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APPLICATI�"1 FOR CONISTRUCT"1N PERMIT � <br />TO BE COMPLETED IN BLACK INK—PLEASE PRINT <br />HEATING SYSTEM: U GAS ❑ ELECTRIC ❑ <br />BUILDING DEPARTMENT <br />259•8810 <br />❑ DEMOLITION ❑ COMBINATION <br />OWNEfl MAIIADORE55 <br />MAIL ADDRESS <br />❑ BUILDING <br />pTV <br />CITV <br />� <br />CITY <br />❑ MECHANICAL G PLUMBING <br />ZIP PHONE <br />PHONE <br />� <br />PHONE <br />GENEflALCONTRACTOR �[AAILADDR 55 CITY '�P PHQNE` � STATEUCENSEN <br />��r��'a� ,! .3�it� G�f Gu�.S D•�i�•9ai.�yav°a-es�s-a�wi�vsa�:�t/ <br />LHANICALCONTPACTOR MAILM1DDR SS QTV ZIP PNONE STATELICENSEx <br />PLUMBI G CONTRACTOR MAIL ADDRESS CITV 21P PHONE STATE LICENSE It <br />N /M -- <br />PPICEOFWORN �' � <br />�� <br />IORKANUSOUAREFOOTAGEINVOL ED <br />OF BUILDING <br />LEGAL OESCRIPTIO>l OF PROPERTY (SHOWN BELOW OR ATTACH TWO COPIES) <br />LOT BLOCK OF <br />PARCELTAXLU.NUMBER <br />WNSTRl1CTION LOAN LENDER. ADUPE55, TELEPH <br />PpWECT ADDRESS <br />80(o SE /�iuGu.7�� <br />PLUMBING <br />N0. TYPE OF FIXTURE OR <br />WATER CLOSET (TOILET) <br />SHOWER <br />K�TCHEN SINK & DISP <br />DISHWASHFR <br />LAUNDRYTRAY <br />CLOTHES WASHER <br />UFiINAL <br />DRINKING FOUNTAIN <br />FLOOR DRAIN <br />BACKFLOW PREVENI <br />ROOF DRAINS-RAIN <br />SINK (SERVICE-8AR <br />SUB TOTAL $ <br />PERMIT $ <br />TOTALFEE $ <br />FOR OFFICE USE ONLY: <br />TYPE Oi CONST. <br />SIZE OF BLDG. <br />OCCUPANCYLOAU <br />REASON <br />LOT AflEA <br />FIRE SPRINkLERS REO'D <br />FIRE ALARM REO'D <br />INTAKEBY � I PVINSAPPROV@DBY <br />�ATE �-,�� �\\� <br />FEE <br />� <br />CONTACTPERSONANDPHONENO. <br />1 /,�il Ci.vod Diffl -�/7 % - <br />1 HEREBY CERTIFY THAT I HAVE READ AtJD EXAMINED THIS <br />APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br />WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br />NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME 1�0 GIVE <br />AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <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 />APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />CONTRACTORS LAW 18.27 RCW AND 296200 WAC. <br />��/��ii.i.�>' ///v4/c*'J�i e�'��l''9� <br />S�c riuA� onrE <br />CIiV BUSiNE55 LIC[NSE N0. <br />FORCED AIR SYSTEMS—B.T.U. <br />UNI i HEAT�RS—B.T.U. M <br />CLOTHES DR'� tRS <br />VENTILATION FAN _ <br />RANGEHOnD <br />WATER HEATER <br />WOOD STOVE <br />METAL FIREPLACE (WOOD BUI <br />FIREPLACE INSERT <br />HEAT PUMP _ <br />GP.S PIPING <br />EXHAUSTFAN <br />� 3[�c� <br />SI�E SETBACK PLAN C'CK NUMB R <br />VACAN i SITE FEES <br />G YFS ❑ NO BUILDiNG <br />actuvaxcr �+o oroweuwcuxrts — <br />�A�P PLUNBING <br />BASEMEN7 idECHANICAL <br />❑ YES ❑ NO <br />HEIGHTLIMITATICN ADDITIONALPLANCHECK <br />OTHER <br />STATE BUILDING SURCHARGE <br />CITY OF EYERETT PUBLIC WORKS <br />LOCAL SALES <br />TN( CODE IS 3105 Torn� <br />TOTAL $ <br />v11T $ <br />FEE <br />� <br />i <br />i <br />T <br />1// �J <br />,� <br />