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APPL.I�ATIC'�i FOR CONSTRUCT""'�PI PERMIT ���� <br />TO BE COMPLETED IN BLACK INK—PLEASE PRINT <br />I HEATING SYSTEM: ❑ GAS ❑ ELECTRIC !J <br />BUILDING DEPARTMENT <br />259-8810 <br />DEMOLITION COMBINATION BUILDING `�MECHANICAL PLUMBING ' SIGN <br />OWNEP IdAILADDR[55 CITV ZIP PHONE <br />PLUMBWGLONiRACTOR <br />h1AIL AD�RE55 <br />r> � �!� <br />AIAIL ADDRESS <br />NAIL ND�RE55 <br />: `�O/?` <br />IAAIL ApOHE55 <br />61AR AODRESS <br />NEW ADDITION ALTERATION <br />.�'� <br />CONiRALTPFiLEOPYlONN /nn. <br />OESGR�BE \'lO�K AND SOUAR �OOiA6E INVOLVED <br />� /vrriJt- �vrrf <br />nROPo ouSE F�u1LOWc /� <br />_�L { !�� -r�J' /i �C (i <br />LEGALD[SCRIPTtONOFPROPE�tY�SM YJNp[LOYIORRI <br />LOT OIOLK OF __ <br />CITV 21P vnurv� <br />//�Jy/���7 '� v./� '_1 i <br />UIL�U�' (�//Cl ��'J / �/ <br />CIiY 21P PHONE <br />Gltt ZIP FHONE <br />i1��va� n�d � � �7/- <br />CITY 21P PHONE <br />CITY ZIP PHON[ <br />STAtE LICENSF. � <br />�/Ps' � <br />STATE LICENSE � <br />SIAiE LICENSE • <br />c� <br />REPAIR . DE�dOLITION WOODSTOVE/FRPL INSERT '. �. BUILDING RELOCATION <br />� CONiACT PERSON ANO PHONE NO <br />r�w�'%�� �Z � �L�rF��-rc�. ,��� ��•� <br />� PLUMBING <br />NO. TYPE OF FI%TURE OR ITEM <br />WATER CLOSET �TOILET) <br />BATHTUB <br />LAVATORV (WASH BASIN) <br />SHOWER <br />KITCHE� SINK 8 �ISP <br />DISHWASHER <br />� LAUNDRYTRAY <br />CLOTHES WASHER <br />URINAL <br />. OflINKING FOUNT.41N <br />� FLOOR DRAIN <br />� BACKFLOW PREVFNTERS <br />. ROOF DRAINS—RAINLEADERS <br />- SINK (SERVICE—BAR, ETC.) <br />SUB TOTAL S <br />PERI.tIT $ <br />TOTALFEE 5 <br />FGR OFFiCE USE ONLY: <br />FRONTSETOACN REA85ETBALK <br />USEZONE LOThREA <br />iVPEUFC011i5ALLOWABIE ttPE�i[ONSt.l.C1IlAL <br />SRE OF BLOG. tlOAF STORIES <br />OCCUPAIlGY LOFp FiRE SPRNKLERS REOD <br />INT�KEBY � P�ANSAPaROVEDBY <br />I HEFlEBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br />APPLICATION AND KNOW THE SAME TO BE TflUE ANO CORRECT. ALL <br />COPIES� PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br />WORK WILL BE COMPLETED WITH WHETHER SPECIFIED F'EREIN OR <br />NOT. THE GFiANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br />AUTHORITY TO VIOLATE OR CANCEL THE PRnVISIONS OF ANY <br />OTHER STATE OFi LOCAL LAW REGULATING CONSTRUCTION OR THE <br />PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br />OWNER OF THIS PROPERTY TO PEflFORM THE WORK FOR WHICH <br />' APPLICATION IS MADE AND I COMPLY WITH THE STAT� <br />CONTRA�' RSLAW1827RC�0296200WAC. <br />X �L�{ �/�"'�^ �� / //�- <br />. /L sr.tlnoec � oe.c� <br />AIR."iVSTEMS—B.T.U. M E.A. <br />HEATER <br />METAL FIREPLACE R <br />FIREPLACE INSERT <br />HEATPUMP <br />VAGANT SITF FEES <br />eui�oiNc <br />aaou:c rmmwrti.rocuens �— -- <br />caouo p�UMBIIJG <br />onSEt1EM MECHANICAL <br />HEIGNTLINIiATION ADDITIGNAL PLAN CHECK <br />SPRINKLER <br />STATE B1111.DI�G SUflCHARGE <br />CITY OF E4ERETT PUBLIC WORKS <br />LOCALSALES <br />TAX CODEIS 3105 rora� <br />FEt <br />5 <br />5 �� � � <br />RECEIPT NO. <br />FEE <br />��� <br />� <br />�— <br />oi. � — <br />