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APPLICATI�''�1 FOR CONSTRUCT^1N PERMIT � <br /> TO BE COMPLETED IN BLACK INK—PLEASE PRINT <br /> BUILDING DEPARTMENT HEA'fiNG SYSTEM: �GAS ❑ELECTRIC ❑ <br /> 259-8610 <br /> 1 DEMOLITION ❑ COMBINATION f=] BUILDING �MECHANICAL j�'PLUMBING ❑ SIGN <br /> OWN[R�I�EE $(�.N�MAILADDRESS CITV IIP rHONE <br /> BUr,vk .v ,B�T.v,� P�• e9�Ka��/P �d� p�3 0�6 339-G 9g�/ <br /> TENANT MAILADDRESS �ITY ZIP PMONE � <br /> ARCNITECTOPDESIGNER MRILADDRESS CITV 21P PHONE <br /> �.9-a, d�si�. <br /> GENERAL CONTRACTOR MAIL qDDRE55 �ITV ZIP PNONL STqTE LICENSE I <br /> �f17?1e �'j �Lv7'!B� <br /> MECMANICAL GGNTRACTOP MRIL ADDRESS CITV ZIP VMONE STATE LICENSE t <br /> PIUMBINGCONTRACTOR MAIIADDRESS CITV ZIP PNONE STATELICENSER <br /> r sv;./� Luix�,.v� n/ s a;�L� ao� y3.s-�P��'� <br /> CONTRACT PNICE OF WOPK <br /> DESCRIBE WORN AND SOUARE FOOTAGE INVOLVED CONTr1CT PEFSON A1D PMONE NO. <br /> i HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br /> PROPOSED USE O;BUILDING APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT.ALL <br /> PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br /> LEGALDESCRIPTIONO�pRO RTY�SNOWNBELOWORATTACMTWOCOPIES� WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HERE:4 OR <br /> NOT. THE GRANTING OF q pERM1T DOES NOT PRESUME TO GIVE <br /> �oi e�ocK oF p,UTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br /> OTHER STATE OR LOCAL LAW REGULATING CONSTriUCTION 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 /> PARCEL TA%I�.NUM9ER CONTFiACTORS L.4W L 27 RCW AND 296200 WAC. <br /> CONSTNUCTION LORN IENDEP,ADDRE55.TELEPHONE NUMBER <br /> PROJECT DDRESS swr���,uAe- �0,.�� � <br /> l.�/Jl� �.i cirreuswc[-�kEnsErvo — <br /> PLUMBING MECHtiNICAL <br /> N0. TYPE OF flXTUFE OR ITEM FEE NO. TYPE OF EOUIPMENT FEE <br /> WATER CLOSET(TOILET) � P✓C—IVHNDLG 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 /> � LAUNDRY TRAY ; WATER HEATER � <br /> CLOTHES WASHER � WOOD STOVE ; <br /> IIRINAL ; METAL FIREPLACE(WOOD BUANING) <br /> DRINKING FOUNTAIN � FIREPLACE INSERT . ; <br /> FLOOR DRAIN � HEAT PUMP � <br /> _ BACKFLOW PREVENTERS ; GAS PIPING ; <br /> ROOF DRAINS—RAINLEADERS � ExHAUST FAN � <br /> SINK(SERVICE—BAR,ETC.) ; <br /> — <br /> � ; <br /> � <br /> _ � <br /> SUB TOTAL $ ; SUB TOTAL $ ' <br /> PERMIT $ PERMIT $ � <br /> TOTALFEE $ TOTALFEE $ � <br /> FOR OFFICE USE ONLY: <br /> FRONT FETBACK PEAR SEiBACK SIOE SETBACN PLAN CHE .NUMBER FEE RECEIPT NO. <br /> use zone LOl pREA VACANT SITE FEES VALUATION FEE <br /> L YES ❑ N� BUILDING i <br /> iVPEOFCONSi. NO.OFSTORIES OCCuosHtr NOOfrnttuiNGUNnS <br /> �aaP pLUMBING <br /> i <br /> T <br /> SREOFBLDQ FIRESPRINKLEFSREO'D BASEMENT MECHANICAL � i <br /> ❑ YES (7 NO '— <br /> OCCUPANCYLOAD FIFEALARMREOD HEIGHTLIMITATION PDDITIONALPLANCHECN i <br /> OTHER � <br /> REASON �— <br /> STATE BUILDING SURCHARGE � <br /> INTAKE B'� PLANS APPFOVED BV CITY OF EYERETT PUBLIC WORKS � <br /> LOCAL SALES � <br /> onre TAX CODE IS 3105 TOTAL J �V � <br />