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APPLICAT!��N FOR CONSTRUC""ION PERMIT � <br />TO BE COMPLETED IN BLACK INK—PLEASE PRINT <br />BUILDING DEPARTMENT I HEATING SYSTEM: ❑ GAS �J ELECTRIC 'J <br />259-8810 <br />�' DEMOLITION i i COMBINATION !' BUILDING <br />ov�NER rnnanoor��ss Z cirv <br />in���Pi. Yh��.vt :-�i _ 7�KInn�„- MAir�... <br />TENANi <br />a�� <br />i ' MECHANICAL <br />arv zir PHONE <br />I I PLUMBING <br />— /� /� <br />i.l SIGN <br />4RCNI/ECTORUE5IGNER �1MLADORESS ��—T_�� CITY ZIP PHONE v• , <br />Y�� k�d.,,.� �� 1.�,�_,�,� t�_���1NA qo?n�—�a4-��-�5_L-. F�1�o8 <br />GENER�ICONTRACTOR l.1AILqD�RESS GiY ZIP PHONE STATELICENSEa <br />`>Teue I�Ir��lir15 1���OU 5�-"`�Quf l(,�FED�,�� Ly�m�u�� g�o�'7 .:Lfo ��l �3 S� BRi+Pc3 )o'�D� <br />h1ECHpNIC4LCONTPACTOR �dNLADDRESS qTY ZIP PHONE SiATELICENSEn <br />/� 2 � <br />�LOFLCRLtSE 50�.7�13E��PLSE Snoham�c.sh 9Y�� .337—>Oc9Ce C'YUc�np�P�z���; <br />C�NTR�CT �P ICE�OF �RK <br />=(' "-S ��C�� ��� <br />D[SCRI6E WOPH AND SOUAPE FOOTAGE INVOLVED <br />PROPOySED USE C'r 3UILDING • � <br />�_T"�{�� <br />LEGAL DAESCRIPTION OF PROPERTV �SHOWN BELOW O1R ATTACH TWO WPIE51 <br />LOT-1--�--_ p�OCK � OF r/��� * <br />PARCEL <br />NO. <br />� OOS O iS� O/OS� <br />LOAN LEIJ�EF, �D�RESS. TELEPNONE N@dBGR <br />OR ITEM <br />BATHTUB <br />LAVATORY(WASH BASIN) <br />SHOWER <br />KITCHEN SINK 8 DISP <br />DISHWASHER <br />I.AUNDRYTRAY <br />CLO.THES WASHER <br />URINAL <br />DRINKING FOUN7AIN <br />FLOOR DRAIN <br />BACKFLOW PREVENTEflS <br />ROOF DRAINS—RAINLEADERS <br />SINK ISERVICE—BAR_ FTC 1 <br />SUB TOTAL S <br />PERMIT 5 <br />TOTAL FEE $ <br />FOR OFFICE USE ONLY: <br />FRONTSETBACK REARgETOACK <br />USE 20NE <br />iVPE OF COIISi., <br />( y��' <br />size oF o�oc. <br />' 2Q ='J . <br />OCCUPANCYLO�O <br />�Enso � � <br />wrnke ov <br />LOiAREA <br />FIRE SPRINKIEflS REO'0 <br />A/0 <br />FIflE MAF1'd REO D <br />/�}t <br />PLANS�PPROVEO �V <br />O�TE <br />FEE <br />0 <br />PHONE <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br />APPLICATION AND KNOW THE SAME TO 8E TRUE AND CORRECT. ALL <br />PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br />WOflK WILL BE COMPLE7ED WITH WHETHER SPECIFIED HERFIN OR <br />NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br />AUTHORITY TO VIOLATE OR CANCEL THE PqOVISIONS OF ANY <br />OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br />PERFORAIANCE OF CONSTRUCTION. THAT I �M AUTHORIZED BY THE <br />OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br />APPLICATION IS MADE A�ID I COMPLY WITH THC STATE <br />CONTRACTORS LAW 18.27 RCW AND 296.200 WAC. <br />crtr <br />ME <br />NO. <br />PLAN <br />TYPE OF EOUIPMENT <br />A/C—A/HN�LG UNITS—H.P. <br />FORCED AIR SYSTEMS—B.T.U. M E.A. <br />UNITHEATERS—B.T.U. M <br />CLOTHESDRYERS <br />VENTILATION FAN <br />RANGEHOOD <br />WATER HEATER <br />WOOD STOVE <br />METAL FIREPLACE (WOOD BURNING) <br />FIREPLACE INSERT <br />HEAT PUMP <br />GAS PIPING <br />EXHAUST FAN <br />vncnwrsire FEES � <br />❑ vEs 7 Na BUIL�ING <br />OCCUP0.qCY t:p OF0:IELLIN40A�t5 <br />��°�� PLUM8ING <br />�7 <br />BAcSrnENr MECHANICAL <br />C: YES xN0 <br />HEIGHTUlAITATI04 AODITIONALPLANf,HECK <br />OTHER <br />STATE BUILDING SURCHARGE <br />CITY OF EiIERETT PUBLIC WORKS <br />LOCAL SALES <br />TAX CODE IS 3105 TOTAL <br />V �cJ? <br />61—I1 — <br />SUB TOTAL $ <br />PERMIT $ <br />-�TAL FEE S <br />RECEIPT t10. <br />S 3C� C�a/. <br />FEE <br />