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— , , <br /> _ �. <br /> APPLICATIC _J FOR !�`flNSTRUC7 . JN PERMIT ���� <br /> TO BE COMPLETED IN BLArK INK-PLEASE PRINT <br /> HEA7ING SYSTEM: C�GD.S ❑ELErTRIC ❑ <br /> BUILDING DEPARTMENT <br /> 259-8810 <br /> i-i DEMOLITION f l COMBINATION � � BUILDING i I MECHANICAL I_I PLUMBING XSIGN <br /> OWNEfl MAILADDRE55 CIN ZIP PHONE <br /> �q�ernc������.��.�,� ���n�t�,�, a�oo� �a-a-�?3 <br /> TEKAN ��MAILADDRE55 CITV ZIP PHONE <br /> E-Caql�1"�'lcs�'�tIG���cooNE33�i-"t.�o r�IlevuL�-I a8a—(v733 <br /> ARCHI EC ORDESIGNER ODRESS GTV ZIP PH E <br /> , ���x, �,�,S��t��� ���-v� V� r��L Q`�3u io�aam ��-,-�a N��s <br /> GENERALCONTRA^.TOF MAILADOHESS CITY ZIP PHONE STATELICENSEt <br /> MECHANICAL:ONTRACTOP MAI'„qDDRESS CITV ZIP PMONE STATE LICENSE I <br /> PLUMBINGCONTRACTOR MALL.AOOPE55 CITV ZIP PHONE STATELICI:NSEt <br /> GLASS OF WOFK <br /> �NEW Ll ADDITION I �. ALTERATION I .i REPAIR I i DEMOLITION f I WOODSTOVE/FRPLINSEflT I I BUILDINGRELOCATION <br /> �/�.�� /—�/� GONTACT PERSON AND PHONE N0. <br /> CONTFACTPRICEOFWORK LJ(,JLJ. VlJ � a3-�ioo <br /> DESCRIBE WORK AND S�UARE FOOTAGE INVOLVED <br /> ����2'-�," ' 1'�lnX.3 `�,S�ifb� -1 �S�enCh• <br /> PROPOSEDUSEOF UILD G �� i HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br /> � APPLICATIOI�AND KNOW THE SAME TO BE TRUE AND CORRECT.ALL <br /> LEGAL DESCRIPJI O PROPEflN(SMOWN BELOW ORATTACM FOURCOPIES� PROVISION£OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br /> WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br /> �or BLOCK oF NOT. THE GRANT�NG OF A PERMIT DOES NOT PRESUME TO GIVE <br /> AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br /> � CF OTHER STATE OR LOCAL LAW REGULATING 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 /> \ \ �e � � o rY1 � �l.�oL�� l�-�'�� <br /> Pp0.1ECT ADDRESS �� • SicN�ruac Z,-�^'� o�re <br /> 7L?� <br /> Cltt BUSINESS LiCENSE NO. <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FD(TURE OR ITEM FEE NO. TYPE CF EQUIPMENT FEE <br /> WATER CLOSET(TOILET) � AIC—A/HNDLG UNITS—H.P. <br /> BATHTUI ; � FORCED AIR SYSTEMS—B.T.U. M E.A. ' <br /> LAVATORY(WASH BASIN) i UNIT HEATERS—B.T.U. M � <br /> SHOWER ' CLOTHES DRYERS ' <br /> KITCHEN SINK&DISP VENTILATION FAN � <br /> DISHWASHER � RANGE HOOD � <br /> LAUNDRYTRAV ; WATER HEATER ' <br /> � <br /> - CLOTHES WASHER � VJOOD STOVE � <br /> URINAL ; METAL FIREPLACE 8 CHIMNEY ' <br /> DRINKING FOUNTAIN i FIREPLACE INSERT i <br /> FLOOR DRAIN � HEAT PUMP ' <br /> BACKFLOW PREVENTERS � GAS PIPING � <br /> ROOF DRAINS—RAINLEADERS � EXHAUST FAN � <br /> SINK(SERVICE-9AR,ETC.) � ' <br /> � �_ <br /> i ' <br /> � <br /> � <br /> � <br /> SUBTOTAL $ ' SUBTOTAL S ' � � <br /> PERMIT $ � PERMIT $ � - � <br /> TOTALFEE $ ' TOTALFEE $ ' _ <br /> FOR OFFICE USE ONLY: �a-30� <br /> FflONTSETBACK FEARSETBACK SIDESETBACK PLANCM CK_f, NUb19ER FEE „ n �S RECEI��/ T <br /> _���a_ ��� � V <br /> usezoNe �REA vncnNrsire FEES VALUATION FEE <br /> C� ( '7 ,�� BUILDING � ' <br /> TYPEOFCONTS.ALLOWABLE TYPEOfCONST.ACiUAL oCGu>.uitr NOOfVNEiUNGuxnS � <br /> eaouv � pLUMBING � <br /> SIZEOFBLDG. NO.OFSTOR!ES BASEMENT MECHANICAL � <br /> OCCUPANCY LOAO FIRE SPRNKLEFS FEO'D HEIGHT LIMITATION ADDITIONAL PLAN CHECK � <br /> p �� i <br /> F•x'�'Id/JE SPRINKLER i <br /> REASON FOR SPflINKLERS � <br /> STATE BUILDING SURCHARGE �6� <br /> INTAKE BV PLANS PPROVEG BV CITY OF EYERETT PUBLIC WORKS i <br /> LOCAL SALES , / ; Sv <br /> TAX CODEIS 31OS TOTAL 7 <br />