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� <br />APPLICATIC"1 FOR CONSTRUCT'-lN PERMIT �� _ <br />TO BE COMPLETED IN BLACK INK—PLEASE PRINT vtrJF. rErr <br />� <br />BUILDING DEPARTMENT HEATING SYSTEM: ❑ GAS ❑ ELECTRIC ❑ � <br />259-P810 <br />❑ DEMOLITION ❑ GQNBINATION "I';'., l i•,BI,�ICD�JG�„i; i:' f7 MECHANICI,L ;�]+PLUMBING ' i SIGN <br />OWNER �/� � MAILADORE55 GTY ZIP PNONE - <br />�t���� l�'�+�eu� u�s ��,'4Ylr GL 51�r� �/ � ti��'ETr q�ab�� 3y��'Pv3 , <br />TENANT MAILF�DRE55 CITY ZIP PHONE �'-�-. � <br />��i%�l� r� i �s.fJ G� �'7,� 0� G��� C.PEE2� L�i,� � _-----= <br />ARCHIT CTORDE..IGNER MAILADOf1ES5 CITV ZIP � PHONE -�" , <br />/ tr,�:_:'�.,'.li : � <br />GENERAL CONTR�CTOq MAll4�DRESS CITV ZIP PHONE � ' ' "�STATE LICENSE p `" � �' - � � <br />MECHANICALLONTRACTOR IAAILA�DRE55 CITV 21P PHONE STATEUCENSEa <br />: I;F'(.��.,I � I i � <br />PLUMBINGCONTP�CTOR MAILA�DRE55 CIiV ZIP PHONE Si{�TELIC�N$E�a!�. �,,.. . <br />CONTRACTPRICEOFWORN � ��-' �� �� � - - � <br />;� . . I� j . .. � I%'J <br />J CRIBEWORKANDSOUAREFOOTAGEINVOLVED CONTACTPERSONAMDPHONENO. <br />eJ �!o �. � I�i�'.�'�."�•.!�.i-„..-�, <br />,G n..�oc ..� Sfr�- � - �O�p � r, <br />PROP6�ED USE O� BUILDING <br />N� kr�=,��1, SFRUf� �,S i9/(° S� <br />LEGAL OESCRIPTION OF PROPEqTV �SHOWN BELOW OR AiTFCN TWO COPIES) <br />LOT BLOCK OF ���� <br />PARCELTA%I.D.NUMBER <br />CONSiRUCTION LOAN LENDER. ADDRESS, <br />PROJECTADDRESS <br />NO. TYPE OF FIXTURE OR ITE <br />WATER CLOSET (TOILET) <br />_ BATHTUB. _ <br />LAVATORY�WASH BASW) <br />SHOWER <br />KITCHEN SINK 8 DISP <br />DISHWASH[R <br />LAUNDRYTRAY <br />CLOTHES WASHER . <br />URINAL <br />DRWKINGFOUNTAIN �-�- � <br />FLOOR DRAIN <br />BACKFLOW PREVENTERS <br />ROOFDRAINS—RAWLE,\DERS ��� <br />SINK (SERVICE—BAR. ETC.) <br />NUMOEfl <br />SUB TOTAL $ <br />PERMIT S <br />TOTALFEE 3 <br />FOR OFFICE USE ONLY: <br />FRONTSETBAGK REnnSE(BACK <br />r <br />b ,p <br />USEZ/ON�E LOTAREA <br />TVPEO ONSi NO.OFSTORIES <br />�i9 �> � <br />OCCUPANCYLOAI <br />/ <br />flEASON <br />INTANE BY <br />FIRE SPRINKLEflS flE0'D <br />No <br />FIRE ALARId FEO'D <br />No <br />DATE <br />BY <br />/ UN(�/ <br />i HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br />APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />PROV�SIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br />�� � WOF�K�WILL�BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br />NOT. THE GRANTING OF A PERMI7i DOES� NOT PRESUME �T/J 31VE <br />AUTHORITY TO VIOLATE OR CANCEL�THE PROVISIONS OF ANY <br />��t � � OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTIGhI,'OR THE <br />PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br />OWNER OF THIS PROPERTY'TO�PERFOI7M�nHE' WORR�FOR'WHICH <br />. APPLICATION IS MAQE AND.,I COMPLY WITH,..THE.,STATE <br />, � � CONTRACTOflS LAW 18.Z7 RCW AIJD 296.200 WAC. '" '� �� <br />���� �Qz✓r�_ �'�iS/-�/� <br />/ _� <br />� . � 5'4Nhyrt ii� I. . onre �� <br />FEE <br />N0, i r. TYPE OF EOUIPMENT <br />AIC—A/HNDLG UNITS—H.P. <br />� =' � ORCED AIR SVSTEMS—B.T.U. <br />UNIT HEATERS—B.T.U. M <br />CLOTHES DRYERS <br />� �� ' ' V NTILATION FAN <br />RANGEHO00 <br />WATER HEATER <br />� WOOD��STOVE <br />.��. �METALFIREPLACE�WOODBURN <br />FIREPLACE INSERT <br />HEAT PUMP <br />. . GAS PIPING <br />�� � EXHAUSTFAN <br />SUB TOTAL $ <br />PERMIT 5 <br />TOTAL FEE S <br />SIOESEIBACK PLqNCHECI' UMBER FEE <br />.� <br />6 � .�.� c�.._. .� %� <br />vncaNrstTe FEES VALUATI( <br />� YES l_' NO BUILDING <br />OCLU�P'ILY 1lOOiDWELLIilCUNi$ '(�r�� <br />eeeua �/ PWMBING <br />�7 jo <br />BnSEMENT MECHANICAL <br />❑ YES }� NO <br />HEiGHi urnirnnorv A�DITIONAL PLAN CHECK <br />�� OTHER <br />S7ATE BUILDING SURCHARGE <br />CITY OF EUERETT PUBLIC WORKS <br />LOCALSALES <br />TAX CODE IS 3105 rora� <br />0 <br />� <br />� <br />T <br />