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APPLICATIGA FOR CONSTRUCTION <br />PERMIT <br />TO BE COMPLETED IN BLACK INK -PLEASE PRINT <br />HEATING SYSTEM: U GAS ❑ ELECTRIC ❑ <br />BUILDING DEPARTMENT <br />259-8810 <br />I 1 DEMOLITION <br />COMBINATION BUILDING I MECHANICAL <br />PLUMBING I SIGN <br />OWNER �11 <br />ce^e ioI^3Nle. <br />MAIL ADDRESS pp CICITY/' ZIP PHONE <br />e6Zq VI>4, / MY FVC✓PII T,5zo6 <br />3.37- 7 <br />TENANT <br />MAIL ADDRESS CITY ZIP PHONE <br />ARCHITECT ORDESIGNER <br />MAILG ADDRESS// p CITY ZIP PHONE <br />�� ✓'STh R4 982c)6 <br />337-133/ 7 <br />6rnf f"t{ Ie A� <br />1 vY L)f.,e <br />GENERAL CONTRACTOR <br />hi�c+s. J 14, ,S <br />MAIL ADDRESS CITY ZIP PHONE TATELICENSES • <br />3y ZS VV" PIg,e .� r �VezeW Fqz 0 $ 337-1033 �N6E TSN/.�2JS <br />A'�LCHANICAL CONTRACTOR <br />MAIL ADDRESS CITY ZIP PHONE <br />STATE LICENSED <br />PLUMBING CONTRACTOR <br />MAIL ADDRESS CITY ZIP PHONE <br />STATE LICENSE <br />CLASS OF WORK <br />I I Mcw I I AnnPTInEU i I AI TFRATION Lk REPAIR I DEMOLITION I WOODSTOVE/FRPL INSERT I BUILDING RELOCATION <br />/// (/ <br />CONTRACT PRICE OF WORK (.� /DO'v0 <br />_ <br />CONTACT PERSON ANDPHONE NO. _ / <br />`U� / 4/0 k�'j0 -1 337-(733ci 33745-Y <br />DESCRIBE WORK AND SOUARE FOOTAGE INVOLVED <br />F,.c ReL4,f Fi 2' fy uq✓f /1 <br />PROPOSED USE OF BUI DINGd i <br />L( 4 � E L n pet,-rL elt T <br />I HEREBY CERTIFY THAT I h.AVE READ AND EXAMINED THIS <br />APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br />WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br />NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br />AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br />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 296.200 WAC. <br />x <br />LEGAL DESCRIPTION/ OF PROP RTY (SHOWN BELOW OR ATTACH FOUR COPIES) <br />LOT375 120 BLOCK OF <br />Z g 2 % f,%i q �J.lf nKC -: <br />/ <br />E fiL 1 j 4 f (� rr7 <br />- <br />PROJECTADDRESS <br />_ <br />SIGNATURE DATE <br />CITY BUSINESS LICENSE NO <br />PLUMBING <br />MECHANICAL <br />NO. <br />TYPE OF FIXTURE OR ITEM <br />FEE <br />NO. <br />TYPE OF EQUIPMENT <br />FEE <br />WATER CLOSET (TOILET) <br />I <br />A/C —A HNDLG UNITS—H.P. <br />I <br />BATHTUB <br />FORCED AIR SYSTEMS—B.T.U. M E.A. <br />' <br />LAVATORY (WASH BASIN) <br />I <br />UNIT HEATERS—B.T.U. M <br />SHOWER <br />CLOTHES DRYERS <br />' <br />KITCHEN SINK & DISP <br />VENTILATION FAN <br />DISHWASHER <br />RANGE HOOD <br />_ <br />LAUNDRY TRAY <br />; <br />WATER HEATER <br />' <br />CLOTHES WASHER <br />I <br />WOOD STOVE <br />URINAL <br />METAL FIREPLACE & CHIMNEY <br />_ <br />DRINKING FOUNTAIN <br />i <br />FIREPLACE INSERT <br />_ <br />FLOOR DRAIN <br />HEAT PUMP _ <br />BACKFLOW PREVENTERS <br />ROOF DRAINS—RAINLEADERS <br />GAS PIPING <br />EXHAUST FAN 1w <br />I <br />' <br />SINK (SERVICE —BAR, ETC.) <br />I <br />' <br />1 <br />I <br />SUB TOTAL $ <br />i <br />SUB TOTAL $ <br />PERMIT $ <br />I <br />PERMIT $ <br />TOTAL FEE $ <br />TOTAL FEE $ <br />' <br />rvn vrrrvc vAa� <br />FRONT SETBACK <br />v..�.. <br />REAR SETBACK <br />SIDE SETBACK <br />PLAN CHECK NUMBER <br />FEE <br />RECEIPT NO. <br />USE ZONE <br />LOTAREA <br />VACANT SITE <br />FEES <br />VALUATION <br />FEE <br />BUILDING <br />PLUMBING <br />y00' <br />TYPE OF CONTS, ALLOWABLE <br />TYPE OF CONS T ACTUAL <br />OCCUPANCY <br />ND v <br />NO OF WELLING UNGS <br />MECHANICAL <br />' <br />SIZE OF BLDG. <br />pfOa SQ r-) ` <br />NO. OF STORIES <br />BASEMENT <br />—� D <br />ADDITIONAL PLAN CHECK <br />3C% <br />OCCUPANCY LOAD FIRE SPRNKLERS RED'D HEIGHT LIMITATION <br />REASON FOR SPRINKLERS <br />SPRINKLER <br />I <br />STATE BUILDING SURCHARGE <br />PUBLIC WORKS <br />I <br />INTAKE BY <br />FLA APPROVED BY <br />CITY OF EYERETT <br />LOCAL SALES <br />TAX CODE IS 3105 <br />TOTAL <br />Say 16L <br />