Laserfiche WebLink
APPLICATIOt'��FOR COWSTRUCTI�?��1 PERMIY � <br />TO BE COMPLETED IN BLACK INK—PLEASE PRINT `-''.:� <br />�a <br />HEATING SYSTEM: U GAS �ELECTRIC U � <br />BUILDING DEPARTMENT ". <br />259-8810 <br />� <br />i I DEMOLITION I I COMBINATION }�f BUILDING I I MECHANICAL I_I PLUMBING ❑ SIGN `� <br />O'/W`NF.R— ,L� O- Sr�(. MAILAO�RESS GiY ZIP PHONE � ' <br />��'P�'i' T LC��U,S �'�2. /:� S S—' j�tp fc/'T ST /h/�tL t%—�.-._C.,.-� .. /// SG, S'/3 � � .��;$ <br />TEN�NT MAILADDRESS Cli 21P PHONE . � =i <br />9lsor'� �-J,� t�C l-� �cy �Eaf ri /rls�%/'/�.� 5�,���,- a, r� <br />1111CH�TECTOADESIGNEf1 M�IL�DORESS CI7Y ZIP PHONE „' �°�❑ <br />vr� v� �'a-�/�u�El/ �'i� ; ���1`s!� ,�(i1-7— 9�'�+ � �>%y-�o91> , � <br />$ <br />GENEfiAL CONTP7 CTOR MAIL ADORFSS CITY ZIP PNONE STAiE LICENSE � 1 <br />Tun�s Conls•s�ev� ricn� 6917� ��v'!ntGU i1'�-1— 9uo4 `� -�7y-b'09�1 T Ns� �i�Rt3 <br />MECHr1NICALCONTR�CTOP MAILADORE55 CITY ZIP PHONE STQELICENSE/ � <br />PLUMDINGCONiR�CTOR MAILRDDRESS CITV ZIP PIIONE STATEUCENSEI :;:`�, <br />Cl�SSOF WORK �• <br />I I NEW I I ADDITION ALTERATION I I REPAIR I I DEMOLITION I I WOODSTOVE/FRPL INSEHT I.I BUILDING FiELOCATION ,��� <br />j ���O<7 N CONiACv Ef150N AND PIIO 7CU��/ 77�/ •�(�y �> � .. �LL <br />WNTRRCi PRICE OF WOBK ` <br />� OESCRIOEWORKANDSOUAREFOOT�GEINVOlVEO �Y ':P:`b�'� <br />n (Y' _ -G'. i f __ .. . � J.. . . <br />LOT <br />� PAOJECT <br />OF BUILDING <br />7AOPEHTY (SHOWN 9ELOW OR ATT�GN FOUR COPIES� <br />BIOCN OF <br />�... t� u!�ilii/� GUit �/ L%' / 5�� <br />BIN6 <br />TYPE OF FI%TURE OR ITEM FEE <br />WATER CLOSET (TOILET) <br />BATHTUB <br />LAVATORY(WASH BASIN) <br />SHOWER <br />KITCHEN SINK & DISP <br />� CLOTHES WASHER <br />URINAL <br />DRINKING FOUNTAIN <br />� FLOOR DRAIN <br />� BACKFLOW PREVENTERS <br />ROOF DRAINS—RAINLEADERS <br />SUB TOTAL $ <br />PERMIT $ <br />TOTAL FEE $ <br />FOR OFFICE USE ONLY: <br />iBONT5EIBACK RE4RSETB�CK SIOESEIMCK <br />lISEZONE LOTAREA V�C�HTSII[ <br />L /� <br />IYPE 0� GONfS. PItOWABIE <br />�N <br />saeorn�oa. <br />W�J�F T� • <br />OCCUPANCYLO�D <br />� <br />n�nsoNror+srnmKiens <br />I HEREBY CERTIFY THAT I HAVE READ AND 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 COMPLETEU WITH WHETHER SPECIFIED HEFEIN OR <br />NOT. THE GRANTING OF A PERMIT DOES NOT PRESI IME TO GIVE <br />AIITHORITY 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 TFiE VJORK FOR WHICH <br />APPLICATION IS MADE AND I COMPLY WITH THE STATE �. � <br />CONTRA TORS LAW 18.27 RCW AND 296.200 WAC. <br />/`� �'� �d—� — S'/ <br />SKN�Il111[ OAtE ' � �� <br />CItY OUSiNE55liCENSE NO <br />MECHANICAL �. � <br />NO. TYPE OF EUUIPMENT FEE � ��"':s <br />A/�A/HNDLGUNITS—H.P. � , �� .'�;,,-.:� <br />--�-- <br />FORCED AIR SYSTEMS—B.T.U. M E.A. � �. - <br />� ,,..._.— ..,,. .. --r � _ <br />VENTIUITION FAN <br />RANGEHOOD <br />WATER HEATER <br />WOOD STOVE <br />METAL FIREPLY�CE 8 CHIMNEY <br />FIREPLACE INSERT <br />HEATPUMP <br />BUILDING <br />ttPEOFLONSi.AC7UnL arorancr rvo.av.v[uixcunits <br />�N �" � PLUMBING _ <br />NO.OFSTORIES OnSEMENt MECIIANIC�L <br />FIPE SP1RN1KLERS REOD HEIGNi IIMIIAiION ADDITIONAL PLAN CHECK <br />ND SPRINKLER <br />STA7E DUILDING SURCHARGE <br />PUNSAPPOOVEDBY CITY OF EYERETT PUBUC WORKS <br />LOCAL SALES <br />�¢/G�' � TAX CODE IS 3105 TOTAL <br />TOTAL FEE $ <br />� �� <br />• ., <br />