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APPLICATIOI FOR CONSTRUCTa'�'N PERMIT � <br /> TO BE COMPLETEO IN BLACK INK—PLEAS�PFwINT <br /> BUILDING DEPARTMENT HEATINO SYSTEM: U QAS D ELEC7RIC O —� <br /> 259-8810 <br /> ❑ DEMOLITION ❑ COMBINATION ❑ BUILDINO . qC MECHANICAI ❑PLUMBIN�i I� SWN <br /> OW1EH M�L�OOREBB GRV i1P PNONE <br /> �arant� co. �o. sdc. a,o� ��K �•�r� �,� �,u �a�24. 3ya- aQ�� <br /> tEwvrt wr�aon¢ae ' cm nr r�aru <br /> �naurecroaoesa�n wu�oaaEsa CITV �ZIP -- _— PIqNE <br /> Aikifiwf �. !t� sW Ib'r3i�P. t2�E►.n�N . wA �tQj�_�_����F1F� <br /> aer�aucaurn�cTon wu��oo�ae cm zw a� sr��i�c�� <br /> BU�°1iN lA. P.O, 6oX 235'1 f�tIF�ETY �wA �7o�-E�357 7_h(i-(da�7 AV•SY tL•T'3'77N'� <br /> n�cwwrx cartw�cron wu aoo�as cm ��105 z a P BTATE LICENSE I <br /> rr��ry SrA� FieE � [�. ��rn iphLK d�-�•��r�wk AAi-o� We�s�1'3�6F <br /> xi..noa«,rw�cron wu��oaaEae a-m n-- :w ' er�reuc�. <br /> u9 Y <br /> cues a waa <br /> �J NEW ❑ ADDITION �ALTERATION I.I REPAIR I. I DEMOLITION I I WOODSTOVFJFqPL INSEFT I I BUILDINO RELO(:ATION <br /> . LONTI�CT AND PNONE N0. <br /> COMTMCT PIIICE GF WOIY( � <br /> DE8C11lEWdll(AlID80U�11E AOlNV VEf' �,OI� �./.� �.• <br /> w� <br /> ����� i HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THI6 <br /> ��(,Gt'�� APPLICATION AND KNOW THE&AME TO BE TRU[AND CORRECT.ALL <br /> �aKa¢ecnrippa (BIIOWHBELOWOflATiACNfWHWVffB) PROVISIONSOFLAWSANDORDINANCES(iOVERNMl07HISTYPF.OF <br /> WORK WILL BE COMPLETED WITH WNETHER SPECIFIED NEREIN OR <br /> �m �� � NOT. THE 4MNTIN6 OF A PEHMIT DOES NOT PRESi1ME TO OIVE <br /> AUTHORIfY TO VIOLATE OR CANCEL THE PROVISIUN9 Of ANV <br /> OTHER STATE OH LOCAL LAW RE�ULATINO CONSTRUC110N Ofi THE <br /> PERFORMANCE OF CONSTRUCTION.THAT I AM AUTHORI7ED BY THE <br /> OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br /> � APPLICATION IS MADE AND 1 COMPLY WITH T.iE STATE <br /> CONTRACTORS LAW 1827 RCW AND YB8.200 WAC. <br /> xlb.�,� �9 �b,- �4,�- <br /> � �cTeoo�ee - 07��� � wa <br /> • an«.iea�ccl��o <br /> �LIII�NIO IIEq1ANICAI <br /> N0. TY�E Of AK11111E OII ITLY FEE N0. TYPE Of EOIMPIIElIT !EE <br /> � WATEq CLOSET(TdLET) � NC-AIHNDL(3 UNITS-H.P. � <br /> BATFiTUB ' � FORCED AIR SYSTEMS-B.T.U. M E.A. � <br /> LAVATORY(WA3H 81181N) � UNIT HEATERS--B.T.U. M ; <br /> SHOWER � • CLOTHESDRVERS � <br /> KITCHEN&NK 6 DIBP , VENTILATION FAN ; <br /> ' DI8HWA8HER � tiAN(3E HOOD �-- <br /> LAUNDRY TRAY � ; WATER HEATER � <br /> CLOTHES WASHER � WOOD STOVE ; <br /> URINAL � METAL FIREPUCE 6 CHIMNEY � <br /> DRINKINO FOUNTAIN i FIREPLACE INSERT ; <br /> FLOOR ORAIN � HEAT PUMP � <br /> BACKFLOW PREVENTERS ; l3AS PIPINCi , — <br /> ROOF ORAINS-RAINLEAOERS � EXHAUST FAN � <br /> SINK(BERVICE-BAR.ETC.) � � " <br /> � ; <br /> i � � <br /> � i <br /> � i <br /> SUB TOTAL i ; SUB TOTAL { ' <br /> PERMIT i � PERMIT { � <br /> TOTAL FEE S ' TOTAL FEE f ` <br /> FOR OFFICE USE ONLY: <br /> FIqNTBETMCN IIEMBETB�CN 910E6ETBACN PIANCHEptMMlER FEE 11ECEIPTNO. <br /> ue¢zo� wr� v�cun s�re FEEB VALUATION FEE <br /> BUILOWO i <br /> TVPEOfLOMf6.NlOW11lF TYPfOfW115fKIWL aoplMif.r Iqafuv[LLNoiwI1 � <br /> � � PLUMBINO � <br /> BIgOFBIDO. NO.OFBTq1�E8 BA6EUENT MECHANICAL � <br /> OCCUPANCYLOAD FIHEBPflMftE118RE09 HEIOMTtM/1TATI0N �PUNCHECN � p� <br /> � — i V <br /> 6PflINKLER �/�-/pOS 3 / D i � <br /> REABON FOR BPRWI(lERB <br /> STA7E BUILDINO SURCHARGE i <br /> wr�ar rur e x •o er CITY OF EYERETT PUBLIC WORKS � <br /> LOCAL 8ALEH � <br /> , 7AX COUE IS 9105 TOTA� o�c 3� � 7 S-- <br />