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APPLICATIQ ~ FOR CONSTRUCT'lN PERMIT � <br />TO BE COMPLETED IN BLACK INK—PLEASE PRINT <br />BUILDING DEPARTMENT L <br />259-8810 <br />LI DEMOLITION I_i COMBINA��ON <br />OWNER M�ILAO�RESS <br />[?.r-_. �t�,C�k H�,.; ��i.�� i�s <br />ICNANT � u.vi ennocec <br />ARCNITECTORUESIGNER 61pILADORESS <br />GENERALWNiRpCTOR MAllA00RES5 <br />HEATING SYSTEM: f] GAS <br />f=] BUILDING <br />CITV <br />%b� i� � � <br />CITY <br />GI7Y <br />IC ❑ <br />LJ MECHANICAL [� PLUMBING <br />ZIP PHONL <br />�La3 �1�-i2�3S� <br />21P PIION[ <br />�"' Z�N VHONE STFT[LICENSE/ <br />SY�1'. <br />McCHANICALCONTRACiOR MRILADDRE55 CITV Z�P PHONE STRTELICENSEII <br />PWMBINGCONTRACTOR MAILAD�RE55 CITY ZIP PNONE SUTELICeNSE1 <br />CONTRACT PRICE OF WORK <br />OLSCRIBE WORK AND $OUARE FOOTqGE <br />J <br />PROPOSED USE OF BUIL�ING <br />LEGAL �ESCFIPTION OF PROPERiV (SHOWN BF:LOW OR A7TACN TWO COPIES� <br />AT�_ BLOGK � OF ��VYVt� � <br />%��R'-l-. i-� I, �k 7�5� "' � U <br />PARCEITA%ID.NNdBEF <br />CONSTRUCTIqN LOFN LE� <br />TYPE OF FIXTURE OR REM <br />WATER CLOSET (TOILET) <br />BATHTUB <br />LAVATORY (WASH BASIN) <br />SHOWER <br />KITCHEN SINK 8 DISP � <br />DISHWASHER <br />LAUNDRYTRAY <br />CLOTHES WASHER <br />URINAL <br />DRINKING FOUNTAIN <br />FLOOR DRAIN <br />BACKFLOW PREVENTERS <br />ROOF DFAINS--RAINLEADERS <br />SINK (SERVICE—BAR. ETC.1 <br />SUB TOTAL 5 <br />PERMIT g <br />TOTALFEE 5 <br />FOR OFFICE USE ONLY: <br />FPONT 3ETBACN PERR SETBACK <br />UoEZONE �OTAREA <br />iYPEOFCONSi. NO.OFSiOPIES <br />SRE OF BLOG. FIRE SPRINKLERS REOD <br />OCCUPANCV LO�D FIPE ALARM REO'D <br />RE�SON <br />INTANE BY <br />DATE <br />APPROVEUBY <br />0 <br />CONTACT PERSON AND PNONE 1�0 <br />CI SIGN <br />i HEREBY CERTIFV THAT I HAVE READ AND EXAMINED THIS <br />APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TVPE OF <br />WORK WILI BE COMPLETED WITH WHETHER SPECIFIED HEHEIN OR <br />N7T. THE GRAN7ING OF A PERMIT DOES NOT PRESUME TO GIVE <br />AUTHORITY TO VIOIATE OR CANCEL THE PROVISIONS OF ANY <br />OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br />PERFORMANCE OF CONSTFUCTION. THAT I AM AUTHORIZED BY THE <br />OWDIER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br />APPLICATION IS MADE AND 1 COMPLY WITH THE STATE <br />CONTRA^CTORS LAW 1827 RC\Y AND 296200 WAC. <br />/4�i �� <br />x .������i��e,"_�`-� �—� - 93 <br />SGN.1lUAC ��lE <br />NO. TYPE OF EOUIPMENT <br />A/C—lUHNDLG UNITS—H.P. <br />FORCED AIR SYSTEMS—B.T.U. M E.A. <br />UNIT HEATERS—B.T.U. M <br />_ CIOTHES DRYERS <br />VENTILATION FAN <br />RANGEHOOD <br />WATER HEATER <br />WOODSTOVE <br />METAL FIREPLACE (WOOD BURNING) <br />FIREPLACEINSERT <br />HEAT PUMP <br />GAS PIPING <br />EXHAUSTFAN <br />PLAN <br />—/ L1 / / � <br />V�CANT SITE FEES <br />u YES �! NO sUi�OWG <br />OLCIIVANCY !.9 0i WRLLItiG L"1'IS <br />eaouv PLUMBING <br />BnSEMENT MECHANICAL <br />❑ YES G NO --- <br />HEIGNT�IMITATION �JDI710NALPLANCHECK <br />OTHER <br />STATE Bl11LDING SURCHARGE <br />CITY OF EYERETT pUBLIC WORKS <br />LOCAL SALES <br />TAX CODE IS 3105 TOTAL <br />fEE <br />v� <br />6 <br />$ <br />a <br />