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APPLICATIO� FOR CONSTRUCT; )N PERMIT � <br /> TO BE COMPLETED IN BLACK INK—PLEASE PRINT <br /> BUILDING DEPARTMENT HEATING SYSTEM: ❑GAS a ELEC'fRIC ❑_ <br /> 259-8810 <br /> ❑ DEMOLITION ❑ COMBINATION ❑ BUILDING ❑MECHANICAL ❑PLUMBING ❑ SIGN <br /> OWNER MAILADDRE55 CIN ZIP PHONE <br /> �SE�FJRST. ��• ��C 3`�033 SC.E;.�F 9�f��{ 358-/oa9 <br /> TENANT MAILADDRE55 �IN ZIP PHONE <br /> saMR ,Soi9 r-_��..,�4a�.e,� w�r F_v�K�7; <br /> APCHITECTORD"cSIGNER MAILADDRE55 CIN ZIP PHONE <br /> GENEBAL CONTRACTOB MAIL ADDRESS CIN ZIP PHONE �rr. ��`STATc LICENSE/ <br /> F� F_�os 1200� sF�✓,�e, �.�� as��s� yst` .9✓e s. /Cfr� 98a3� F�-ec- e.z-sx�� � <br /> MECHANICALCONTFACTOR MAILADDRESS CITV ZIP PHONE SIATELICENSEt <br /> . PLUMBING CONTflACTOR MAIL ADDRESS CITV ZIP PHONE STATE LICENSE N <br /> CONTqACT PRICE OF WORK <br /> 8 y�_ o <br /> �ESC E WORK AND SOUARE FOOTAGE INVOLVED CONTACT PERS N AND PHONE NO. <br /> or �oa s. — :< �S-S-�S'aG <br /> I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br /> PROPOSED USE OF BUILOING APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT.ALL <br /> BAN1=�N 4 PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br /> LEGALOESCRIPTIONOFPflOPEFTY�SHOWNBELOWORAITACHTWOCOPIES) WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br /> NOT. THE GRANTING OF A PERMIT DOES NO'f PRESUME TO GIVE <br /> LOT ' BLOCK oF AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br /> OTHER STATE OR LOCAL LP.W REGULATING CONSTRUCTION OR THE <br /> PERFORMANCE OF CONSTRUCTION.THAT I AM AUTHORIZE�BY'i HE <br /> OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br /> APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> PARCEL TPX I.D.NUMBER CONTRACTORS LAW 18.27 RCW AND 296200 WAC. <br /> 8/ -000 - oi7- a�o /� /'� <br /> CONSTRUCTIONLOANLENDER,AODRESS.TELEPHONENUMBER '( �/'�_ O /�_,s/ �/yly3 _ <br /> AJQ�7�S <br /> - PROJECT ADDRESS S�GNATUPE o..e <br /> �O� � �5.�, CITYBUSINESSUCLNSENO. <br /> PLUMBING MECHANICAL <br /> N0. TYPE OF FIXTURE OR ITEM FEE N0. TVPE OF EQUIPMENT FEE <br /> WATEFi CLOSET(TOILET) � A/�NHNDLG UNITS—H.P. � <br /> BATHTUB ; FORCED AIR SYSTEMS--B.T.U. M E.A. ' <br /> LAVATORY(WASH BASIN) � UNIT HEATERS--B.T.U. M � <br /> SHOWER � ' CLOTHES DRYERS � <br /> KITCHEN SINK&DISP � � VENTILATION FAN � <br /> � DISHWASHEq � RANGE HOOD � <br /> LAUNDRY TRAY ; WATER HEATER " <br /> CLOTHES WASHER � WOOD STCVE � <br /> URINAL ; METAL FIREPLACE(WOOD BURNING) ' <br /> DRINKING FOUNTAIN � FIREPLACE INSERT � <br /> FLOOR DRAIN ' HEAT PUMP ' <br /> BACKFLOW PREVENTERS ; GAS PIPING � <br /> � <br /> ROOF DRAINS—RAINLEADERS � EXHAUST FAN � <br /> SINK(SERVICE—BAR,ETC.) ; � <br /> , i <br /> i � <br /> SUB TOTAL $ ' SUB TOTAL $ ' <br /> PERMIT $ � PERMIT $ i <br /> TOTAL FEE $ ' TOTAL FEE $ ' <br /> FOR OFFICE USE ONLY: <br /> FRONTSETBACK REARSETBALN EIDESEiBACH PLANCHECKNUM�ER FEE FECEIPTNO. <br /> /�a� <br /> USEZONE LOTAREA VACANTSITE FEES VALUATION FEE <br /> O YES � NO BUIL�ING ,� � ' <br /> NPEOFCONST. NO.OFSTORIES OCCUVAN:Y xOAFOWEIInICUNrtS i <br /> eAoua pLUMBING i <br /> SREOFBLOG. FIRESPHINKLEfl5RE0'D BASEMENT MECHANICAL � <br /> ❑ YES ❑ NO 1— <br /> OCCUPANCVLOAD FIFEALARMFEO'D HEIGHTLIMITATION ADDITIONAIPLANCHECK i <br /> i <br /> OTHER i <br /> FiEASON i -7� <br /> STATE BUILDING SURCHARGE �S(/ <br /> INTAHE BV PLANSAPPROVED BV CITY OF EUERETT PUBLIC WOFiKS i <br /> LOCALSALES —� <br /> onre TAX COOE IS 3105 TOTAL a�� ; �� <br />