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APPLICATIC"�1 FOR CONSTRUCT�N PERMIT <br />TO BE COMPLETED IN BLACK INK—PLEASE PRINT � <br />BUILDING DEPARTMENT HEATING SVSTEM: ❑ GpS 0 ELECTRIC ❑ <br />259-8810 <br />❑ DEMOUTION ❑ CpMBINATION ❑ BUILDING ❑ MECHANICAL ❑ PLUMBING ❑ SIQN <br />��R AURADORE55 <br />�����ET � � CRV ZIP PYqNE <br />/ 9z s /{/b/K+�✓o ��E3T GJi} ,Q,S�-8590 <br />�wwr cua. �noness cm nr r� <br />ARCHITECTORDE6IC.NER IM0.ADDRE55 CRV ZIP pHp� <br />�/rice co �CNny CoirsTtkc.7`",e,.�. izsz c,yv,�,csy,,y ut�++: o.l,r,�„�yc or� "� ST�„c Sux.ow <br />�������� �K�E� CITY 21P PlpNE STATELICENSE� <br />I <br />' ������T� WILADD11E55 CITV ZIP Pf10NE STATELICENSEI <br />, �F e2 3, 9s7, ou <br />� OElCMEWOIMtNIDBOW111EF00T110EINVOWED <br />' �O�K �E/ii�t � j�j,`—�QOOF Fi <br />i A i <br />i�O<5� /L4A��/w/(i �6�I�. <br />I viarosEo usE a euioMo S� n <br />�L <br />I �ct� oEecmrr�oH a vnoaenrv �sHativN eE�ow <br />�or �� � <br />/ �� <br />� TA%I.D.MAlER <br />CaAl�llCt�]I LON1lEMER. ADd1E53. TELEP110N <br />� <br />�. �°°� /9as �sS <br />Kw.wu <br />ta. rnE oF Axn� on m <br />FOR OFFICE USE ONLY: <br />marrsE,e�cu n�wsE,e�cK <br />me a caxsT. <br />: �i. �_: � <br />SUB TOTAL <br />flRE SFRRKLERS REO'D <br />w� <br />CONT�CT PERSON AMD PMONE NO. <br />I HEREBV CERTIFY THAT I HAVE READ AND EXAMINED THIS <br />APPLICATION AND KNOW THE $AME TO BE TqUE AND CORRECT. ALL <br />PROVISIONS OF LAWS AND ORDINANCES 60VERNIN(i THIS TYPE OF <br />WORK WILL BE COMPLETED WITH W1{�{ER SPECIFIEO HEREIN OH <br />NOT. THE GRANTING OF A PEHMIT DpES NOT PRESUME TO OIVE <br />AUTHORITV TO VIOLATE OR CANCEL THE PROVI310NS OF ANV <br />OTHER STATE OR LOCAL LAW qE0UUT1N0 CONSTRUCTION OR 7►�E <br />PERFORMANCE OF CONSTRUCTION. T'►IAT I AM AUTHORIZED BY THE <br />OWNER OF THIS PHOPERTV TO PERFORM THE WORK FOR WHICH <br />APPLICATION IS MADE AND 1 COMPLY WITH THE STATE <br />CANTRACTORS LAW 1827 RCW AND 298.200 WAC. <br />� (r��— �-zs�3 <br />g�,,,� �„� <br />AIR SYSTEMS—B.T.U. M E.A. <br />UNR HEATER: <br />CLOTHES DRV <br />VENTILATION I <br />RAN6EHOOD <br />WATER HEATE <br />WOOD STOVE <br />METAL FIREPL <br />FIpEPIACE INI <br />HEATPUMP <br />OAS PIPIN6 <br />...���i%(� <br />��� 5�.� �es <br />❑ YES ❑ NO BUILDING <br />oawulcv ra.arvxcuncunrs <br />saouv <br />PLUMBIN(i <br />B�SEMEN7 MECHAN�CRL <br />❑ YES ❑ NO <br />NEIGHi LIMITATION ADDITIONAL PUN CHECK <br />oniea <br />STA7E BUILDING SURCHAROE <br />CITY OF EYERETT PUBLIC WORKS <br />LOCAL BAIES <br />TAX CODE 18 �105 mr�� <br />FEE <br />SUB <br />i <br />� <br />� <br />