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APPLICATIv�I FOR CONSTRUC7 .ON PERMIT <br /> TO BE COMPLETED IN BLACK INK—PLEASE PRINT � <br /> BUILDING DEPARTMENT HE�7iNG SYSTEM: U GAS U ELECTRIC O � <br /> 259-8810 <br /> I i DEMOLITION COMBINATION BUILDIN(i MECHANICAL ',XPLUMBIN(i i i gION <br /> JNMER MI11L RDORESS CITY 21P PIIONE <br /> . V.Dawsa� �pz�! �tr �v��erf y'8aa� z��� 'FPy6 _ <br /> TENAM M�IL�DORESS GITY I�P PNONE <br /> ow►.re r Se[ m e... <br /> �qGNRECTdi0E510NER M�ILMDHE55 dTY ZIP PMCMlE <br /> Q-►Un,er S[ r'n� <br /> OENENQCONTR/�CIDH M�IL�DDRE55 CITY ZIC PMONE ST�TELILENSEI <br /> �rn�✓ li'1S'�a/(o-� SQ rh� <br /> MECMANICM GONTRACTOR M�IL 11DDRE55 G7Y ZIP PHONE 6TI1TE IICEN3E� <br /> ��W Y1 Q�V S�( vYrt <br /> PLUMBMO CONTiUCTOR M�IL�DDRE55 CITY ZIP P110NE 6T�iE LICENSE� <br /> �nQ r� SA.-� '� <br /> r��eS OF Wdi <br /> iNEW I ��OL`�TION , '� pLTERATION � '��, REPAIR � DEMOLITION WOODSTOVE/FRPL INSERT I I BUILDING 9ELOCATION <br /> �—�-- <br /> p CONUCT PERSON�ND PHONE NO <br /> LONTRACTPRICEOF�IqiK N /� <br /> DEBCRIPp' �. "'N!DlW�REFIX�'AOEINVOLVED ^ �� <br /> G'�tr W C , l.t�G Sh� v SHf�u»i r <br /> pno usef�auaoiria Z K l��(� i HEREBY CERTIFY THAT I HAVE READ AND E7(AMINED THIS <br /> ,(A✓� /C�Y1Q/� Ty B � M�Ve � APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br /> LEML OEBCRiPiqN OF PROPERIV ISHOVM ELOW OR�TTACN F C PIE6� PROVISIONS OF LAWS AND ORDINANCES OOVERNIN6 THIS TYPE OF <br /> WOP.K WILI BE COMPLETED WITH WFIETHER SPECIFIED HEREIN OR <br /> �oT e�ocK oF NOT. THE GRANTINO OF A PERMIT DOES NOT PRESUME TO OIVE <br /> AUTHORITV TO VIOLATE OR CANCEL TNE PROVISIONS OF ANV <br />� OTHER STATE OR LOCAL LAW REOULATING CONSTRUCTION OR THE <br /> � — PERFORMANCE OF CONSTRUC710N.THAT I AM AUTHORIZED BV THE <br /> '� OWNER OF THIS PROPERTV TO PERFORM TNE WORK FOR WHICH <br /> APPLICATION IS MADE AND I COMPLV WITH THE STATE <br /> CONTRACTORS LAW 18.27 RCW AND 296.200 WAC. <br /> ��/���''rn°-�. <br /> ' s P11QIEct ss surutune arE <br /> Cliv MME!!110EMlE q� <br />'I " ! p�,�php MECMAINCAL <br /> �. ;.�� 11p, TYrE Of fll(TIME OII ITEM PEE NO. TYPE OF EOUIPMENT FEE <br /> � / WATER CLOSET(TOILET) � - MC-A/HNDLQ UNtTS-H.P. � . <br /> �� BATHTUB "- FORCED AtR SYSTEMS-B.T.U. M E.A. � <br />� LAVATORV(WASH BASIN) � UNIT NEATERS-B.T.U. M _ _�_ <br /> .,i SHOWER ~- CLOTKESDRYERS ' . <br /> �'"'i KITCHEN SINK 6 DISP i 'JENTILATION FAN _� ��. <br /> DISHWASHER � RANGE HOOD � I <br /> / UUNDRV TRAV ;- WATER HEATEH __ ' '' <br /> / CLOTHES WASHER -� -" WOOD STOVE � _ <br /> URINAL ' METAL FIREPLACE Q CHIMNEY _ : <br /> ORINKINO FOUNTAIN � FIFlEPLACE INSERT ___T <br /> FLOOR DRAIN � 11EAT PUMP �_ � <br /> BACNFLOW PREVENTEFS ;- OAS FIPINO „ _�_ <br /> ROOF DRAINS-RAINLEADERS � EXHAUST FAN . � . I <br /> SINK(SERVICE-BAR,ETC.) '� — � <br /> i ' <br /> T <br /> 1 - I <br /> I � <br /> � T <br /> SUB TOTAL S SUB TOTAL S <br /> PERMIT S �O't} PERMIT S � <br /> TOTAL FEE S ' TOTAL FEE S ' ' <br /> FOR OFFlCE USE ONLY: <br /> FRONTSETMCN REARSETBGCK SIDESETBACN PLANCHECNNUMBER /1 FEE PE�E�PThO. <br /> :7 <br /> ��yE zp�e �or�ne� v�cu�r sire FEES VALUATION FE�_ <br /> � <br /> BUILDINO ' <br /> fYVE Of CONfS�LLOW�BIE IYPF Of CONS7�LIU�L oavr+nc. ra o•wrtwlauxire � <br /> °"d^ PLUMBIN3 � ' <br /> . �� g�pp g�pp. NO OF STORIES BASEMENT MECHAPiICAL � <br /> _ <br /> oCCUP�NCY LWD FIPE spqNHLENS REVD NEI�NT LIMIT�iKK1 ADOITIONAL PLAN CHECK � <br /> i <br /> SPRINNLER i <br /> REASON FOR BPPN/NLEPS � <br /> SiATE BUILOINO SURCHAROE � <br /> iN7�xE er PIANs�vPROVEn Br CITI�OF EYERETT PUBLIC WORNS � <br /> LOCAL SALEE � <br /> TAII COOE IE J105 *aT�� <br /> ��� <br />