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APPLICATIOAI FOR CONSTRUCTF+41� PERMIT � <br /> TO BE COMPLETED IN BLACK INK—PLEASE PRINT <br /> BUILDING DEPARTMENT HEATING SYSTEM: ❑GAS ❑ELECTRIC ,� //Y R o.v iG <br /> 259•8810 <br /> ❑ DEMOLITION ❑ COMBINATION I7 BUILDING DQMECHANICAL [7PLUMBING ❑ SIGN <br /> OYMEfl MAII�DOf1E55 CIiY ZIP PIIONE <br /> SosiNG- Co. P.D • Boy ?7v7 , SEA-,-r�� wn �8►a4 aG�-3S63 <br /> TEN�HT M�RADUf1ES5 CITY ZIP PNONE <br /> l3oEiN4� Co . P.D �iiy 37t?7 � S�n-n!f (,�Il i�i/7 �/ � ( G - `.', 5 (.� 3 ' <br /> ARCIIITECTq10E516NER AURAUDRESS ptV 211' P1qNE <br /> AfFlL4�lTCl� FN4�yffdS` C,.?S N SfGot �. , M�nis,�,v t,✓l � 5�37oJ � <br /> 6ENEMLCONTMCTOR M�RAUORESS CI7Y ZIP PIIONE STAELICEI <br /> G�«�.wsw� YooN� Po . Byr (�7z $ , 6ecc.evuc . wA� 98u�� 9S/- �877 <br /> 4ECMMlM,AI.CONTflACTOfl IMILMOflESS CITY 21P PIqNE STATELICENSEI <br /> MLC/NS1A% Cn. /?t7. /�,�r �4S(,7 SfA��TtI (.�A 99/2t� 7!�- 33// MGK/I/372 NO <br /> PLUMBMIOCONiRACTOfl 1MIL/�WHESS � CITY 21P P110NE STATELICENSE/ <br /> L��• <br /> CONTMCT PflICE OF WIXIK <br /> OUO � <br /> D SCR9E WOPN 11ND 90U E FOOTAOE piVOLVE CONT�CT PERSON N/D PHONE N0. <br /> A�e„✓ /SJ/l.Die/G. — BOC/A/ A�Nic�N 6 F I a - o <br /> � <br /> a <br /> TI;T 11nFq �AG,000 f-r ,�.vJ -t�i[l/ SvnFY ro I/[ ?'� <br /> z . <br /> ItV G• /S J T i HEREBV CERTIFY THAT 1 HAVE READ AND ExAMINED THIS <br /> rmroseo use or aunnua APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECL ALL <br /> �! T j C/L i% ' PROVISIONS OF LAWS AND OFiDINANCES 60VERNING THIS TVPE OF � ���,i <br /> LEMLDESCNIPTqNOFP110PEflTY�S110WN0ELOWORATTACN7WOCOPIES) WORK WILL BE COMPLETEO WITH WHETHER SPECIFIED HEREIN OR '� <br /> NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO OIVE '��� <br /> �or eiocn o� AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANV <br /> OTHER STATE OR LOCAL LAW HEGULATINd CONSTRUCTION OR THE -�'� <br /> PEflFORMANCE OF CONSTRUCTION.THAT I AM AUTHORI2ED DY THE ����^"' <br /> OWNER OF THIS PHOPERTV TO PEHFOHM THE WORK FOR WHICH . <br /> APPLICATION IS MADE AND I COMPLV WITH THE STATE � <br /> PAi10EL T/JI I.D.NUMBER CONTRACTORS LAW 1827 RCW AND 298200 WAC. <br /> CONSTflUCTqN�ON1LENOEN.�DDf1E35.TELEP110NENUMBEf1 ��. ' <br /> -93 <br /> PflOJECT ADDRE88 s�auiuu wic <br /> i00� 41. CI�S/NU �1F�-� './fRl • I�/Q. cnnxisnesx� Hu � <br /> PLUMSINO MECHANICAL <br /> N��. TYPE OF FlXTURE OR ITEM FEE N0. TYPE OF EOUIPMENT FEE <br /> WATER CLOSET(TOILEn � AI�A/HNDLG UNITS—+i.P. � <br /> BATHTUB ' FORCEDAIRSYSTEMS—B.T.U. M E.A. � <br /> LAVATORY(WASH BASIN) i • UNIT NEATEfiS—B.LU. M i <br /> SHOWER ' CLOTHESDRVERS � <br /> KITCHEN SINK 6 DISP � � S • VENTILATION FAN ; <br /> � DISHWASHER � flANGE HOOD � <br /> UUNDHY TRAV ; • WATER H[ATER ' <br /> CLOTHES WASHER � WOOD STOVE � <br /> URINAL ' METAL FIREPLACE(WOOD BURNIN6) � <br /> DRINKIN6 FOUNTAIN � FIREPUICE INSEHT � <br /> FLOOR DRAIN � • HEAT PUMP � <br /> BACKFLOW PREVENTERS ; GAS PIPINO ' <br /> ROOF DRAINS—RAINLEADERS � � EXHAUST FAN � <br /> SINK(SERVICE—BAR,ETC.) ; <br /> � i <br /> � , <br /> SUB TOTAL S ; SUB TOTAL S ' � <br /> PERMIT S � PERMIT S � <br /> TOTALFEE S ' TOTALFEE S ' � <br /> FOR OFFICE USE ONLY: <br /> FRONTSETBAGK NEA115ET8ACN SIDESETBACN PlANC11ECNNUA10Efl FEE NECEIPiNO. <br /> o�a� <br /> USEIONE LOTAl1EA VACANTSiTE FEES VALUATION FEE <br /> ❑ ves ❑ No eui�oir+a � <br /> IYPfOiCONST NO.OFSTONIES OCpYMn waaruNlltMGunl� � <br /> �"p1P PWMBINQ � <br /> SREOFBL06. FIflESPflVIKLEfiSf1EQD BASEMENi MECHANICAL � <br /> ❑ VES ❑ No , <br /> OCCUPANCYLOAD FIPE/�lAflMflE00 ��EiG�ItLUAIT�TKK� ADDITIONALPUNCHECN � <br /> � ,r� <br /> OTHER � <br /> fiEA50N -� <br /> STATE BUILOIN4 SURCNARGE ; <br /> WTANE BY PUNS PPflOVED BY CITY OF EYERETT PUBLIC WORKS � <br /> 11� LOCAL SALES , <br /> o,ve (� _ � ., q � TAX CODE IS 3105 ��� ; <br /> � <br />