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� <br />APPLICATIQN FOR CONSTRUCT�.�N P�RMIT � <br />TO BE COMPLETED IN BLACK INK—PLEASE PRINT <br />BUILDING DEPARTMENT HEATING SYSTEM: ❑ GAS ❑ ELECTRIC ,.I � <br />259-8610 <br />i 1 DEMOLITION � 1 COMBINATION i I BUILDING •-' MECHANICAL I PLUMBING l SIGN <br />MAIL AUOPE55 <br />ARCMITEIiORDESIGNER MqILADDRES° <br />PLUMBING <br />CONTRACT PRIGE OP WORN <br />e <br />OESCR16E WURK AND SOUAI <br />MAIL ADDRESS <br />fib <br />CITY <br />�a <br />cirv <br />CIiY <br />GTV <br />li� <br />GTY <br />PROPOSEO USE OF BUIIDING <br />�Yisn� �.,�,�PM�. <br />LEGALOESCRIPTIONOFPROPERTV�SHOWNBELO ORATTFGHTWGCOPIES� <br />W f BLOCK — Of <br />PARCELTAXID.NUMBER <br />CONSiRU TION l0 LENOER. A�DRESS. TEI EPHONE NUMDER <br />(�..,�,�,�.� ,9� 2S 33�� a� �fs� <br />NO. TYPE OF FU <br />WATER CLOSET (TC <br />BATH7UB <br />LAVATORY (WASH B <br />SHOWER <br />KITCHEN SINK 8 DI; <br />DISHWASHER <br />LAUNDRYTRAY <br />CLOTHES WASHER <br />URINAL <br />DRINKING FOUNTAI <br />FLOCR DRAIN <br />BACKFLOW PREVE <br />ROOF DRA�NS—NA <br />FOR OFFICE USE ONLY: <br />FRONTSETBACK REAR: <br />USEZONE <br />TYPE Of CONST. <br />512E OF BLDG. <br />OCCUPANCVLOAD <br />REASON <br />NOAF <br />c OA ITEM <br />FEE <br />SI IB TOTAL 5 <br />PERMIT S <br />TOTAL FEE $ <br />FlRE SPRINKlERS PEO'D <br />FIPE ALARM REOD <br />MTANEBY � PLANSAPPROV[D <br />pATE <br />SIDE SETOACK <br />ZIP FMON[ <br />!�� 4qda� <br />ZIP PHONE <br />ZIP PMONE <br />7.IP PHONE <br />` V CXC� <br />ZIP PNONE <br />STATE LIGENSE • <br />J (.� J D <br />$TATE UCENSE t <br />ur rnurve ainieu�enaer <br />CONTqCT PERSON AND PNONE ND � <br />c,� v"��''C-�FF <br />2 5a '1� �l � ��; �S �'6 1 <br />I HEREBY CERTIFY THA�f I HAVE READ AND EXAMINED THIS <br />APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />PROVISIONS OF LAWS AND ORDIM1ANCES GOVERNING THIS TYPE OF <br />WORK WILL 8E COMPLETED WITH WHETHCR SPECIFIED HEREIN OR <br />NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br />AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br />OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br />PERFOR\1ANCE OF CONSTqUCTION. THAT I AM AUTHORIZED BY THE <br />OWNER O� THIS PROPERTY ?O PERFORM THE WORK FCR WHICH <br />APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />CONTRACTORS LAW 18.27 RCW AND 296.200 WAC. <br />SxIGN�tUfl' �� ` �% Y [ � � x � <br />��,. o�,s�,�Ess ���E„s� �o <br />MECHANICAL <br />NO. TYPE OF EOUIPMENT FEE <br />AiC—A�HNDLG UNITS—H.P. <br />FORCED AIR SYSTEMS—B.T.U. M E.A. <br />UNIT HEATERS—B.T.U. M � <br />CLOTHES DRYERS <br />VENTILATION FAN ' <br />RANGEHOOD � <br />WATER HEATER ' <br />WOOD STOVE � <br />METAL FIREPLACE (WOOD BURNING) <br />FIREPLACE INSERT <br />HEAT PUMP <br />GAS PIPING <br />EXHAUSTFAN ._ _ <br />VFCANT SITE �CCJ <br />'�' YES � NO BUILDING <br />acuoeHcr xoo�o'�vEwaoux��s — <br />L90p° PLUMBING <br />BASEMENt MECHANICAL <br />❑ ves � No <br />HEIGHTUMRATION ADOITIONAL PLAN CHECK <br />OTHEFi <br />STATE BUILDING SUf,�HANGE <br />CITY Of EYERETT PUBLIC WORHS <br />LOCAL SALES <br />TAX CODEIS 3105 TOTAL <br />SUB TOTFI 5 ' <br />PERMIT 5 <br />TOTAL FEF S , <br />a <br />� <br />� <br />; <br />� <br />