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APPLICATIG`�'J FOR CONSTRUC'f��JN PERMIT <br />TO BE COMPLETED IN BLACK INK—PLEASE PRINT ����� <br />I HEATING SYSTEN: C] GAS ❑ ELECTRIC ❑_ <br />BUILDING DEPARTMENT 7� �, <br />259-8810 //J�� n : ,is �,: (�� � IG� � �' :, � �vCl loa.7 -�03 =.. <br />L I DEMOLITION C 1 COMBINATION I 1 BUILDING CI MECHANICAL <br />TENANT <br />MAIL ADORESS <br />cin <br />ZIP <br />V'�IONE <br />LJ PLUMBING <br />AFCHITECTOFDESIGNEF MAIIAD�RE55� CITV ZIP PHONE <br />Sl�l< <OIST'Ri�Ci�R <br />GENERALCONTRACTOR MAILAOOFIESS CIN ZIP PHONE STATELICENSEp <br />MEVHt scc�� c�i IN�- psL]%_33143 SenYttE WA 48133-3"t`i} �2UV243 MEVERS�lf214�E <br />MECHANICALCONTRACTOR MAILAD�BESS CITY 21P PHONE STATELICENSEu <br />P�1M INGCONTRACTOR MAILADDRESS CITY ZIP PHONE STATELICENSEx <br />�SS QF WORK <br />NEW L] ADDITION LI ALTERATION <br />... rs _ "' G O <br />DESCRIBE VlORK AND <br />USE OF BUILUING <br />I�. i REPAIR I� I DEMOUTION I 1 WOODSTOVE/FRPL INSERT I I BUILDING RELOCATION <br />LEGAL �ESCRIPTION OF PROPERTY (SHOWN BELOW OF A7TACH FOUR COPIES) <br />LOT BLOCY. �F <br />PRQIECTAODRESS <br />PLUMBING <br />NO. TYPE OF FIXTURE <br />WATER CLOSET (TOILET) <br />BATHTUB <br />KITCHEN SINK & DISF <br />D�SHWASHER <br />LAUNDRYTRAY <br />CI OTHES WASHER <br />URINAL <br />DRINKING FOUNTAIN <br />BACKFLOW <br />_ RJOF DRAI <br />FOR OFFICE USE ONLY: <br />FflONiSETBACK AEAP'. <br />(,—II� <br />TYPE OF C01li5. ALLOV <br />SRE OF BLUG. <br />OCCUPANCYLOAD <br />REASON FOR SPflll <br />INTt KE BY <br />FEE <br />SUB TOTAL 5 <br />PERMIT $ <br />TOTALFEE 5 <br />AREA <br />�jo �6 <br />OF W NSi. ACTUAL <br />OF STORIES <br />: SPRNKLERS REO'D <br />NS EDBV <br />�_17_ <br />VACANT SITE <br />CONTACT PEflSON AND PHONE NO. <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br />APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />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 REGULATING CONiTflUCTION OR THE <br />PERFORMANCG OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br />OWNER OF THIS PROPERTY TO PERFORM THE WOHK FOR WHICH <br />APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />CONTRACTORS LAW 18.27 RCW AND 296.200 WAG. <br />X / `:hqa 7�Q��4 <br />SIGNAiU AiE <br />{:I I1 tlY]M[�a ���.cn�c n� <br />MECHANICAL <br />10. TYPE OF E�UIPMENT <br />AI�NHNDLG UNITS—H.P. <br />FORCED AIR SYSTEMS—B.T.U. M E.A. <br />UNIT HEATERS—B.T.U. M <br />CLOTHES DRYERS <br />VENTILATION FAN <br />PLAN <br />RANGEHOOD <br />WATER HEATER <br />WOOD STOVE <br />HEAT PUMP <br />GAS PIPING <br />EXHAUST 5 <br />& CHIMNEY <br />BUILDING <br />acuvaxcr rmo�o-x[wn,urvrts <br />�flO�P � PLUM6ING <br />BASEMENt MECHANICAL <br />HEi 7uMrtnTloN ADDI710NAL PLAN GHECK <br />oFL��NG SPRINI'LER <br />STATE BUILDING SURCHARGE <br />CITY OF EIIERETT PUBLIC WORKS <br />LOCALSALES <br />TAX COOE IS 3105 TOTAL <br />PEFMIT <br />T.OTA� FEE <br />I FECEIPTNO. <br />�o, a o <br />ret <br />