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APPLICATIC-'1 FOR CONSTRUCT'"1N PERMIT . <br /> TO BE COMPLETED IN BLACK INK—PLEASE PRINT �\j�� <br /> BUILDING DEPARTMENT fiEATING SYSTEM: ❑GAS ❑ELECTRIC ❑ <br /> 259•8810 <br /> ❑ DEMOkIT�ON Ci COMBINATION l BUILDING ❑ MECHANICAL ❑PLUMBING i I SIGN <br /> OLYNER AIAILADDflE55 CITV ZIP PHONE <br /> H2.p+1.s Brn2uqqJ � <br /> $'A c�i�; u :��t F�.Hir:�r ��.'v: 3 <br /> TENANT MAILADDRE55 CITY ZIP PHONE <br /> ARCHITECiORDESIGNER MAIL�DDRESS CITV ZIP PHONE <br /> GENERAL CONTRACTOP MAII ADDRESS CITY ZIP PHONE STATE LICENSE N <br /> 1�5�- �F..✓ �iu- l�uc �.� 3x 3i�� F ��lsrr ry° r�,3 �It, iuo , Ni��iF..c� i3�o � <br /> AIECHANICA�CONTRACiOR MAIIADDRESS �IiY ZIP PHONE STATELICENSEx <br /> PLUMBINGCONTRACTOR AIAILADDRESS CITY ZIP PHONE STATEIICENS.Y <br /> CONTPAGT PRICE OF WORK <br /> (l7 O�O <br /> � � OESCRIBEWORNANDSOUAREFOOTAGEINVOLVED CONTACiPERSONANDPHONENO <br /> . � �t- -of-L �'!K-R.sxr� ( /+n.� �or7 /,JrR.� c�+.i���� 3ie -e�<( <br /> S�i -% Gns�:�. ��,� wz - <br /> n.�. <br /> : ' %'*���ri Od/-r iY' L I HEREBY CERTIhY THAT I HAVE REI,D AND EXAMINED TNIS <br /> PqOPOSEDUSEOFB ILDING qppLlCAiION AND KNOW THE SAME TO BE TRUE AND CORRECT.ALL <br /> . s�-�L PROVISIONS OF IAWS AND ORDINANCES GOVERNING THIS TVPE OF <br /> , LEGALDESC/PJIPTIONOFPROPERTV�SHOWNBELOWORATfP�M/TW//O,COPIES� WORK WILL BE COMPLETED WITH WHETHER SPECIPIED HEREIN OR <br /> � �or--L_ BLOCK oF l�� 76'-� NOT. THE GRANTING OF q PERMIT DOES NOT PRESUME TO GIVE <br /> AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANV <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 /> PARCELTA%I.D.NUMBEP APPLICATION IS MADE AND I COMPLY 'NITH THE STATE <br /> � _ _ � CONTRACTORS LAW 1B.27 RCW AND 296200 WAC. <br /> CONSTqUCTIONLOANLENDER,AU0RE5S,T LEPMONENUMBER l <br /> aRa S x�'``'--�- l�! �-L s'�— <br /> ��,� q,� s���.r�AE —o o.,E <br /> ���� ����'v p2 �C'/�7�zi/ cirveus�nessucenscr,o <br /> UMBING MECHANICAL <br /> NO. TYPE OF FI%TUFE OR ITEM FEE NO. TYPE 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� � UNlT HEATERS—B.T.U. M � <br /> SHOWER � CLOTHES DRYERS <br /> KITCHEN SINK 8�ISP ; VENTILATION FAN <br /> DISHWASHER � RANGE HOOD <br /> LAUNDRY TRAY ; WATER HEATER � <br /> CLOTHFS WASHER WOOD STOVE <br /> URINAL ' METAL FIREPLACE(WOOD BURNING) <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 /> SUB TOTAL �S ' SUB TOTAL 5 � <br /> PERMIT 5 � PERMIT $ ; <br /> TOTAL FEE S ; ' TOTAL FEE $ � <br /> FOR OFFICE USE ONLY: R,�ip� 5��,��� (�� E�7,��s �z�o� JBc.. �I-/ �; , <br /> FRONTSETBAC% qEARSEiBACK/ SIDESETBACK PLANCHEC NUMBER FEE. RECEIPTNO. <br /> � � � z� <br /> use�e � LOTAREA VACANTSITE FEES VALUATION FEE <br /> "' ❑ YES ❑ NO BUILDING �C 6� <br /> i <br /> NPEOFLON57 NO.OFSTORIES o[tuvputv HOofOx'ttuhGUHrtS S �vJ • <br /> ��J ��,�3 PLUMBING i <br /> SIZEOFBLDG. FIREJPRII�KLERSREO'D BASEMENT MECHANICAL � <br /> � �j 0 � YES ❑ NO ' _ <br /> OCCUPANCYLOAD FIREALARMREO�� HEIGHTLIMITATION ADDITIONALPLANCHECK � � � 1 � <br /> REASON r� N� Z / OTHER � <br /> T— <br /> STATE BUILDING SUFCHARGE ��. � <br /> IN7AKEBY PLANSAPPROVEDOY i <br /> CITY OF EYERETT PUBLIC WORKS , <br /> J� LOCALSALES � <br /> DATE g�s�5 TAX CODE IS 3105 rorn� -� � ��.�.� <br />