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` � APPLICATIQ`1 FOR CONSTRUCT'1N PERMIT � <br /> TO BE COMPLETED IN BLACK INK—PLEASE PRINT <br /> HEATING SYSTEM: ❑GAS ❑ELECTRIC ❑ <br /> BUILDING DEPARTMENT <br /> 259-8810 <br /> ❑ DEMOLITION ❑ COMBINATION � BUILDIN(i ❑MECHANICAL ❑PLUMBING ❑ SI(iN <br /> pymEp M�IL ADDRESS CITY ZIP F�E <br /> HD S/EPFE�TCO �.'S,O �•'�,.� 1l EUE�e7j� .?S9-Sl�S — <br /> TEWINT MAILADDRE55 ��TY Z�P PHOhE <br /> Evr-lzc7T DowNrowN 5>D¢AUE a3ao i�ecr��7r ��' QS9 -5�ao <br /> ARCMItECTOR�E5IGNER MRILADDRE55 CITY ZIP PNONE <br /> c.oNce MveG.GrR � A�c. /30 ���5�t� ��Sv ,fe�fit,� 56/� 2 3sS-aSS3 ��39(, <br /> OENERiV.CANTNACTON MMLADDHESS CITY ZIP PHONE STATELICENSE� <br /> • <br /> MELNANIGALCONTMCTOR MI1ILA�DRESS CITY ZIP PHONE STATELICENSEI <br /> pLLIAlM(iCp1TRACTOR MAILADDRE55 CITY ZIP PNONE ST�TEIICENSE� <br /> CONTMCT PPILE OF WIXiK ,�n / <br /> / <br /> DESCRIBEWOHKANDSOUAREFOOU INVOLVEU CONTACTPEHSONANDPHONENO. �,C <br /> �Qa !uU <br /> � �OD s � e��i�N �b_�-��N� ��s-ass3 <br /> ' �S�/4GE - i HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br /> � PROPOSEDUSEOF WRDMC APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECL ALL <br /> � � � � PROVISIONS OF lAWS AND ORDINAN(;ES 60VERNIN6 THIS TYPE OF <br /> LEd1LCE9CHIPTKINOFPNO�'ERTY�SMOWNBEIOWORATTACNTWOCOPIES) NOT. THELORANT�O O AD ERMIT DOE ENOT PRIESUMEETO 61VE <br /> � �oT e�xK � AUTHORItY TO VIOLATE OR CANCEL THE PFOVISIONS OF ANY <br /> � ER STATE OR LOCAL LAW REGUUTING CONSTRUCTION OR THE <br /> PERF NCE OF CONSTRUCTION.THAT 1 AM AUTHORIZED BY THE <br /> OWNER OF IS PROPERTY TO PERFORM THE WORK FOR WHICH <br /> APPLICATION MADE AND I COMPLY WITH THE STATE <br /> �. P^�.3 7 I D�O �00/ -000� CONTRACTORS 1827 RCW AND 296200 WAC. <br /> . C(ydgTqllCTqNLdWLENDEN.ADDRESS.TE�EPNONENUMBER �.� � <br /> ' � san�. o�rt <br /> M1p,lECT ADDRESS <br /> , Cil"flUiME55L�CFNSE NO <br /> , ��� MECHANICAL <br /> � .. N0. TYPE OF FlXTURE ON lTEM FEE N0. <br /> TYPE OF EOUIPMENT FEE <br /> WATER CIOSET(TOILE� � NC-NHNDLG UNITS-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 DR�'ERS ' <br /> ' VENTILATION FAN � <br /> KITCHEN SINK 8 DISP ' � <br /> DISHWASHER � RANGE HOOD � <br /> LAUNDRY TRAY ; WATER HEATER <br /> 1 CLOTHES WASHEP � WOOD STOVE ' <br /> URINAL ; METAL FIREPLACE(WOOD BURNING) ' <br /> DRINKING FOUNTAIN � FIREPLACE INSERT � <br /> FLOOR DRAIN HEAT PUMP � <br /> BACKFLOW PREVENTERS � GAS PIPING � <br /> ROOF DRAIN�RAINLEADEflS � E%HAUST FAN �.— <br /> � <br /> SINK(SERVICE-BAR.ETC.) � � <br /> � <br /> � � <br /> � <br /> � ---i--- <br /> � <br /> SUfI TOTAL $ ' SUB TOTAL $ �_ <br /> � PEHMIT S � PERMIT E � <br /> TOTAL FEE S TOTAL FEE S ' <br /> FOR OFFlCE USE ONLY: /�03. 4a� <br /> SIDESETB�LN� PLANCH GKNI�MBEN/ F� FE�PTy�.��� <br /> FRONT SETBACK Q REAR�oETBRCK � i��� ,,��.a� pa' <br /> ti <br /> ur=za+E VACANTSITE FEES VALURTION FEE <br /> C r � LOT AREA � <br /> ❑ YES ND BUILDING � ��a� ; ��-'v <br /> TYPEOiCONST. NO.OFSTORIES acucen[r MOo�WrtlliNGUNPS y <br /> 2 �SWZ � PLUMBING ___� <br /> � 6 -- - , <br /> SIZE OF BLDG. FIRE SPRINKLERS REO'D BASEMENT MECHANICAL —T <br /> ❑ YES 7!G NO ; <br /> 3I f�.D ��� HEIGHT LIMITATION ADDITIONAL PLAN CHECK ��� � 7J <br /> OC:UPANCV LO�D FIRE AIvARM REO'U i <br /> 5� 1�f OTHER � <br /> REASON 1 <br /> �N-,�/ � l��r���y._ STATE BUIIDING SURCHARGE V� <br /> Riwv �wr7�f•T�v <br /> INTAKE BY PLANS APPROVEO BY CITY OF EYERETT PUBLIC WORKS ��' ����� <br /> JM TAX CODE IS�3 05 TOTAI � '� ��`.� <br /> DATE 9�'� <br />