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" APPLICATI�I FOR CONSTRUCT"-)N PERMIT � <br /> TO BE COMPLETED IN BLACK INK—PLEASE PRINT <br /> BUILDING DEPARTMENT HEATING Si.iTFM: GAS 'ELECTRIC ❑ <br /> 259-8810 <br /> ;J DEMOLI7ION f7 COM8INATION f ] Bt1!_DING �MECHANICAL ❑PLUMBIN(i U SIfiN <br /> ��C,1CS �M�f�c�n cr��e a.�j�l �r+'� dsY P�+ 98�� no ,on��,.�t <br /> TENANT MAILADDRE55 CITV ZIP PHONE <br /> v�,l u� <br /> �RCHITECTORDESIGNER MAILADDRE55 CITV ZIP PHONE <br /> �l� <br /> OENEMLCON }T�O.R IMILADDRESS CITV ZIP PHONE STATELICENBE� <br /> ��, l p' <br /> MECMNIId1LCONTRnCTO31�OM1T�1`\ �Y� WT �VaU ` la(s�J�I�J�I�E n�Y`�(NTr\\`�'Jll� <br /> ci. <br /> PLUMBRq CONTRIICTOR M�R.ADDRESS � LITV ZIP PHONE STATE LICENSE I <br /> _�0.Nn� �.S (V�,fCV�uv�,Cal -- <br /> �,�,K � <br /> ! f � EW f_I ADDITION I l ALTERATION f J REPAIR I i DEMOLITION f�I WOODSTOVFiFRPLINSERT CI BUILOINf3qELOCATI0F1 <br /> �, �40� CONTALT PEPSON AND PXONE NO. <br /> '� COMMCT PRICE OF WORK <br /> '' �ESCRIlE MlqSOUARE FOOT�GE NlVOIVED <br /> � � �n - S W.�. ; <br /> ����� i HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS i <br /> ���Y(��' APPUCATION AND KNOW THE SAME TO BE TRUE AND COHRECT.ALL I <br /> � . � LEML OESCRIPTpN OF PROPERiY(SHOWN BELOW OR�TfRG1 FOUR COPIE5) PROVISIONS OF UYVS AND ORDINANCES(iOVERNMKi iH18 TYPE OF �� <br /> WORK WILL BE CAMPLETED WITH WHETHER SPECIFlEO HEREIN OR � <br /> � . �oT e�oac or NOL THE ORANTINO OF A PERMIT DOES NOT PRESUME TO OIVE i <br /> ' AUTHORITY TO VIOLATE OR CANCEL THE PROYISIONS OF ANV <br /> i OTHER STATE OR LOCAL UW REOULATNO CONSTRUCTION OR THE � <br /> PERFORMANCE OF CqJSTRUCTION.THAT I AM AUTHORIZED BV THE <br /> OWNER OF THIS PROPERTY TO PERFORM TNE WORK FOR WHICH ��� <br /> ! APPLICATION IS MADE AN� I COMPLY WITH THE STATE � ' <br /> � CONTHACTORS LAW 18.27 RCW AND 296.200 WAC. , ���� <br /> � z �K..��'.�.� ��.r,�Ye�-�-� �y�23 � <br /> � T � <br /> . . ppp�q�Op�V\ �lM+��� �V� earwn� wre ,.�. <br /> d� em awreea icerae ra. <br /> � j �� �� � <br /> �. N0. TrPE OF RX7URE OR REM FEE N0. TYPE OF EWNPMENT F�E - <br /> ! WATER CLOSET(TOILEn � AMr-NHNDl6 UNITS—H.P. � . ' <br /> i BATMiUB ' FORCED AIR SYSTEMS--B.T.U. M E.A. � � <br /> � UVATORY(WASH BASIN) UNIT HEATERS--B.T.U. M � � <br /> � � SHOWER � CLOTHES DRVERS � <br /> . KITCHEN SINK 8 DISP ; VENTILATION fAN ; , <br /> � � DISHWASHER � RAN(iE HOOD � � <br /> UUNDRY TRAY ; WATER HEATER ' <br /> CLOTHES WASHER � WOOD STOVE � <br /> , URINAL ' METAL FIREPUCE d CHIMNEY � i <br /> DRINKINO FOUNTAIN � FIREPUCE INSERT ; <br /> FLOOR DMIN � HEAT PUMP � <br /> � BACKFLOW PHEVENTERS ; GAS PIPIN� ' �I <br /> � ROOF DRAINS--RAINLEADERS � E%HAUST FAN � � � <br /> SINK(SERVICE—BAR,ETC.) ; ' , <br /> , <br /> � <br /> � i <br /> SUB TOTAL S ; SUB TOTAL S ' <br /> PERMIT S � PERMIT S / i <br /> TOTALFEE S ' TOTALFEE S ' <br /> FOR OFFICE USE ONLY: <br /> FVIONTSETBIiCK REARSETBACK SIDESETBACK PIANCHEGKNUMPEfl FEE NECEIPTNO. <br /> 3977 <br /> use zor+E LOT APEA v�awt si� FEES VALUA710N FEE <br /> ew�onrc � <br /> IYPEDFCONic/iLLOWMLE 1VPEOFCONSf.ACNAL accuwicr noaow[uixcu��rs i <br /> tnauo pLUMBING � � <br /> SIZEOFBLDG. NO.OFS70RIE5 B�SEMEN7 MECHANICRL � <br /> i <br /> OCCUPANCYLOAD FIRESPRNKLERSREO'D HEI6HTLIMITATION ADDITIONALPUNCHECK � <br /> SPRINKLER � <br /> i <br /> REASON FOR SPRMKIERS <br /> STATE BUILDINC SURCHARGE i <br /> INTANE BY PLANS APPROVEO BV CITY OF EYERETT PUBLIC WORKS � <br /> LOCALSALES ,'— <br /> TAX CO�E IS 3105 *�T�� ; <br />