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APPLICATIG.J �OR CONSTRUCT �N PER�VIIT � <br />TO BE COMPLETED IN BLACK INK—PLEASE PRINT <br />r HcATING SYSTEM: U GAS ❑ ELECT. RIC ❑ � <br />3UI�GiNG DEPARTMENT <br />259-8810 <br />❑ DEMOLITION ❑ COMBiNATION �� BUILDING iJ MECHANICAL CJ PLUMBING i] SIGN <br />OWNER MAILA�ORESS TY ZIP Lf // PHG E� <br />�G�T <'� !N� 3�3 ,S r,l� ���t� �lfj/ ��� � �d C_/� + �-c��� <br />TENAYT MAILADDRESS CITV ZIP PNONE <br />ARCHITEGTOROESIGNER MP'�ADDRE55 CITV ZIP PHONE <br />GENEflALCONTRAC'iOR MAILAD�RESS CI?V ZIP PHONE STATELICENSEN <br />� O G✓,�1�,� <br />NECHANICALCONTRACTOR MAILADDRE95 CITV ZIP PHONE STATELICENSE# <br />PLUMBINGCONTRACTOR h1?ILAGUAESS LIN ZIP PHONE STATELICENSEp <br />CLASS OF WOflK <br />LJ NEW 17 ADDI'I'ION I.1 ALTERATION L i REPAIR I� I DEMOLITION I_-1 WOODSTOVE/FRPLINSERT I_I BUILDINGREIOCATION <br />ICONTACTPERSOryANDPHONENO. y1z O <br />CONTflACT PRICE OF WURK �� - n, '�' '" <br />1 DESCRIBEWORKANDSOUAREFOOTAGEINVOLVED <br />r � a�� — <br />, PFOPOSEU US° O�ILOING ' <br />SS.�?i�std2� < <br />LEGAL OESCR�FiPN (EHOWN 6ELOV <br />LOT BLOCN OF <br />; � 3 3 SqL <br />�PRQIECT ADDRE55 <br />� <br />� PLUMBING <br />NO. TYPE C <br />: WATER CLOSE <br />BATHTUB <br />� LAVATORY (WA <br />SHOWER <br />. KITCHEN SINK <br />CLOTHES <br />FLOOR DRAIN <br />BACKFLOW Pf <br />ROOF URAIyS <br />� I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br />� APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />FOUflCOPIES) PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br />WORN WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br />— NOT. � HE GRANTING OF A PERMIT DOES NOT PRES1IME TO GIVE <br />AUTHqRITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br />OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br />PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br />OWNER UF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br />APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />CONTRACTORS LAW 1827 RCW AND 296.200 WAC. <br />X •c.���i 7�3/�5 2 <br />L S�GNRTIIRE OATE <br />ITEM FEE NO. TYPE OF E�UIPMENT FEE <br />� A/C—A/HN�LG UNITS--H.P. � <br />�� FORCED AIR SYSTEM�—B.T.U. M E.A. ' <br />� UNIT HEATERS—B.T.U. t.t � <br />� CLOTHi:S DRYERS ' <br />' VENTILATIONFAN �'�� I <br />� RANGEHOOD � <br />j ; WATER HEfTER ' <br />i' <br />' � WOOD STOV� � <br />� METAI FIREPLACE & CHIMNE ' <br />; FIREPLACE INSERT � <br />--� <br />� HF.AT PUMP ' <br />: GAS PIPING , � <br />SUB TOTAL $ <br />PERMIT $ <br />TOTALFEE $ <br />FOW OFFICE USE ONLY: <br />FflOYTS�ACK REARSE,TBACK <br />CJ <br />USEZONE LOTAREA <br />��� <br />TYPECFCONTS.ALL0IVA E 7YFEOFCONSi.ACTIIAL <br />V - n%` ✓ -' '�/ <br />SRE OF BLOG. r� NO. OF STORIES <br />� �l � �' ` 1 <br />OCCUPANCY LOA� FIPE PRNNLERS REO'D <br />�� <br />INTANE <br />SIDE <br />SUB TOTAL $ <br />PERMIT $ <br />TOTAL FEE $ <br />I FEE � RECEIPTNO. <br />'r J- y3 5 7//a 3 <br />VACANT SITE hth5 <br />BUILDING <br />OCNGNICV NO OfpYlElL�ryGUNR3 <br />3 °9�° � PLUMBING <br />BaSEMEN7 MECHANICAI <br />HEIGHT�MITATION AODIfIONALPLANCHECK <br />SPRINKLER _ <br />STATE BUILOING SURCHARGE <br />CITY OF EUERETT PUBLIC WORKS <br />LOCAL SALES <br />TAX CODE IS 3105 TOIAL <br />N <br />