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' APPLICATIO.. FOR CONSTRUCT� JN PERMIT <br /> TO BE COMPLETED IN BLACK INK—PLEASE PRINT ����� <br /> BUILDING DEPARTMENT HEATING SYSTEM: U GAS U ELECTRIC L7 � <br /> 259-8810 <br /> I DEMOLITION I i COMBINATION � UILDING T�MECHANICAL I I PLUMBINCi i I SIGN <br /> OWNER M�I1 ADDRE55 CITY IP PHONE <br /> 7�tiE �iN<T �A DIIPSo� (�oX 3']Q7, M�S'— �`'F ���P S��-7l'GE'�l✓�. 9��Z� 3�2-7339 <br /> SA�md /�5 Ol��veti <br /> �f1GHITECTOROfiSqNER M�IL�ODRE55 CITY 21P VMOME <br /> r/�� LonxWoo,� G�T�'�' • <br /> OENERALCONTQRA�GTOR M�II/�ODRE55 CIIY ZIP PIqNE STATEIICEN5E1 <br /> ��T (J✓ST/i✓ CU. <br /> MECNANIC�L CONTRACTOR MMl�UDRE55 CIIY 21P PNONE 9T�TE LICENSE� <br /> PLUMBINOGONTMCTOR M�K�DOf1FS5 CITY Z�N P�E 6T1TE IICENSC� <br /> CUS90F WORk <br /> ' I NEW ADDITIqN I I ALTERATION I I REPAIR I I DEMOLITION I i WOODSTOVE/FRPL INSERT I I BUILDINO RELOCATION <br /> �Sd eao CONGCTPERSON�NDPNONEND <br /> CONTRIICTPRMEOFWdIX L�oNR��.l� C.rM'1QORSk• 2GH-3rC:� <br /> �EBCRIBE WOi1Nl1NDSOWhE FOOiAOE WVOLVEU <br /> rqoroseouseoFeu�onro � HEREBV CERTIFY THAT I HAVE READ AND E%AMINED THIS <br /> G'(.[SYln/ 5 67FL �l4/NT ���5�'�'�'M1" APPLICATION AND KNOW THE SAME TO BE TRUE ANO CORRECT.ALL <br /> �Ep�' �EFGpIp7qNOF PROPER(VISIqWII BELOW OIIIITTIICH FW9COPIE9� PROVISIONS OF LAWS AND OHDINANCES OOVERNINO THIS TYPE Of <br /> WORK WILL BE COMPLETED WITH WHETF�LR SPECIFIED HEREIN Ofi <br /> �a� aiacK oF NOT. THE GRANTING OF A PEHMIT DOES NOT PRESUME TO GIVE <br /> � AU7HORIiV TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br /> OTHER STATE OR LOCAL LAW REQULATIN6 CONSTRUCTION OR THE <br /> PERFORMANCE OF CONSTRUCTION.THAT I AM AUTHOHIZED BV THE <br /> OWNER OF THIS PROPERTY TO PEHFORM THE WORK FOR WHICH <br /> APPLICATION IS MADE AND 1 COMPLV WITH THE STA?E <br /> CONTRACTORS LAW 18.27 RCW AND 296200 WAC. <br /> X /l/y/I��__�p_/-Y11 . 4�f�.,� 6�s'��- <br /> SNIIIWE G� D�tE <br /> PROJECT AODRESS � YQ-2� <br /> �j W' C�S/^�ut •� cnveus�rtssiwtwstr�o <br /> PLUMBINO � MECMANICAL Y f <br /> qp, TYPE OF FIXTURE OR REM FEE NO. TYPE OF E�UIPMENT FEE �� <br /> WATER CLOSET(TOILET) , F R ED AI�R SVSTEMSHB.T.U. M E.A. � `'� '"� � �y P � � <br /> BATHTUB � � , <br /> LAVATOHY(WA S H BASIN) � UNIT HEATERS-B.T.U. M _ r <br /> SHOWER � CLOTHESDRYERS __ �`�( <br /> KITCN�N SINK 8 DISP i VEN7ILATION FAN � � <br /> DISHWASHER � FANGE HOOD <br /> LAUNORYTHAV � WATER HEATER <br /> CLOTHES WASHER � WOOD STOVE <br /> URINAL ' METAL FIREPLACE 8 CHIMNEV _ / <br /> DRINKINO FOUNTAIN � FIREPLACE INSERT _� 2'V <br /> FLOOR DRAIN � HEAT PUMP ' � r J <br /> BACKFLOW PREVENTERS � GAS PIPING ��� ' 2 � 1 <br /> ROOF DHAINS-RAINLEADERS � EXHAUST FAN ' 3 <br /> SINK(SERVICE-BAR,ETC.) � , <br /> � ' _.� <br /> � ' .+� <br /> � i <br /> i <br /> i � <br /> SUB TOTAL S ; SU8 TOTAL S � v° <br /> PERMIT S � PERMIT S 5�� _ <br /> TOiAL FEE S ' TO7AL FEE S PS��f"� _ <br /> FOR OFFICE USE ONLY: <br /> FRONTSETBACI( RE�RfiETBACN 6�DE8ETB�CN PLIINCHECKNUMBER FEE n°GEII•INU <br /> ,.3 �03 <br /> usezorve �or�ne� WC�VIl81TE FEEB VALUATION FEE � <br /> � <br /> BUILDINO ' <br /> IYPEOICONISMIUY�BIE IYPFIXLpISI.ACIWL ou�R+F[r IqdowntwGUMns � <br /> °NA7 � PLUMBIN6 �_ <br /> r•r , <br /> SIIEOFBLDO. NOai6Tq1iE8 BASEMEN� MECHANIC�I. •7�.j5 � <br /> 1 <br /> OCCUP�NCY LOAU FIRE 6PPNItlENS REQD NEIOHT LIMIIAIION ADDITIONAL PLAN CHECY. � <br /> — i <br /> �f �, SPRINKIER _T <br /> REI150N FOR fiPRINN:ER9 � <br /> ��� � STATFBUILUINGSl1RCH�R�E ' <br /> r� , <br /> M7�NEBY PUN "�PPROVEDBY CITY OF EYERETT PUBLIC WORNS � <br /> J �` LOCAL SALES , , � �ti �_ <br /> �� TAX CODE IS 3105 *�T�� <br />