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APPLICATIC''1 FOR CONSTRl1CT''1N PERMIT � <br /> TO BE COMPLETED IN BLACK INK—PLEASE PRINT <br /> BUILDING DEPARTMENT HEATING SYSTEM: U GAS U ELECTRIC ❑_ <br /> 259-8810 <br /> ❑ DEMOLITION CU�COMBINATION G BUILDING ❑MECHANICAL ❑PLUMBING ❑ SIGN <br /> OWNER MRII AUDRE55 CIT�s, ZIP PHONE <br /> .�Amc.s L . �arker C�a�e4�- � 9oslt'2� ni�er 9�:zol :zs2 • �G 31 <br /> TENANT MAII ADDRE55 CITY ZIP PHONE <br /> ��iGr��ct, �Jun n� '7.9r1GUW-��� ��c.. �Vt. 9 $Zvl 258'�479 <br /> �RCHITECT OR DESIGf1ER MR L ADURESS CITY ZIP PHONE <br /> GENER�:CONTRACTOfl MPILAODRESS CITV ZIP PHONE STATELICENSEI <br /> Dwn �er Sa,r � <br /> MECHANICRLGONTRACTOR MAILPDDRESS CITV ZIP PHONE STATEUCENSE• � <br /> PLUMBINGCONTRACTOfl MAILADDRE55 CITV ZIP PM04E STATEUCENSEI 1 <br /> Ly <br /> i <br /> CONTRACT PflICE OF WORN 1 1 p <br /> sCJjn O��:� �� �' <br /> �SCPIBE WORN AND SOOARE FOOTAGE INVOLVED �� CONTACT PERSON ANO PHONE NO. <br /> r+e�� Frdmr jFeri l u .rc <br /> RemovC -eJ�crgt,h Sh�nq�es • Ru-oo Co <br /> SM�n Ies " �k.cen�E�ucS �y � ��" -a-G��cnd ���� i HEREBY CERTIFY 7HAT i HAVE READ AND EXAMINED THiS <br /> PROPOnSE�USE OF BUIID,ING APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT.ALL <br /> rtenJ G e I (OC�?u W%c.�., PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br /> LEGALOESCRIPTIONOFPROPERTV�S�ELO T70GHTWULOPI VVORK WILL BE COMPI.ETED WITH WHETHER SPECIFIED HEREIN OR � <br /> �oi J��' ��e����p �� o��L d� �� ' �Y NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br /> � AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY � <br /> B�q /�E COQ /�rqGS'G'F'-�J�.�L'C TJt � I oOJ�T T� OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br /> 1 PERFORMANCE OF CONSTRUCTION.THAT I AM AUTHORIZED BY THE <br /> 7'14 N l2 a Ft T h 6�.5 JF7 T�J� S I Z oF� I/1 W S7 - OWNER OF THIS PROPERTY 70 PERFORM THE WORK FOF WHICH ! <br /> APPLICATION IS MADE AND I COMPLY WITH THE STATE r <br /> PARCEL TA%I.O.NUMBER CONTRACTORS LAW 1827 RCW AND 296.200 WrC. .E <br /> 2a29a5" -`/-093 �- 000g o <br /> CON iR TI LOANLE R.ADDRESS.T LEPHIXJENUMBER �� <br /> � � r ,.. �ca� 6 - 2•-4" 3 <br /> EC ADDRESS S�GN� c o�iE <br /> CI ISME$$OLENSEIq <br /> PLUMBING M MANICAL <br /> ►�p. TYPE OF flIfTURE OR ITEM FEE NO. TVPE OF EOUIPMENT FEE <br /> WATER CLOSET(TOILET) � A/�AIHNDLG IINITS—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 /> D13HWASHER RANGE HOOD <br /> LAUNDRY TRAY ; WATER HEATER ' <br /> CLOTHES WASHER � WOODSTOVE <br /> URINAt. ' METAL FIREPLACE(WOOD BURNING) ' <br /> DRINKING FOUNTAIN � FIREPLACE INSERT � <br /> FLOOR DRAIN � HEAT PUMP ' <br /> BACKFLOW PREVENTERS ; GAS PIPING � <br /> q00F DRAINS—RAINLEADERS � E%HAUST FAN ' <br /> SINK(SERVICE-9AR,ETG.) I <br /> � ' <br /> � - <br /> � ' <br /> � _ <br /> � ' <br /> SUB TOTAL $ ' SUB TOTAL $ ' <br /> PERMIT $ � PERMIT $ � <br /> TOTAI FEE $ ' TOTAL FEE $ ' <br /> FOR OFFICE USE ONLY: <br /> FRONTSETBACK REARSETBACK SIDESETBACK PLANCHEC NUMBER FEE RECEIPTNO. <br /> �� � <br /> USEZONE LOTAREA VACANTSITE FEES VALUATION FEE <br /> ❑ YES ❑ NO BUILDING Q(� ' (� <br /> 7VPEOFCONSi. NO.OFSTORIES OCLUPANtv NaafUW[llivGUMns � <br /> GqppP PLUMBING � <br /> SIZE OF BL�G. FIRE SPRINKLERS REO'D BASEMENT MECHANICAL � <br /> ❑ ves � No � <br /> OCCUPANGV LOAD FIRE ALRRAI REO'0 HEIGMT LIMIT�TION ADDITIONAL PLAN CHECK � <br /> i <br /> OTNER i <br /> REASON <br /> . STATE BUILDING SURCHARGE � CY� <br /> i <br /> INTAKEBV PLANSPPPPOVEDBY CITY OF EYERETT PUBLIC WORKS i _ <br /> LOCAL SALES � <br /> DATE TAX CODE IS 3105 T�TA� �!�O <br />