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� <br /> .APPLICATIOrI FOR CONSTRUCT JN PERMIT �'Ve�p�t <br /> ��E,�,�,�„ TO BE COMPLETED IN INK—PLEASE PRINT � <br /> arv oF <br /> eve rett HEATING SYSTEM: GAS ❑ELECTRIC ❑ <br /> BUILDING DEPARTMENT <br /> 259-8810 � � <br /> ❑ DEMOLITION f_l COMBINATION I I BUILDING li?'MECHANICAL I I PLUMBING I I SIGN <br /> OWNFfi MAILRODfiE55 CITY ZIP PHONE <br /> I�noniuE SAYA1�1 (Z� l��iT�ST S U #I Fv pFrr 9R�C�y 7y -�5�� <br /> TENRNT MAIIAUURESS CITY ZIP PHONE <br /> ARCHIIECTOHDESIGNEH 1d�IlADDRESS CITY ZIP PHONE <br /> GENERQCONiBAC70H MAIIAU�RESS CITY ZIP PIIONE �ICENSE/ <br /> (�a�naoE�,y.�M�-►ariA po.Cir�r�y� �,v► m .� i��A_gg�t. y74--��3 <br /> MECHANICAICONTRACTOR M�KADURE55 �� CITY IIP PHONE LICENSE/ <br /> Ol4Mv�CMCJ.�A�G.�i� aor�r�r�2l �y�;y��..���c.�/� q�0 (o y7y-�S�ll ��ypy1r17oo� <br /> PLUMBNN3CONTRACTOR M�ILAUDRE55 CITY ZIP PHONE LICENSE� <br /> C SOFWORK <br /> . NEW I � ADDITION I I ALTERATION I I REPAIR I I DEMOLITION I I WOODSTOVE/FRPL INSERT I_i BUILDING RELOCATION <br /> CONT�CT PERSON ANO PNONE NO. <br /> , CONTRACTPRICEOFWOflK O OO _ <br /> L <br /> DESCRIBE VNRK�ND SW�RE FOOTAGE INVOIVEU <br /> 5• � <br /> PiqPOSEDUSEOFBUIlOMO I HEREOY CERTIFY THAT I HAVE READ AND E%AMINED THIS <br /> ' �Q�fit APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT.ALL <br /> IEG�L DESCRIPTqN OF PROPERTY�SNOWN BELOW OR ATTRCH FOUfl COPIE51 PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br /> WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br /> �oi aiocK oF NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br /> - AUTHOHITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br /> FEL]Fic L I�1# q I 14�'i7�1 C� OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br /> PERFOHMANCE OF CONSTRUCTION.THAT I AM AUTHORI2ED 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 1827 RCW AND 296200 WAC. <br /> � SI6NATUpEOFCONiMCTOf10R�UTNOHREDAGENT DAi <br /> 70� <br /> _ ' R6E X <br /> P SS <br /> � AVMICANTSCITY 5$� SENO.MlD&1 SNAME <br /> PLUM IN6 MECHANICAL <br /> NO. TVPE OF flXTURE Ofl ITEM FEE NO. TYPE OF E�UIPMENT FEE <br /> WATER CLOSET(TOILEn � A/C—A/HNDLG UNITS—H.P. , <br /> BATHTUB ; FORCED AIR SYSTEMS—B.T.U. M E.A. � <br /> LAVATORY(WASH BASIN)� � � UNIT HEATERS—B.T.U. M ' <br /> SHOWEF � CLOTHES DRYERS � <br /> KITCHEN SINK 6 DISP ; VENTILATION FAN � <br /> DISHWASHER � RANGE HOOD , <br /> LAUNDRYTRAY ; WATER HEATER � <br /> CLOTHES WASHER � WOOD STOVE ; <br /> URINAL ; METAL FIREPUICE 8 CHIMNEY � <br /> DRINKING FOUNTAIN i FIREPLACE INSERT ; <br /> FLOOR DflAIN � HEAT PUMP � <br /> —�_ <br /> BACKFLOW PREVENTERS ; GAS PIPING � <br /> ROOF DRAINS--RAINLEADERS � EXHAUST FAN , <br /> SINK(SERVICE—BAR,ETC.) � , <br /> ' � <br /> � � <br /> � � <br /> � <br /> � <br /> � <br /> � <br /> SUB TOTAL S ; SUB TOTAL S — <br /> PERMIT S � PEHMIT $ ; � <br /> TOTALFEE S ' TO7ALFEE $ '� � <br /> FOR OFFICE USE ONLY: <br /> FNONTSETBACN qEANSETBACK SIDESETBACN PLMlCHECKNUMBEii FEE RECEIPTNO. <br /> USE ZONE LOT APEA VACANi 51IE FEES VALUATION FEE <br /> AUILDING ' <br /> i <br /> fYl'EOfCONISALOWA0IE IYPEOfCON5IAC111AL axUru1tr Mn�puWnpq,ux�ls — <br /> cnmr PLUMBINC� � <br /> i <br /> SI2EOFBLO(i. NO.OFSTORIES BASEMENf MECHANICAL 9//hJ�I <br /> — _—L�-/1— <br /> OCCUPANCYLOAD FIRESPfiNKLEfl5flE0'D HEIGHTLIMIiA710N ADDITIONALPL/�NCHECK � <br /> i <br /> i <br /> omeR � <br /> REASON FOR SPRINKI.ERS � <br /> STATE BUILOING SURCHAfiGE � . <br /> INfAKE BY PL�N^u APPPOVEO BY CITY OF EYERETT PUBIIC WORKS i <br /> LOCALSALES ' <br /> TAX CODE IS 3105 to��� q��� � <br /> -- — ------- - -- -- __—�- _ <br />