Laserfiche WebLink
APPLICATIO. FOR CONSTRUCTI�N PERMIT � <br /> TO BE COMPLETEO IN BLACK INK—PLEASE PRINT e��hnt <br /> BUILDING DEPAHTMENT HEATING SYSTEM: U QAS O ELEC7RIC ❑_ � <br /> 259-8810 <br /> I I DEMOLITION I I COMBINATION BUILDIN(i �MECHANICAI i I PLUMBINd ! SNiN <br /> OMINEH � MAILADORESS GITY 21V VIqNE <br /> $e�-ew.�, Cu,,r�. f'U Rox 37u�7 .Senrrlc 9K1�4—��v7 _ 266� yi Sv <br /> TENANT MMLADORE66 CITY ZIP PIM':C <br /> 11qLNITECTORUE610NER MAIL�DDHESS GITY ZIP PIqNE <br /> F�rh6ti yt'1uh� lE _ <br /> OENERK Cidl 1A�LL MDPESS CITY ZIP PkONE ST/tE LICENBE 1 � <br /> MECNN11G1LC(NITRACTOR IMLAOONESA LtTY 21P P110NE 6"ATELILENSE� <br /> PlUY9pqCONTMCTOR 1MIL�WPE58 CITY SIP PIIONE STATFLICENSEI <br /> CUB JF WOPN <br /> C 1 NEW i 1 ADDITION I I ALIERATION i ! qEPAIR ' DEMOLITION I � WOODStOVE�FRPI INSERT I ! 8'JILDINO RELOCATION <br /> CONT�CT PERSON N/D PIIONE NO. <br /> �T�,��E�� �lB,� ZLl- yl '/ � <br /> o¢scnroE wow�uro sou�re coor�m�vaveo <br /> .INstn I Trn�lsvs <br /> rnovoseouseoceu�una I HEREBY CERTIFV THAT I MAVE READ AND E%AMINED THIS <br /> O f�1 c E Sn A�E APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECt AI.L <br /> �a�oescnirraNaF r RTY(����LOW di�TTACN FWR COVIE81 PROVISION3 OF lAW3 AND ORDINANCE8 CiOVERNINO THIS TVPE OF <br /> WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEHEIN OR <br /> �or e�ocK oF _ NOT. THE aRANTIN6 OF A PERMIT DOES NOT PRESUME TO aIVE <br /> AUTHORITV TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br /> OTHER STA?E OR LOCAL UW REOULATING CONSTRUCTION OR THE <br /> PERFORMANCE OF CONSTRUCTION.THAT I AM AUTHORIZED BV THE <br /> OWNER OF THIS PHOPERTV TO PERFOflM THE WOfiK FOR WMICH <br /> APPLI TION IS MAUE AND I COMPLV WITH THE STATE <br /> CONT AC S LAW 18.27 RCW AND 288.200 WAC. <br /> x — __�I�' �- � �"q Z <br /> PRQ�f(�iT�Dd�88 I 6 111PE W�E <br /> � �l/ � � I � � GiYM19N[BlIICEN4Clq <br /> �� ��AL <br /> N0. TY/[OP/IXTINI[OII ITEY fEE N0. TII/[OF tGU1PMENT R[E <br /> WATER CLOSET(TOILE'Q � A/C—AiHNDLO UNIT�H?. � <br /> g�7�7�9 ' PORCEDAIRSVSTEMS—B.LU. M E.A. ' <br /> LAVATORV(WA9H BA91N) � UNIT HEATEHS--B.T.U. M � <br /> g�pyyEp � CLOTHE6 ORVERS � <br /> KITCHEN SINK 8 OISP � VENTILATION FAN ; <br /> � DISMWA9MEH � RAN(3E Fi00D � <br /> � UUNORV TRAV ; WATER HEATER ' ._ � <br /> CLOTHES WASHER � WOOD STOVE � <br /> URINAL ' METAL FIREPLACE 8 CHIMNEY ' �� <br /> DRINKINO FOUN?AIN �- FIREPLACE INSERT .T ' <br /> FLOOR DRAIN � HEAT PUMP � � <br /> BACKFLOW PREVENTERS ; CiAS PIPINO _+_ <br /> p00F DMINS—RAINLEADERS � EXHAUST FAN � <br /> SINK(SERVICE—BAR,ET0.) � � <br /> � � <br /> � � <br /> SUB TOTAL Z ; SUB TOTAL S ' <br /> PERMIT t � PERMI? S � <br /> TOTALFEE S ' T07ALFEE S ' <br /> Fon oFFrce use oN�r: <br /> f110NTBETBACN NEM6ETBACN BIDE6ETB/�CN WNCMEC1cNUGBER D / _ RECEIVTNO <br /> 355�6(� a,<<i <br /> us�za+e �oT�n� VACAN7 BITE FFES VALUAiION FEE <br /> BUILDINO 7 pOa 6 d � <br /> i � <br /> TYPF Of COUT6.AIIOW�l/F 1VPE Of CONSf ACN�L aeuwrtr wo d ewe�uwa uwn� i <br /> � /J �^�''1° � PLUMBIN(i i <br /> i i <br /> 817EOFBL06. o� NO. BTqitEB BASEMENt MECMANICAL � <br /> i <br /> `� _— i <br /> OCCUPANCYLWD FIRE6PNNNLFRSPEO'0 MEH'iHTLwIUTION ADDITIONALPUNCHECK � � <br /> � <br /> (S � SPRINKLER � <br /> REA80N FOR 6PRIN1(LEPS — i �y, <br /> . <br /> STATE BUILDING SURCHAROE � � v <br /> MAItE Bv S ROVED BY CITY OF EYERETT PUBLIC WOFKS i <br /> �ociu su�a <br /> � TAX CODE IS�105 ror�� ;,�j <br />