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APPLICATI� FOR CONSTRUCT�N PERMIT � <br />TO BE COMPLETED IN BLACK INK—PLEASE PRINT <br />HEATING SYSTEM: Q�GAS ❑ ELECTRIC O <br />BUILDING DEPARTMENT <br />259-8810 <br />❑ DEMOLITION ❑ COMBINATION C1 BUILDING ❑ MECHANICAL �(pLUMBING ❑ SIGN <br />OWNER MAIL ADDRESS CITY ZIP PHONE <br />2/e� / a�/3/ -/G6�`i'C Sr G�-p+�F�f ��Z�Y 337-7i�� <br />TENANT MAILAODRESS CIN ZIP PHONE <br />ARCHITECT OP DESIGNER MAI� ADDRESS CITY ZIP PHONE <br />GENERRLCONTRACTO� h1AILADDRESS <br />CITV 21P PHONE STATE LICENSE I1 <br />AIECHANICALCENiRACTOR MAILADDRESS GTY ZIF PMONE STATE�ICENSE� <br />PWMBINGCONTRACTOR MAILADDRESS CIiY ZIP PHONE STAiELICENSER <br />CONiPACTPRICEOFWORK - 7 (/C' <br />3eo��— /.�.�t�� <br />DESCRIBE WORN AND SOUAPE FOOTAGE <br />PROPOSED USE OF BUILDING �F �'J <br />�[ PS � <br />LEGAL OESCRIPTION OF PROPERTY (SHOWN BELOW OR ATTRCH TWO <br />�o.� a�aK y oF .cb . d��.. <br />�iv Z <br />� J/ /� <br />P�RCELTAXI.O.NUMBER <br />CONSTRUCTION LOAN LEI <br />raaeCT I�DDRE$; <br />_�LZ(v_ <br />PLUMBINO <br />N0. TYI <br />� / WATER CL� <br />/ BATHTUB <br />� ao 9 — �o—�' �' <br />ADDRE55. TELEPHONE NUMBER <br />5HOWER <br />KITCHEN SINK 8 OiiR <br />LAUNDRVTRAY <br />CLOTHES WASHER <br />URINAL <br />DRINKItJG FOUNTAIN <br />BACKFLOW <br />ROOF DRAI <br />FOR OFFICE USE ONLY: <br />FRONTSETBACK AEAR: <br />USE ZONE <br />1YPE Of LONSi. <br />S2E OF BLDG. <br />OCCUPRNCVL <br />FEASON <br />INTAKE BV <br />OR ITEM <br />ETC.) <br />o� � <br />� <br />SUB TOTAL $ <br />PERMIT $ � <br />TOTAL FEE $ <br />TBACN SIDE SETBACK <br />LOT AREA <br />NO. OF STORIES <br />FIqE SPAINKLERS REO'D <br />FIRE AIAFM REO'D <br />PLANSAPPROVEDBY <br />onre <br />CONTACTPERSONANDPHONEYO. <br />%� fG�� .33y-7i5 J <br />i HEREBY CERTIFY THAT 1 HAVE READ AND EXAMINED THIS <br />APPLICATION AND KNOW THE S���dE TO 9E TRUE AND CORRECL ALL <br />PROVISIONS OF IAWS AND ORDINANCES GOVERNING THIS TYPE ��F <br />WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br />NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME T:1 GIVE <br />AUTHOFITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br />OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION C�t THE <br />PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED DV ?HE <br />OWNER OF THIS PROPERTV TO PERFORM THE WORK FOR WHICH <br />APPL�CATION IS MADE AND I COMPLY WITH THE STATE <br />CONTRACTORS LAW 76.27 RCW AND 296200 WAC. <br />� � i9-s� <br />SK'iNAiUFE OAiE <br />MECHANICAL <br />10. TYPE OF EGUIPMENT <br />FORCED AIR SVSTEMS--B.T.U. <br />UNIT HEATERS—B.T.U. M <br />VENTILATION FAN <br />RANGEHOOD <br />WATER HEATER <br />WOODSTOVE <br />METAL FIREPLACE <br />FIREPL ACE INSER' <br />HEAT PUMP <br />GAS PIPING <br />TOTAL <br />Ei <br />PLANCNECKNUMBER � fEE I RECEIPTNO. <br />�. �� YES ❑ NO BUILDING <br />OCCU>ANCY h0 W VN[IIINGUNi1S ' <br />cnouv p�,UM81NG <br />BASEMENT MECfiANICAL <br />G YES C NO <br />MEIGHTLIMITqTION ADDITIONALPLANCHECK <br />OTHER <br />STATE BUILDING SURCHARGE <br />CITY OF EYERETT PUBLIC WORKS <br />LOCAL SALES <br />r�r r.nnF is a�ns rorn� <br />