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APPLICATIC'1 FOR CONSTRUCT"�N PERMIT � <br />TO BE COMPLETED IN BLACK INK—PLEASE PRINT <br />BUILDING DEPARTMENT HEATING SYSTEM: ❑ GAS ❑ ELE�TRIC i] <br />259-8810 <br />❑ DEMOLITION ❑ COMBINATION � BUILDING I] MECHANICAL ❑ PLUMBING ❑ SIGN <br />OWNER MAIL�DDRE35 CITY ,/ ZIP PNONE <br />�/Ec.//,o�✓c/ �C��.+^s..% z'�i//h/�r'1 .�riE•ee0� �l�"�G/ ?�—�j3�G <br />TENRNT _ MAILADDRESS -� CITY 21P PMONE <br />MAIL ADDRESS <br />w r <IY <br />GENERAICONTRACTOR MqILADDRESS CITV Zlp pqONE <br />�HiNfe/�— '�� <br />MEGHNlICAL CONTRRCTOR MAIL FOORESS CITY ZIP PHONE <br />I <br />STATE LICENSE • <br />PLUMBINGCONTR�CTOR MAILADDRESS CITY ZIP PNONE STATELIC_NSER <br />CONTRACT PRICE OF WORK <br />�� oev <br />DESGRIBE WOfiK AND RPE FOOTAGE INVOLVED <br />s�.s�1,. // /d - �/scS � c��^t,� <br />� <br />S ��+�r� <br />PROPOS D USE OF BUIICING <br />, �✓.e..-e. iiws� <br />. IEGAL DESLHIPTION OF PROPEFTV �SHOWN BELOW OR ATTACM TWO COPIES� <br />y LOT BLOCK OF <br />I <br />� PARCELTA%ID.NUMBEF <br />I <br />� CONSTRUCTION LOAN LENUER. AODRE55. TELEPNONE NUMBER <br />i PROJECT ADDRE333 3 z,3 �� �� S.'1� / <br />f�f r rt�. <br />! PLUMBINO <br />� NO. TYPE OF flIfTURE OR ITEM FEE <br />WATER CLOSET (TOILET) � <br />BATHTUB � <br />j LAVATORV(WASHBASW) <br />SHOWER � <br />, KITCHEN SINK 6 DISP ; <br />I DISMWASHER � <br />, LAUNDRYTRAY ; <br />CLOTHES WASHER � <br />URINAL � <br />�, DRINKING FOUNTAIN ; <br />� FLOOR DRAIN � <br />i BACKFLOW PREVENTERS ; <br />� ROOF DRAINS—RAINLEADERS � <br />SINK (SERVICE—BAR, ETC.) ; <br />� ' <br />t � <br />� SUB TOTAL $ ; <br />; PERMIT $ <br />TOTAL FEE $ ' <br />�� FOR OFFICE USE ONLY: <br />FRONT SETBACN REAR SETB�CK SIDE SETBRCK <br />USE ZONE <br />7VPE Of CONSi. <br />SIZE OF BLOG. <br />OCCUP�NCYLOAD <br />REASON <br />LOT AREA <br />NO. OF STORIES <br />FIRE SPPINKLERS fiEO'D <br />FIRE ALARM REO'D <br />PL\NS OBY <br />° S_ )D. 5; <br />G YES ❑ NO <br />OCCpGµLY NOIRVMIIINGUH�iS <br />LFWP <br />BRSEMENT <br />❑ YES ❑ NO <br />HEIGHT LIMITRTION <br />CITY OF EYERETT <br />LOCAL SA! ES <br />TAX CODE IS 3105 <br />NO. <br />5�-�3lrG <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br />APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />PROVISIONS OF L/1WS AND ORDINANCES GOVERNING THIS TVPE OF <br />WORK WILL BE COMPLETED WITH WHcTHEfl SPECIFIED HEREIN OR <br />NOT. THE GRANTING OF A PERfdIT DOES NOT PRESUME TO GIVE <br />AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br />OTI-1ER STATE OR LOCAI LAW REGULATING CONSTRUCTION OR THE <br />PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br />OWNER OF THIS PROPEfiTV TO PERFORM THE WORK FOR WHICH <br />APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />CONTRACTORS LAW 18.27 HCW AND 296200 WAC. <br />i� . <br />NC—A/HNDLG LNITS—H.P. <br />PORCED AIR SYSTEMS--B: <br />UNIT HEATERS—B.T.U. M <br />CLOTHES DRYERS <br />VENTILATION FAN <br />WATER HEATER <br />WOOD STOVE <br />FIREPLACE INSERT <br />HEAT PUMP <br />EIfHAUST FAN <br />PLAN CNECK <br />BUILDING <br />PLUMBING <br />MECHANICAL <br />ADDITIONAL PLAN CHECK <br />OTHER <br />STATE BUILDING SURCHARGE <br />PUBLIC WORKS <br />TOTAL <br />SUB TOTAL $ <br />PERMIT $ <br />TOTALFEE S <br />FEE I RECEIPTNO. <br />YN <br />tl <br />