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APPLICATIQ� : FOR CQ�NSTRUCTnN PERMIT � <br />TO BE COMPLETED IN BLACK INK-PLEASE PRINT <br />HEATING SYSTEM• ❑ GAS ❑ ELECTRIC ❑ � <br />BUILDING DEPARTMENT � - <br />259-8810 <br />i= EMOLITION ❑ COMBINATION +�BUILDING ❑ MECHANICAL ❑ PLUMBING ❑ SIGN <br />O ER MAILFD�RESS qTV 21P PHONE <br />- �►if� Z�'o5 Sr 353 'l�75� <br />T NANT � MAIIAD�RE55 CITV ZIP PMONE <br />[ <br />AflCHITECTOR0E51GNEP MAILADORE55 CITY ZIP PHONE <br />MECHANICALCON7AACTOR MAILAD�RESS <br />PLUMBINGCON?RACTOR �'AILADORESS <br />CONiRFCT PRICE OF N'.MK <br />OESCRIBE WORK AND SOUARE FOOTAGE iNVOLVED <br />16' � ��sz_ t sMo,� � � <br />PROPOSED USE OF BUILDING <br />�� �� <br />LEGA DESCRIPTIONOiPPOPERTY�SHOWNBELOWORAiTALHTWOCOPIES� <br />J <br />LOT BLOCK OF <br />PARCELTA%ID UMBER <br />�5 � � D/3-v0 - o00 <br />CONSTRUGTION LOAN LENOER, AUDRE55, TELEPHONE NUMBER <br />P OJECT ADDRESS <br />�0.� /SM�-�I <br />PLUMBING _ <br />NO. TYPE OF FI%TURE OR ITEM <br />LAVATORY (WASH BA; <br />SHOWER <br />KITCHEN K 8 DISP <br />OISHWASHE <br />LAUNDRY TRAV <br />CLOTHES WASHER <br />URINAL <br />DRINKING FOUNTAIN <br />FLOOR DRAIN <br />BACKF�OW PREVENT <br />ROOF DRAINS--RAINI <br />SINK (SERVICE—BAR, <br />SUB TOTAL $ <br />PERMIT $ <br />TOTALFEE i <br />FOR OFFICE USE ONLY: <br />FRONTSETBACK REARSETBAGK <br />USE20NE LOTAREA <br />7VPE Of CONST N0. OF STORIES <br />SRE OF BLOG. <br />REASON <br />INTAKE BV <br />FIRE SPRINKLERS REO'D <br />FIRE ALARM RE00 <br />DATE <br />G�TY � ZIP 9%�3 PHONE��. �M STAT� EiSE �' <br />1 6 w u <br />CITV ZIP PHONE STATELICENSEt <br />GITV 21P PHONE STATELICENSE� <br />CJNTACT PEHSON AND PHONE NO. <br />i HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br />APPLICATION AND KNOW THE SAME TO BE TRUE ANC CORRECT. ALL <br />PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br />YJORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br />NOT. 1���-' r,RANTING OF A PERMIT DOES NOT PRE5UME TO GIVE <br />AUTHC�� �'�. f TO VIULATE OR CANCEL THE PqOVISI0N5 OF ANY <br />OTHER S J>.i E OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br />PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZE� BY THE <br />OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br />APPLICATION IS MADE ANO I COMPLY WITH THE STAIE <br />CONTRACTORS LAW 18.27 RCW AND 296.200 WAC. <br />A/C—NHNDLG UMTS—H.P. <br />FORCED AIR SVSTEMS—B.T.U. M E.A. <br />UillTHEATERS—B.T.U. M <br />CLOTHES DRYERS <br />WATER <br />WOOD' <br />GAS PIPING <br />EXHAUSTFAN <br />PLqN <br />❑ YES ❑ NO BUn DiNG <br />OLWPAi�LV q0 OfpN[IIINGLNIiS <br />saoue PLUMBING <br />BASEMENT MECHANICAL <br />❑ YES ❑ NO <br />HEI3HiLIMITATION ADDITIONALPLANCHECK <br />OTHER <br />STATE BUILOING SURCHA(iGE <br />CITY OF EYERETT PUBLIC WORKS <br />LOCAL SALES <br />TAl( CODE IS 3195 T�TAL <br />SUB <br />RECEIPTNO. <br />��L <br />