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n <br />APPLICATIMI FOR CONSTRUCT'�N PERMIT � <br />TO BE COMPLETED IN BLACK INK—PLEASE PRINT <br />BUILDING DEPARTMENT HEA7ING SYSTEM: ❑ GAS ❑ ELECTRIC ❑ <br />259-8810 � <br />CI DEMOLITION L_I COMBINATION <br />f 1 MECHANICAL CI PLUMBING ❑ SIGN <br />OWNEF MIIL.I�DRE55 � CITV ZIP PIIONE <br />��NA//S 1�E' TTEQSKN� a�yu75 /l��H��j� ALE E11ERE'� 9�20/ (1dl� i�Z �1�Q <br />TENANT MAILAOORE55 CITY 21P PHONE <br />SAM� <br />ARCMRECTOROESIGNER _ MRILADDRESS CITY ZIP PHONE <br />GENEfiAL CONTRqCTOR ` MAII ADDPESS CI1Y ZIP pqpNE STATE LICENSE r <br />SnMF <br />MECHANICAL CON� RACTOR MAIL A�DRE55 CITY ZIP PMONE STATE UCENSE t <br />PLUMBING <br />CONTPACT PflICE Of W0.7K <br />MPIL HUUHtJJ <br />WORK ANG SOUARE fOOTAGf. INVOLVED <br />PPOPOSED USE OF BUILDING <br />CITY <br />LEGRL DESCRIP IJN OF PROPERTV ISHOVM BELOW O/R ATTRCX TWO COPIE51 <br />LOT � BLOCK � OF L" ��-F 7 � ND <br />C�pMPnNV'� FivST RnDlTloi.! To �Fe�i'1'� <br />IN_A � /t_o�l _.. „--Q�t: 4� <br />PAPCELTA%Ip.NUMBER <br />S/Slo - S� - C2� 3- c'2`X� <br />CONSTRUCTIONIOANLENDER.ADDRESS.TELEPHONE NUMBER <br />WATER CLOSET <br />SHOWER <br />KITCHEN SINK 8 DISP <br />LAUNDflYTRAY <br />CLOTHES WASHER <br />DRINKING FOUNTAIN <br />FLOOR DRAIN <br />BACKFLOW PREVENTERS <br />ROOF DRAINS—RAINLEAO <br />SINK ISERVICE—BAR, ETC <br />PERMIT $ <br />TOTALFEE $ <br />FOR OFFICE USE ONLY: <br />FRONTSETB�CK REARSETBACN <br />2G� � <br />USE�E � LOT AREA <br />� <br />iYPE OF CONSi. NO. OF STORIES <br />SREOFBLDG. <br />REASON <br />INT�KE BY <br />FIFE SPRINKLERS REO'D <br />FIRE ALARM REOD <br />PLANS APPflOyEO BY <br />� �v <br />D�TE 3 /31 /� <br />PHONE <br />CONTACT PERSON AND PMONE NO <br />STATE LICENSE � <br />F�JE . 7.S'$ � �� 18 <br />i HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br />APPLICATION AND KNOW THE SAME TO BE TRUE AND COflRECT. ALL <br />PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br />WORK WILL BE COMPLETED WITH WHETHER SF'ECIFIED HEREIN OR <br />NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME 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 AUTHORIZED BY THE <br />OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br />APPLICATION IS MADE AND 1 COMPLY WITH THE STATE <br />CONTRACTORS LAW 18.27 RCW AND 296200 WAC. <br />�4�4fie �C��� �/lO "7S� <br />SIGN� q O�iE <br />FEE NO. TYPE OF E�UIPMENT <br />� A/C—AIHNDLG UNITS—H.P. <br />FORCED AIR SYSTEMS--B.T.U. M <br />� UNIT HEATERS--B.T.U. M <br />' CLOTHESDRVERS <br />' VENTILATION FAN <br />� RANGEHOOD <br />; WATER HEATER <br />� WOOD STOVE <br />; METAL FIREPLACE (WOOD BURN�NC <br />' FIREPLACE INSERT <br />� HEAT PUMP <br />; GAS PIPING <br />� EXHAUSTFAN <br />SIDESETBACK� I PLAN <br />GANT SITE <br />i , YES i_i NO <br />;ueaxcr r�oaowEuixcuxrts <br />❑ YES iL <br />HEIGHT I.IMITATION <br />H /J % <br />CITY OF EYERETT <br />LOCALSALES <br />TAIf CODE IS 3105 <br />BUILDING <br />PLUMBING <br />MECHANICAL <br />ADDITIONAL PLAN CHECK <br />OTHER <br />STA7E BUILDING SI�RCNARGE <br />PUBLIC WOFKS <br />TOTAL <br />FEE <br />PERMIT $ <br />TOTAL FEE $ <br />S <br />� — <br />� <br />