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APPLIC�'�TIO: \� FOR CONSTRUCT(�N P�RIIAIT � <br />T�J 6�E COMPLETED IN BLACK INK—PLEASE PRINT <br />�� HEATING SYSTEM: Cl GAS ❑ ELECTRIC Q —� <br />BUILI�ING DEPARTMENT S <br />259•8810 <br />t I DEMOLITION C 1 COMBINATION �� BUILDING MECHANICAL �PLUMBING i 1 SIGN <br />OWNER � _ NAILADORES� _ n CI ' 21P PHOHE '//� n/_^^ <br />GONTHACTOR <br />MAIL ADDRESS <br />MAIL ADDRESS <br />MAIL ADDRESS <br />1l� �Cr�nntl-, � ZD,�i <br />��ry 21P PHONE <br />CIN ZIP PHON'c <br />��7y ZIP PHONE <br />��ry ZIP PHONE <br />_/Uc� ��Ty Zlp PHONE <br />STATE LI�ENSE M <br />STATE UCENSE � <br />STATE LICENSE s <br />CLASS OF WORK <br />�NEW � 1 ADDITION ❑ ALTERATION f-1 REPAIR I J DEMOLITION I.'�. WOODSTOVE/FRPL INSEFT f_1 BUILDING RELOCATION <br />I CONTACTPERSONANDPHONENO. <br />CONTRACT PRICE OF WORK <br />4 <br />Pfi0iO5ED USE OF BUILDING <br />LEGAL DESCRIPTION OF PROPcflN (SHOWN BELOV <br />LOT BLOCK OF <br />.3.32_ S� �J <br />PLUMBING <br />NO. TYPE OF FIXTURE C <br />� WATER CLOSET (TOILET) <br />BATHTUB <br />KITCHEN SINK & DISF <br />DISHWASHER <br />LAUNDRYTRAY <br />CLOTHES WASHER <br />URINAL <br />DFlINKING FOUNTAIN <br />FLOOR DRAIN <br />BACKFLOW PREVENI <br />ROOF DRAINS—RAIN <br />SINK (SERVICE—BAR <br />REM <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br />APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />COPIES� PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br />WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br />NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br />AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br />OTHER STATE OR LOCAL LAW REGUUITING CONSTRUCTION OR THE <br />PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br />OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br />- APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />CONTRACTORS LAW 18.27 RCW AND 296200 WAC. <br />X / / ��� �/""`i_ /s <br />7 �� _ oere <br />`�" CINBUSINESSLICENSENO. <br />MECHANICAL <br />FEE NO. TYPE OF E�UIPMENT FEE <br />A/�PJHNDLG UNITS—H.P. <br />FORCED AIR SYSTEMS—B.T.U. <br />UNIT HEATERS—B.T.U. M <br />CLOTHES DRYERS <br />VENTILATION FAN <br />RANGEHOOD <br />WATEH HEATER <br />W OOD S'i OVE <br />METAL FIREPLACE & CHIMNEY <br />FIREPLACE INaERT <br />HrAT PUA9P <br />GAS PIPING <br />EXHAUSTFAN <br />SUB TOTAL 5 <br />PERMIT 5 <br />TOTALFEE 5 <br />FOR OFFICE USE ONLY: <br />FRONTSETBACN FEAflSETB�CK <br />USE20NE IGTAREA <br />lYPEOFCONiS.AILOWABLE IVPEOFLONSi.ACTO�L <br />SREOrOL�G. N0.vF570RIED <br />OCCIIPANCV LOAD FIRE SPRNKLERS REO'D <br />INTAKE BY <br />BY <br />SiLP. <br />BUILDMG <br />OWOGANLV N9.OfDWFLLINGON115 <br />cnour pLU!ABIIJG � <br />oASGdENT MEGHANICAL <br />HEIGHiLIMITATION ADDITIONALPLANCHECK <br />SPRINKLER <br />STATE BUILDING SURCHARGE <br />CITY OF EYERETT PUBLIC WORKS <br />LOCALSALES <br />TAX CODE IS 3105 Tora� <br />TOTAL <br />$ <br />FEE � RECEIPTNO. <br />M <br />� <br />