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APPLICATIC l FOR CONSTRlJCT� 1N PERMIT <br /> TO BE COMPLETED IN BLACK INK—PLEASE PRINT � <br /> BUILDING DEPARTMENT HEATING SYSTEM: ❑GAS O ELECTRIC O <br /> 259-8810 — <br /> i7 DEMOLITION ❑ COMBI:�ATION ❑ BUILDING ❑AAECHANICAL ❑PLUMBING ❑ SIGN <br /> ONME� ��0.�.npes� CITY ZIP PHONE <br /> � �71G f—� ew��� o, ,� ( z-_ <br /> TEN�NT IMILMDRESS � �pY�-�� � V��, a�i�y� <br /> CITY ZIP PHONE <br /> ' � � S � • , o <br /> �HCHITECTOR�ESIGNER MR!LAUDRE55 CITV ZIP PHONE <br /> GENER�LCONTR�CIDR MAILADDRESS CITV ZIP PMpNE <br /> STATE LICENSE� <br /> MECH�NIC�ICONTRACTOR MAILADDRESS CITV ZIP PNONE — <br /> ST�TE UCENSE/ <br /> PLUMBINGCONTRACTOR MAILADORESS CITY 21P PHONE <br /> ST�TE UCEN:E Y <br /> GONTR�CT PqICE OF WORK <br /> DESCRIBE RKA OSOWREFOOTAGEI OLVE CONTACTPEfl$ONANDPHONENO. <br /> 'n <br /> PflOPO5EDU5EOF8UILDING i HEREBY CERTIFY THAT I HAYE READ AND EXAMINED THIS <br /> APPLICATION AND KNOW THE SHME TO BE TRUE AND CORRECT.ALL <br /> a�� ���'�\`^ PROVISIONS OF LqWS AND ORDINANCES GOVERNING THIS TYpE OF <br /> LEG�LDESCNIPTqNpFppppERTY�S BELOWORATTACHTWpppplES) WORK WILL 8E COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br /> �or B��K oF NOT. THE GRANTING OF A PERMIT DOES NOT PqESUME TO GIVE <br /> AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br /> OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br /> PERFORMANCE OF CONSTRUCTION.THAT I AM AUTHOHIZED BY THE <br /> OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br /> P�RCELT�XI.O,NUMBER APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> CON?RACTOHS LAW 18.27 RCW^AND 296200 WpC. <br /> CONSiRUCT10N LO�N LENDEfl.ADDPE55,TEIEPNONE NOI IBFR � / <br /> e��.0 <br /> PROJECTADDRE33 s,a„ �„E ��-� 4-14-9N <br /> DAiE <br /> C t BUS ESS IICEH$E Iq <br /> ���� MECHANICAL <br /> NO• TYPE OF FlXTURE OR ITEM FEE N0. TYPE OF EOUIPMENT �E <br /> WATER CLOSET(TOILET) � NC—A/HNDLG UNITS—H.p. <br /> BATHTUB ' FORCED AIR SVSTEMS—B.T.U. M E.A. <br /> UVATORY(WASH BASIN) � UNIT HEATERS—B.T.U. M � <br /> SHOWER � CLOTHES DRYERS <br /> KITCHEN SINK 8 DISP ; V�NTILATION FAN � <br /> DISHWASHER � RANGE HOOD <br /> UUNDRYTRAY ' WATERHEATER � <br /> CLOTHES WASHER WOODSTOVE � <br /> URINAL � METAL FIREPLACE(WOOD BURNING) � <br /> DRINKING FOUNTAIN � FIREPLACE INSERT � <br /> FLOOR DRAIN � HEAT pUMP � <br /> BACKFLOW pREVENTERS ; GAS PIPING <br /> ROOF DRAINS—RAINLEADEflS � EXHAUST FAN � <br /> SINK(SERVICE—BAR,ETC.) � � <br /> � � <br /> � <br /> i <br /> � <br /> I <br /> � <br /> SUB TOTAL $ ' SUB TOTAL $ <br /> PERMIT $ � PERMIT $ ; <br /> TOTAL FEE $ ' TOTAL FEE $ 7 0 i o 0 <br /> FOR OFFICE USE ONLY: ys�� � <br /> FRONTSETB�CK RERRSETBAI ( SIDESETBRCK PLANCHECKNUMBER FEE RECEIPTNp. <br /> USEZONE LOTAqEA V�CANTSIiE FEES VALUATON FEE <br /> ❑ YES ❑ NO BUILDING � <br /> TYPEOFCONST. NO.OfSTORIES utn:Pexcr nOaUWFLLMtUxrtS � <br /> tnouc p�UMBING i <br /> i <br /> SREOFBIW. FIRESPflINKLERS0E0'U 9�SEMENT --�— <br /> � ❑ YES � NQ MECHANICAL ' <br /> OCCUPANLY LOAD FIPE AURM REOU HEIGHT LIMITATION ADDITIONAL PLAN CHECK � <br /> i <br /> pEA50N OTHER ' <br /> � <br /> i <br /> STATE BUIL�ING SURCHqRGE � <br /> INTAkE BV PLA45 APPROVED BY CITY OF EYERETT PUBLIC WORKS � <br /> LOCAL SALES � <br /> o�re TAX CODE IS 3105 ror�� � <br /> � <br /> I <br />