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APPLICATIC�1 FOR CONSTRUCT��N PERMIT � <br />TO BE COMPLETED IN BLACK INK—PLEASE PRINT <br />I HEATING SYSTEM• U GAS O ELECTRIC ❑ I <br />BUILDING DEPARTMENT <br />259-8810 <br />❑ DEMOLITION ❑ COMBINATION l I BUILDING C] MECHANICA _ C PLUMBING ❑ SIGN <br />OWNER M�ILPODRE55 CITY ZIP PHONE <br />��Er�� H NA�9c�, 2�3L NlGra�Au: ��f.' 9X�� LSL-'1YJrt <br />TENpNT MAILADDRE55 CITV Z�P PHONE <br />ARCHITECTORDESIGNEN MAILADDPESS r���� ��T� Z�P PN�NE ����i}QU� <br />NAGanu � sr � � <br />, <br />GE EflQCONTFACTOR MAIIADDRESS GIfV ZIP PMONE STATELICEN I <br />F#� 9 r G�rs7, <br />ECH�NICQCONTRACTOR MAILADDAESS GITY ZIV PHONE STATELICENSE/ <br />PLUMBINOCONTNACTOR MAI��DDRESS CITV 21F PMONE STATELICENSEt <br />CONTAACT PRICE OF WORK <br />DESCRIBE WORI( AND SOUM <br />S <br />s <br />PROPOSED USE OF BUk01N S��` <br />�r �i/��! <br />IEGAL OESCRIPTION OF PROPERN (SH� <br />wT 20 — l.� e�ocK 4.S <br />CilAYd dne.f/ON <br />PARCELTA%I.O.NUMBER <br />CONSTRUCTION LOAN LEI <br />BELOW OR PTTACH TWO fAVIES) <br />_ oF G/.IR�ItLP <br />NUMBER <br />,,,,,.......__.._ 11Lo r(I`K�9r�o <br />PLUMBINfi <br />Np. TYpE OF Fll(TURE OR ITEA <br />WATER CLOSET (TOILET) <br />BATHTUB <br />LAVATORY(WASH BASIN) <br />SHOWER <br />KITCHEN SINK 8 DISP <br />� DISHWASHER <br />LAUNORYTRAY <br />CLOTHES WASHER <br />URINAL <br />DRINKING FOUNTAIN <br />FLOOR DRAIN <br />BACKFLOW PREVENTERS <br />ROOF DRAINS—RAINLEADERS <br />FOR OFFICE USE ONLY: <br />FPONT 52�' R�R � <br />/t � __> <br />TYPE GF CONSi. <br />_�1� <br />SIZE OF BIOG. <br />!uog SF <br />OCCUPANCVLORD <br />REASON <br />INTAKE BY <br />SUB TOTAI S <br />PERMIT S <br />TOTALFEE $ <br />FIRE SPR,INIKLERS REO'D <br />N� <br />FIRE ALARM REO� <br />PLANS <br />DATE <br />LONTACT <br />l � � S'J�a <br />i HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br />APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECL ALL <br />PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br />WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br />NOT. THE GRANTING OF A PERMIT DOES NOT PRESUML 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 AUTHORI2ED BV THE <br />OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br />APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />CONTH�"'ORS LAW 18.27 RCW AND 29fi.200 WAC. <br />�� 9�.0.� �_L��3 <br />xH�iUFE _ O�TE <br />TYPE OF EOUIPMEN7 <br />WC-NHNDLG UNITS-H.P. <br />FORCED AIR SYSTEMS-B.T.U. M E.A. <br />UNIT HEATERS-B.T.U. M <br />CLOTHESDRYERS <br />VENTILATION FAN <br />RANGEHOOD <br />WATER HEATER _ <br />METAL FIRE <br />FIREPLACE <br />HEAT PUMP <br />GAS PIPING <br />EXHAUSTF� <br />TOTAL <br />PUN CMECN NUMBER FEE <br />./ni. �7 ii"7C� <br />VACANT SITE �«� <br />❑ YES ,r N� gUILDING <br />OCCUP�NCY HO Of VMIIIHG W45 � <br />�90"P PLUMBING <br />M-� <br />BASEMENT MECHANICAL <br />❑ YES '._�NO <br />HEIGHT LIMITATIO ADDITIONAL PLAN CHECK <br />/ <br />Z OTHER <br />favq qe <br />,/ STATE BUII.DING SURCHARGE <br />CITV OF EYERETT PUBLIC WORNS <br />LOCAL SALES <br />TAl( COOE IS 3105 rorn� <br />$I ' <br />RECEIPTN_ O. <br />/Jn �� <br />F� <br />�� � <br />i <br />i <br />i <br />i <br />i <br />�'� J <br />� <br />i <br />�T <br />/J°/ ISc� <br />