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�. .� <br /> APPLICATI�..� FOR CONSTRUCTrON PERMIT <br /> TO BE COMPLETED!N BLACK INK—PLEASE PRINT � <br /> BUILDING DEPARTMENT HEATING SYSTEM: ]GAS ❑ELECTRIC ❑ <br /> 1259-8810 <br /> yJ DEMOLITION ❑ COMBINATION ❑ BUILDING ❑MECHANICAL ❑PLUMBING ❑ SIGN <br /> OWNER{' MAILADDRESS <br /> GA�� ���E lISZ7 ��I� C� W`� ��(Y ��v PHONE <br /> f ( <br /> TEN�NT MAIL�pDPE55 CITY ZIP PHONE <br /> ARCNITECTORDESqNER MAILAODflE55 CITY ZIP PMONE <br /> � OENERALCONTMCTOq M�ILADDHE55 CITY ZIP PHpNE STATEUCENSEt <br /> SI�'1ZRIE CoK�C'. CO. ' <br /> MECMMlIOA�(�N7p�CTOR MAIL�DDRE55 CITV 21P PHONE STATELICENSE/ <br /> PLUMBINOCONTR�CTOq MAIL�DDqESS QTV ZIP PIqNE STATELICENSEI <br /> CONTRACT PRICE OF NqpK <br /> DESCflIBE WdiN AND SOUAqE FOOT�GE INVOLVED CONT�GT PEfl50N AND PHpNE NO. <br /> ! <br /> ��� <br /> rnoroseouseoFeurto�+o 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 LqWS AND ORDINANCES GOVERNING THIS TYPE OF <br /> LEMIDE$CpIPTqNpFPROPERTY�SHOWNBEIOWORATT�CNTWpCOPIES� WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br /> �or &aK pF NOT. THE GRANTING OF A pERM1T DOES NOT PRESUME TO GIVE <br /> AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br /> OTHEF STATE OR LOCAL LAW REGULATING CONSTRUCTION Ofl THE <br /> PERFORMANCE OF CONSTRUCTION.TFIAT I AM AUTHORIZED BY THE <br /> OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br /> PAPCELT %ID.N ee APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> '� -��— Q� �Q�S CONTR TORS LAW 1827 RCW AND 296200 WAC. <br /> CONSTRUCTION LWN lENOER,IIDDRESS.TELEP110NE NUMBER <br /> PRO.IECT ADDRESS � ' _a-��-,� <br /> srvurwE w�c- <br /> D ci�r a;2M[55 iC[us[w <br /> PLUMBINO MECHANICAL <br /> NO. TYPE OF Fl%TUNE OR ITEY FEE N0. TYPE OF EOUIPMENT FEE <br /> WATER CLOSET(TOILET) � /VC—AMNDLG UNITS—H,P. <br /> BATHTUB ; FORCED AIR SYSTEIAS—B.T.U. M E.A. � <br /> LAVATORY(WASH BASIN) � UNIT HEATERS—B.T.U. M � <br /> SHOWER � CLOTHES DRYERS <br /> KITCHEN SINK d DISP . ' VENTILATION FAN � <br /> DISHWASHEfl RANGE HOOD <br /> LAUNDRY TRAY ; WATEfl HEATER <br /> CLOTHES WASHER � WOODSTOVE � <br /> URINAL ' METAL FIREPLACE(WOOD BURNING) <br /> DRINKING FOUNTAIN �IREPLACE INSEf;T <br /> FLOOR DRAIN NEAT PUMP , <br /> BACKFIOW PREVENTERS ; GAS PIPING � <br /> ROOF DRAINS—RAINLEADERS E%HAUST FAN <br /> SINK(SERVICE—BAR,ETC.� � <br /> � <br /> � <br /> � <br /> SUB TOTAL S ; SUB TOTAL S <br /> PERMIT S PERMIT S <br /> TO7ALFEE S TOTALFEE S <br /> FOR OFFlCE USE ONLY: <br /> FRONTSETB�CK NE�FSCT&�CR SM1IFuE7B�Cn PlN1CMCCKNUMBER fEE RECE�PiNO <br /> �se Zor� l07 AREA v�cN�r s�re FEES VALUATION fEE <br /> ❑ VES p NO '—*— <br /> owwir�c <br /> rrttacaci raorsrwaa ozv.�c� naowuwcur,� — <br /> � PLU6101t�IG � <br /> SiTEOr&DO �Itl[qFqUMy(RB11f7D g�SEUEIrt � <br /> ❑ YES ❑ NO �'��CHANICAL <br /> p�wvu+�rlWO rinCNu�uRCpD NE�6N1�M17Ailp1 ADDITId1�LPWIL�IECN � <br /> � <br /> RC�� OTI/ER ; <br /> — �. <br /> S1ATE BU4DING SUNf,H�R6E <br /> �"'�"�` °`""`A0"""'f°"� CITY OF EYERETT ruou;wa+vs <br /> LOCAL EALES <br /> u.*c TA1(CODE IE�105 To*�� <br />