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APPLICATIO"' FOR CONSTRUCTI�N PERMIT � <br /> TO BE COMPLETED IN BLACK INK—PLEASE PRINT <br /> BUILDING DEPARTMENT HEATING SYSTEM: �GAS ❑ELECTRIC O <br /> 259•8810 <br /> ❑ DEMOLITION ❑ COMBINATION ❑ BUILDING Lx MECHANICAL ❑PLUMBING ❑ SIGN <br /> �Eq MRILADDRE55 CIN ZIP PHONE <br /> �ior� � R,�c� 57�7 G�eNqv�oc} l�vc Evere� 9fSZ03 3ys-v7�/�l <br /> TENAN MAILADDRE55 GITV ZIP PMONE <br /> ARCHITECT OR DESIGNER AIAI�RDDRESS CIN ZIP PHONE <br /> GENERAL CONTflACiOR MAIL AGJRESS GTV ZIP PHONE STATE LICENSE t <br /> MEC �CALCONTRACTON MRILADGRESS LIN ZIP PMONE STqTELICEN5El1 <br /> PL ING COhTHACiOR MAIL ADDRESS GIiV ZIP PHONE STATE LICENSE� <br /> COP:TflACT PRIGE OF WORK �—/�L^/d V <br /> /�V— _ <br /> DESCBIBE WORK AND SOUARE FOOTAGE INVOLVE� CONTFCT PERSON AND PHONE NO. <br /> F��� w �e,� + 4���ace � s � c .o <br /> i HEREBY CERTIFY THAT I HAVE READ AND EXAM�NED THIS <br /> PROPOSEDUSEOFBUILDING APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT.ALL <br /> UH�Q PROVISIONS OF LAWS AND ORDINANCES GQVERNING THIS TYPE OF <br /> IEGRLDESCRIPTiONOF7ROPERTY�SHOWNBELOWORATTPCHTYOCOPIES) WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br /> NOT. THE GRANT'NG OF A PERMIT DOES NOT PRESUME TO GIVE <br /> toT BLOCK oF AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br /> OTHER STATE OR LOCAL LAW REGULATING CONSTRUC,'fION OR THE <br /> PERFORMANCE OF CONSTRUCTION.THAT I AM AUTHORIZED BY THE <br /> OWNER O'r THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br /> APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> PARCF.LTA%ID.NUMOER CONTRACTOR LAW 18.27 RCW ND ZBE.2OO WAC. <br /> CONSTRUCTION LOAN LENDER.AUDRE58 TELEPHONE NUM9EF G� <br /> /l iu -�s-9 <br /> PROJECT ADDRESS s'�"",u"` o,�E <br /> � cirr ousiNEss ucExsE Ho <br /> PLUMBIN(3 MECHANICAL <br /> NO. TYPE OF FlXTURE OR ITEM FEE N0. TVPE OF EOUIPMENT FEE <br /> WATER CLOSET(TOILET) � A/C—A/HNDLG UNITS—H.P. <br /> BATHTUB FORCED AIR SYSTEMS—B.T.U. M E.A. ' <br /> LAVATORY(WASH BASIN) � UNIT HEATERS—B.T.U. M � <br /> Sf'OWER ' CLOTHES DRYERS ' <br /> KITCHEN Si4K 8 DISP � VENTILATION FAN T_ <br /> DISHWASHER � RANGE HOOD <br /> LAUNDRY TRAY ; WATER HEATER ' <br /> CLOTHES WASHER � WOOD STOVE � <br /> URINAL ' METAL FIREPLACE(WOOD BURNING) ' <br /> DRINKING FUUNTAIN � FIREPLACE INSERT � <br /> FLOOR DRAIN � HEAT PUMP ' <br /> BACKFLOW PREVENTERS ; GAS PIPING � <br /> ROOF DFAINS—RAINLEADERS � EJ(HAUST FAN <br /> SINK(SERVICE—BAR,ETC.) � <br /> � <br /> — �� <br /> � <br /> � <br /> � <br /> SUB TOTAL $ ; SUB TOTAL £ <br /> PERMIT 5 PERMIT $ <br /> TOTALFEE $ TOT�LFEE 3 ' <br /> FOR OFFICE USE ONLY: <br /> � TBACN PLANCMECKNUMBER FEE PECEIPTNO. <br /> FRONTSETBACK AEARSETBACK SIDEuE <br /> � <br /> � 1I5E20NE �OTAiiEA �ACANTSITE FEES VALUATION FEE <br /> � ❑ YES ❑ NO BUiLDiNG ' <br /> �I iVCE OF CON51 NOAF STORIES O[NaeN[r NO Ci NVEwNGUHrts � <br /> GFWP PLUMBING � <br />�� <br /> 1 <br />�� SRE OF BLDG. FIRE SPFINKLERS PEO'0 BASEMENT MECHHNICAL � <br /> �I ❑ YES ❑ NO � <br /> � � <br /> � OCCUPANCVLOAO FIREALARMREO'� HEIGHiLIMITATION ADDITIONALPLANCHECK �_ <br /> i <br /> OTHER i <br /> REASON � <br /> STATE BUILOING SURGHARGE � <br /> I ' <br /> INTAKE BV PLANSAPPROVEDBY CITY OF EYERETT PUBLIC WORKS <br /> LOCALSALES <br /> onre TAX CODE IS 3105 TOTAL <br /> .�� <br />