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APPLICATIC� 1 FOR C�ONSTf�t�CT�N PERMIT � <br /> TO BE COMPLETED IN RLACK INK—PLEASE PRINT <br /> HEATING SYBTEM: ❑GAS ❑ELECTRIC � Ne r1� <br /> BUILDING DEPARTMENT <br /> 259-8810 <br /> ! I DEMOLITION i.l COMBINATION �'aUILDING ! J MECHANICAL i i PLUMBING 1 SIGN <br /> OWNER MAILADDRE55 CITY 21P PHONE <br /> Cke�s����+��(,� Jacks�m al'.�2colkml��AAuf �v�,�etf��i9kw3 348-3�S1 <br /> TENANT MAIL ADDRESS CIiY ZIP PMONE <br /> ARCNITECTORDESIGNEfI MAIL�DORE55 CITY 21P PHONE <br /> Q.t��-l�u�n� f�e��Ac1 �7�� lOfhA�i� sw �H� �k. 98/� � 7�3 -ylo$ <br /> GENERRICONTRACTOR MAILADORE55 CITY ZIP PNONE STATELICENSEII <br /> C�U..��`�e 1� <br /> MEGNANICALCONTR�CTOR MAII�ODflESS CIiV ZIP PHONE STATELICENSEf <br /> PWMBINGLONTRACTOR MAIUDDRE55 CITY ZIP PMONE STATELICENSE/ <br /> CLASS OF WORK �"� <br /> � � NEW I�ADDI OA N I-1 ALTERATION ' ! REPAIR I I DEMOLITION -: ���. WOODSTOVFJFRPL INSERT I.I BUILDING RELOCATION <br /> a �✓is�1 � L!� CONTACTPEPSONANDPHONENO. <br /> CONTRACT PRICE OF WORK U��W •OO <br /> DE/SC�F�IBE�WORKANDSOU1AP1EFOOTAGEINVOLVED ,.�,[1I[ <br /> PROPoSEoa 3u�oi�' � IU �� S' �� I HEREBY CF.RTIFY THAT 1 HAVE READ AND E%AMINED THIS <br /> S.�rQ GE APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT.ALL <br /> LEGAL DESCHIPT'ON OF PROPERTY(SHON^!BELOW OR PTfACN FOUR COPIES) PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br /> WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br /> �or� d Z e�ocK �I oF D � NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br /> iin�� AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br /> �I U(S I M �J OTHER STATE OR LJCAL LAW REGULATING CONSTRUCTION OR THE <br /> PERFORMANCE OF CONSTFUCTION.THAT I AM AUTHORIZED 6Y THE <br /> OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br /> APPLICATION IS MADE AND I COMPLV WITH THE STATE <br /> CONTFACTORS LAW 1827 RCW AND 296.200 WAC. <br /> � � c� �o-(.�u�A-tv/� �o -�j^�j Z <br /> SIGNATUA[ D�tE <br /> PPQIE/C�T ADDRE55 I� < <br /> �/ I J� C(�I(/ ✓YI ICJI l9 �V L GItV BUSMESS LiCENSE NO <br /> CJ[ <br /> PLUMBINO MECHANICAL <br /> NO. TYPE OF FlxTURE OR ITEM FEE NO. TYPE OF EOUIPMENT FEE <br /> WATEH 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 /> SHOWER ' CLOTHES DRYERS � <br /> KITCHEN SINK 8 DISP � VENTILATION FAN � _ <br /> DISHWASHER � RANGE HOOD � <br /> LAUNDRVTRAV ; WATER HEATER <br /> CLOTHES WASHER � WOOD STOVE ' <br /> URINAL ' METAL FIREPLACE 8 CHIMNEY ' <br /> DRINKING FOUNTAIN � FIREPLACE INSERT � <br /> FLOOR DRAIN � HEAT PUMP ' <br /> BACKFLOW PREVE RS ; GAS PIPING � <br /> ROOF DRAINS— INLEADERS � EXHAUST FAN ' <br /> SINK(SERVI --BAR,ETC.) � � <br /> i <br /> � ' <br /> _ � I <br /> � <br /> � ' <br /> SUB TOTAL 8 ; SUB TOTAL $ ' <br /> PEFiMiT $ � PERMIT S � <br /> TOTAL FEE $ ' TOTAL FEE $ <br /> FOR OFFICE USE ONLY: neceivr No. <br /> FRONT SETBACK REAR SETBACK SIDE SETBRGN PLAN CHECN UMBER FEE <br /> Z� �o�,� o- 5�,. �0� � �31� �v ��. �r <br /> LOTAREA VACANTSIT� FEES VALUATION FEE <br /> USEZONE G� � ,�/� i <br /> -Z SJ�'0� ,YO BUILDING OQ / �00 <br /> iYPEOFL�NT5.0.LOWABLE tVPEOFCONSiPCNAL ��xa NOOvO'MIUNGONiiS ' <br /> i <br /> � �"01P PLUMBING ' <br /> � � <br /> SIZE OF BLD6. NO.OF STOBIES BASEMEN MECHANICAL _ � ' <br /> i <br /> O� S pDDITIONAL PLAN CHECK � <br /> OCCUPAN V LOAD FIRE SPRNKLERS REO'0 HEIG�L�i ATION � <br /> V SPRINKLER � <br /> REASON FOR SPRINNLEPS NO � <br /> STATE BUILOING SURCHARGE ' � <br /> INTAKEBY PLANSAPPROVEDBY CITYOFEYERETT PUBLICWORKS � <br /> J 1 � LOCAL SALES � <br /> ,c 9L TAX CODE IS 3105 TOTA� � � SO <br />