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, APPLICATIC�� FOR CONSTRUCY'"1N PERMIT � <br /> \� TO BE COMPLETED IN BLACK INK—PLEASE PRINT <br /> �`, <br /> BUILDING DEPARTMENT HEA7b�G SYSTEM: j�GAS ❑ELECTRIC ❑ <br /> 259-8810 <br /> ❑ DEMOUTION ❑ COMBIMATION ?Q BUaLDING ❑MECHANICAL ❑PLUMBING ❑ SIGN <br /> ONMER MAILADDRh55 CITY 21P PMONE <br /> ,qRiHu2 GRoSSmIfN 322 }{EAiN�RD FV�2E7 98103 ZSZ-CJ087 <br /> TENANT MRIL aDDRE55 CITY ZIP PMONE <br /> .1RCHITECTORDESIGNER MFILADDRE55 CITY 21P PHONE <br /> P,o�3EaT Hac;GA2n Z5�3f1Ewirr t�c�ZE1� 943Zo1 259-2203 <br /> GENERALCONTRACTOF MAILADDflE55 CITV 21P PHONE STRTELICcNSEk <br /> /�\Ac:i-iIPSCON:��UC�f�(crv �'`uc.1�121 15"S/ft.� A/EfSM�7[�+�LG(, 9Y19d 3�({!66 AtA�(,;�s CLG/ Fr - - <br /> MECHANILALCONTRACTOR MAILADDRESS dTY ZIP PHONE STATELICENSE+1 <br /> PLUMBINGCONTRACTOR MAILpUDRE55 QTV ZIP PHONE STRTELICENSEY <br /> CONTF�,CT PRICE OF WORK <br /> YI <br /> DESCRIBE WO K AN�SOIIRRE FOOTAGE INVOLVED CONTACT PERSON AND PHONE NO. 25Z—OO H�I <br /> n�nr gep2oo�.. ArH DD�TiOl� ViRC I�.IiH G'�C�.aSlvlAl� <br /> HC-26 Nv�sE C�;eNtor�;. <br /> go0 sF <br /> I HEREBY CERTIFY THAT I HAVE READ AND EXAMINEU THIS <br /> PROPOSEDUSE OFBUILDING APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT.ALL <br /> 1�ES 1 DE N G� PROVISIONS OF LAWS AND ORDINANCES GO`/ERNING THIS TYPE OF <br /> LEGALDESCRIPTIONOFPROPERTY�SHOWNBELOWORARACHTWOCOPIES) WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HFHEIN OR <br /> �oT � BLOCH oF V�E:u R�oc;E NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br /> AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF pNY <br /> ADD IT lO N � Z. VOL, �2 PP � 5 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 WHICFI <br /> APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> PARCEL TAX I.D.NUMIiER CONTRACTORS LAW 78.27 RCW AND 296200 WAC. <br /> S'�49 - ��3 - 005- 0003 <br /> CONSTRUCTION LOAN LENDER.A�DRESS.TELEPHONE NUMBER <br /> /.1m. IST NATL BANK EJE2� i I Y /,/,.,�� G r�/��.f.v 9�R.��9�J <br /> PROJECT ADDRESS sicx+ru�ic �� � �G�{ o^� <br /> 32Z �EA7F-�t�Z. � crtvauvNessuceNseno. <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM FEE NO. TVPE OF EflUIPMENT FEE <br /> � WATER CLOSET(TOILET) � A/C—NHNDLG UNITS—H.P. _ <br /> BATHTUB ' FORCFD AIR SYSTE!i5—B.T.U. M E.A. ' <br /> Z LAVATORY(WASH BASIN) � UNIT HEATERS—B.T.U. M � <br /> � SHOWER � CLOTHES DRYERS ' <br /> KITCHEN SINK&DISP � VENTILATION FAN_ T_ <br /> DISHWASHER RANGE HOOD � <br /> LAUNDRYTRAY ; WATER HEATER ; <br /> CLOTHES WASHER � WOOD STOVE � �. <br /> URINAL ; METAL FIREPLACE(WOOD BURNING) ' <br /> DRINKING FOUNTAIN � FIREPLACE INSERT � <br /> ---r— <br /> FLOOR DRAIN HEAT PUMP <br /> BACKFLOW PREVENTERS � GAS PIPING � <br /> ROOF�RAINS—RAINLEADERS � EXHAUST FAN <br /> SINK(SERVICE—BAR,ETC.) � <br /> � � <br /> � � <br /> � � <br /> T <br /> I � <br /> SUBTOTAL $ ' SUBTOTAL $ ' <br /> PERMIT S PERMIT $ � <br /> TOTAL FEE $ ' TOTAL FEE $ ' <br /> FOR OFFICE USE ONLY: a5�' �S <br /> FRONTSET9ACK � REARSETBAGK � SIDESET� � PLAN�CKNUMBER� PEE /' RECEIPT�C��� <br /> �/� � ` �_ <br /> USE20NE _/ LOTAREA VACANTSITE FtCS VALUATION FEE <br /> ❑ ves ❑ NO eui�oiHc �'j� (Pa �/J �{b 3 F:>(d ? �,��-� <br /> 7VP CONSL NOAFSTORIES ocCuvpxtr NaOimvFwxGUxnS i <br /> •� 540°3 PWMBING �,� __���� � <br /> — K. <br /> SIZE OF BLDG. FIRE SPRINNLERS REO'D BASEMENT MEGiANIGAL /� � �"` � <br /> � �v d o n ves ❑ No ,— <br /> ADDITIONAL PIAN CHECN I <br /> OLCUPANCV ORO PIRE ALARM REOD NEIGHT LIMITATION j ___ _ <br /> � / <br /> O Ol'IiEA <br /> pEASON <br /> STATE BUILDING SURCHARGE �/ ;��_ � <br /> INT�NE BY PLANSAPPROVEUBV ��n OF EYERETT Pl18lIC WORKS -"��— <br /> �(.� LOCAL SALES �, <br /> DATE � �� p� TAX CODE IS 3105 TOTA� -t� 'J ; �,�? <br />