _I—__ " � ' <br /> SQEOFBLUO FIRESPRINNIERSNEO'D B�SEMENT �� MECHANICRL <br /> ��� �_ I �. YES '�:YNO - — <br /> ����p�y�p�D FIPE�L�RIA PEOD MEIONT LIMIUTION ADDITIONAL PIAN CHFCK — <br /> / ' <br /> ,� u � OTHER <br /> PE�SON <br /> STATE BUIIUING SURCHFRGE � �(� <br /> INiRMF Ov PIANS��VPQVF�BV CITY OF EYERETT PUBIIC WOflKS <br /> �j LOCAL SALES <br /> nq1E ,� q TIU(COOE IS 3105 TOTAL ', l(� <br />