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�R y APPLICATIG�1 FQR CONSTRUCT jN PERMIT <br /> TO BE COMPLETED IN BLACK INK—PLEASE PRINT �T <br /> BUILDING DEPARTMENT HEATING SYSTEM:�GAS ❑ELECTRIC 0 <br /> 259-E310 <br /> : I DEMOLITION COMBINATION BUILDING MECHRNICAL ! PLUMBING i I SIGN <br /> OWNER � MfJLADDRE55 CITY 21P � PHONE <br /> � l_4l21��M 1 Z� �✓. •�vr*+��_y`°`t� ��2� Co12 -lo��� <br /> TENANT MAIL ADDRE 5 q Y ZIP PHONE I, <br /> ARCMITECTORDESIGNER �+AILAD�RESS CITY Z�P PMON[ �l� �' <br /> .`�'UTi�Ak'�i 1��L ��`yJ II ��'�- �..-. �L�i �-IQ-{!L-�1+-��, ��A • �`d�3'� <br /> GE ERAL NTRACTOH MAIL ADDRESS CIiV 21P PMONE STATE UCENSE� <br /> �1 4 u " p �• ?t.�TMAGa• 'L�4rIZ <br /> MEGHANICAL CONTRAI,�OR MAIL ADDRE55 f '� 'CJ�TV �OTJ �y£ ZIP c���.� PHONE STATE LICENSE M <br /> '4 r� oL r--� rt 1 <br /> �tCi MEi!/��/�Nlc./� ri¢a.�r�.sw� h,ri.�c,��_ �17't'f5s'fl Y P -I�l <br /> PLUMBING ONT ACTOR MPIL AODRE55 ITV ZIP PHONE STATE LICENSL t <br /> 12125 Z�^i �• oy�jl'�5 3lOZ- W'z'ac,+ <br /> ,�r'1YVJ pW P'ii�iu�bl� �-,E��_ <br /> CLASSOF ORK <br /> `NEW f I ADDITION i �� ALTERATION �, �� REPAIR �� � DEMOLITION ! '�� WOODSTOVE/FRPL WSERT . BUILDING RELOCATION <br /> v�.� �y5�i QS'� , CONTACT PEPSON AND PHONE N0. <br /> 'IV �j � y�� <br /> CONTRACT PRICE OF WORK �`�' "' � y� <br /> DESCFIBE WOFK AND SOUARE FOOTAGE IN O�VED � <br /> 2 5ra�-�l c�o�� �t� � 70 7(v i?/�i �e. <br /> pqppp$E�USG�lFBUILDING � y � HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br /> 1 y APPL�CATION AND KNOW THE SAME TO BE TRUE AND CORRECT.ALL <br /> LEGALDESCRIPTIONOFPROPERTY HOWNBELO ORATTACHFOURCOPIES) PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br /> r WORK WILL BE �OMPLETED WITH WHETHER SPECIFIED HEREIN OR <br /> . ; ���,�,� , NOT. THE GRAiJTING OF A PERMIT DOES NOT ARESUME TO GIVE <br /> tl: .�`.� rYIY �9 RGL li4 AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF AhY <br /> .:KtH)r REC AF NU 8G l O100322AEA5URV�RECT OTHER STATE OR LOCAI.LAW REGULATING CONSTRUCTION OR THE <br /> �� ' u J 410105005 RE V PER AF NUS PERFORMANCE OF CONSTRUCTIGN.THAT I AM AUTHORIZED BY THE <br /> � ' '� L lU3I1 G 890ti135UO2 UEING PTN UF OWNEA OF THIS PRCiPEHTY TO PERFORIv1 THE WORK FOR WHICH <br /> ��4 M!'i'f= LF.GAL DESCRIPTIUN DN FI1.E *'k« APPUCATION IS MADE AND I COMPLY WITH THE STATE <br /> CONTRACTORS LAW 18.27 RCW AND 296.200 WAC. <br /> "� �E X y.� .�� <br /> sic nn E onrE <br /> PflQIECT ADDRESS <br /> .IiV SMESSULENSENO <br /> PLUMBING HANICAL _ <br /> NO. TYPE OF FIXTURE OR ITEM FEE TYPE OF EQUIPMENT FEE _ <br /> WATER CLOSET(TOILET) 6� I A/C—NHNDLG UNITS—H.P. ___ Y_ <br /> 3 BATHTUB �; FORCED AIR SYSTEMS—B.T.U. M E.A _ __ ; <br /> � VATORY(WASH BASIN) � UNIT H TERS—B.T.U. M � <br /> SH ER a O ' � CLOTHES RYERS ' <br /> KITC N SINK 8 DISP ,�� ( `/ENTILATIO FAN � <br /> 1 DISHW HER J' � RANGE HOOD ' <br /> � LAUNDR RAY J ; \ WATER HEATER <br /> � CLOTHES SHER � WOODSTOVE � <br /> URINAL ; 3 METAL FIREPLACE&C NEY O ' � <br /> DRINKING FOUN N � FIREPLACE INSERT � <br /> FLOOR DRAIN i�IEAT PUMP ' <br /> BACKFLON'1'REVENT S ; GAS PIPING � <br /> ROOF DRAINS—RAINLEA RS � EXHAUST FAN � ' <br /> Z SINK(SEFVICE—BAR.ET0.) tJ � <br /> , loco — �� � <br /> i <br /> � <br /> i � <br /> � SUB TOTAL $ ;�,�; � SUB TOTAL S ' <br /> PERMIT 5 � PERMIT 5 � <br /> TOTALFEE S ' TOTALFEE $ ' <br /> FOR OFFICE USE ONLY: S ,S <br /> FROtIT5ET8ACN REARSETB�CN SIDESETBACK PLANCHECNNUMBER � FEE RECEIPTNO. <br /> .'���/�%r✓'.qG P�.9 •4/� - 3lp a.�/ �`77�?.25 (,�3.3�;� <br /> USELONE LOTAREA VACPNTSITE FEES VALUATION FEE <br /> � IO� BUILDING S � <br /> lYPEOFCONIS.AILOWABIE 1VPEOFCONSi.AC1UAL o[cuvArttY NOOrrnv[ui4GUNrts ' <br /> i <br /> �a�"" PLUMBING '�j� p1 / � ,� iO4 <br /> �-i.� �- -3 � <br /> 52E OF BLDG. NO.OF STORIES BASEMENT MECHANICAL �70 ��U <br /> �(y,�J SF f; � p ' <br /> O 5 �+a� 3 ADDIiIONAL PLAN CHECK � <br /> OCCUPANCY LOpD FIRE SPRNKLERS REO'D NEIGHT LIMITATIO% <br /> /f� i <br /> A YE 5 ��/ �^/ SPRINKLER i <br /> . REASON OR SPRINKLERS 3�S��X�GC�'. <br /> i <br /> Et� �� f �i.�e �[� IS'�-0 JL�; f��^� F�C& ��heR <br /> STATE BUILDING SURCHARGE 'S � <br /> INTANE BY PI.ANS APPiiOVED BV CITY OF EYERETT PUBLIC WOHKS � i��� <br /> LOCALSALES /� i � <br /> n��y" �/t�I 4 .Z TAX CODE IS 3105 TOTAL ? <br />