Laserfiche WebLink
� <br />APPLICATIC" 1 FOR CONSTRUCT�N PERMIT <br />TO BE COMPLETED IN BLACK INK—PLEASE PRINT �'n <br />HEATING SYSTEM: ❑ GAS ❑ ELECTRIC ❑ <br />BUILDING DEPARTMENT <br />259-8810 <br />❑ DEMULITION .�COMBINATION ❑ BUILDING ❑ MECHANICAL ❑ PLUMBING ❑ SIGN <br />OWNER MAILAODRE55 CITY 21P PHONE <br />� ,. .�� �rJ�.���b 7�o S�wA�.�e. SQ�A- �IBI�y .�2!-b2gi , <br />TENANT MAILADDflESS CITY ZIP PHONE .�„t �-(_ ��2� ! <br />SE�� �i•,s�aad IMAN.o�c -�f'S3a �ve�.�.�u�a.,_ Evr.�w�-k- q tii20/�-S�S) `` � <br />AflCHITECTOROESIGNEfl MRILADD ESS CITV ZIP PMONE <br />�.�M.(UL l-ivwa�-cl hielsc.� • il� ��Nc ST �'�4- . 98/0 � G23-LI�J`t `7 • <br />GENERALCONTPACTOR MAILAD{�DRE55 CITV 21? PHONE STATELICENSEa <br />�-,,)e1�-rrl.���a.,�ro.�c.+fbn� I�SnJ 2r.e5 141�i E�-LlGrr q�,)! SC'.r1- %8 ��`f 2`dZ'1;�Z1� ^ Se�TCe �DI F3� <br />MECHANICALCONTRAGTOR MAILADDRESS CITV ZIP PMONE STPTELICENSE• <br />'r'F317 � 5 C .�- o <br />PLUMB�CQNTPACTOR MAILADDRESS CITY ZIP PHONE STATELICENSEN <br />I � . <br />CONTF�CT.PRICE OF WOIRK / <br />,�� t031p , <br />AND SOUARE FOOTAGE INVOLVED <br />Z'1 <br />PROPOSED USE OF PUILDING <br />LEGAL DESCRIPTION OF PqOPERTV (SHOWN BELOW OF ATTACH TWO COPIES) <br />LOT BLOCK OF <br />r^ARCELTF%I.D.NUMBEH <br />CONSTBUC110N LOPN LENDEii, ADDP <br />PROJECT ADDRE S/ � <br />`�� <br />PLUMBING <br />Np, TYPE OF FU <br />WATER CLOSET (TC <br />BATHTUB <br />LAbATORY�WASHE <br />SHOWER <br />KITCHEN SINK & DII <br />DISHWASHER <br />LAUNDRYTRAY <br />CLOTHES WASHER <br />URINAL <br />DRINKING FOUNTAI <br />FLOOR DRAIN <br />BACKFLOW PREVE <br />ROOF DRAINS—RA <br />SUB TOTAL 5 <br />PERMIT 5 <br />TOTAL FEE $ <br />FEE <br />0 <br />GONTACT PERSON AND PMONE NO. <br />'M►P,:�ty.\L. zo1o� zg2--13po <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br />APPLICATION AND KNOW THE SAME TO BE -RUE AND CORRECL ALL <br />PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br />WORK WILL BE COMPLETGD WITH WHETHER SPECIFIEO HEREIN OR <br />NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br />AUTHORITY TO VIOLATE OR CANCEL THE PFlOVISIONS OF ANY <br />OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br />PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY T;IE <br />OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br />APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />CO TO LAW 18.27 RCW AN 296200 WAC. <br />.� ( `, ��A.ta,�_� 9-I�-`T�—I <br />OF <br />FORCED AIR SYSTEMS—B. <br />UNIT HEATERS—B.T.U. M <br />CLOTHES DRYERS <br />VENTILATInN FAN <br />WATER HEATER <br />WOOD STOVE <br />METAL FIREPJ�CE ( <br />FIREPLACE I�JSERT <br />HEAT PUMP <br />GAS PIPING <br />EXHAUSTFAN <br />FOR OFFICE USE ONLY: <br />FqONTSETBACN RE4RSETBACN SIDESETBACN PLANCHE KNUMBER <br />SLv % 3 <br />USEZONE I �OTAREA <br />ttPEOfCONSi �����ra�v��ca <br />SIZE OF BLDG. FIRE SPFINKLERS REO'D <br />2 o t• � • "V� <br />OCCUPANCYLOAD PIREALAFMPEO'0 <br />� �V <br />REASON ,// <br />�/� J rL? . <br />INTAKE BY PLANS AP (ZVEO BV <br />sv� <br />❑ YES O NO BUILDING <br />occuauicv xo.ormttwrvsuxrts <br />av,L pLUMBING <br />BnSEMENT MECHANICAL <br />❑ ves n No - <br />HEiGHT uMI7ATiON ADDITIONAL PLAN CHECK <br />OTHER <br />STATE BUiLDING SUf1CHAFGE <br />CITY OF EYERETT PUBLIC WORKS <br />LOCALSALES <br />TFlX CODE IS 3105 rora� <br />� <br />M E.A. <br />—,-- <br />� <br />� <br />�T <br />SU9 TJTAL $ � <br />PERh71T 5 � <br />TOTAL FEE S ' <br />F� � � �v RE�a�s�� <br />VALUATION FEE <br />ao c�� � �o �� <br />� <br />i <br />i <br />� <br />� <br />� <br />i <br />i <br />i <br />�4 <br />i <br />� <br />� <br />