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APPLICATI4N FOR CO►NSTRUCTI-+ON PERMIT � <br />TO BE CuMPLETED IN BLACK INK—PLEASE PRIN i <br />HEATING SYSTEM: ❑ GAS ❑ ELECTRIC O <br />BUILDING DEPARTMENT <br />259-8810 <br />�fi' DEMOLITION ❑ COMBINATION ❑ BUILDING CI MECHANICAL ❑ PLUMBING ❑ SIGN <br />0 ER MAILMDRE55 CITY 21P d PHONE ��GerV` L(1/, <br />.�Lo 4,DaL� /�1liciy�Gs �/�6 / ii/E-' Z~ S��`JbiT� zm '� 9d�f� <br />T NANT s MAILADDRE55 CITY ZIP PHONE <br />ARCHITEC�ROESIG���A��AODNE55 CITY ZIP PHONE <br />PLUMBINGCONTR�CTOR MAILADDRESS CITV ZIP PNONE STATELICENSE� <br />CONTRACT PRICE OF \'IORK <br />DESCRIBE WORK <br />PROPOSEG USE OF BUILDING <br />FOOTAGE INVOWED <br />IEWL UESGNIPTION OF PROPERTY ISHOMM BELOW OP Ri TACH TWO COPIES� <br />LOT� BLOCK � OF ��I�� ���P <br />� l/OL� /� %P �o? <br />�7 �/ 7 �' ��O -O�8 „OOOd <br />PARCELTA%I.D.NUMBER <br />A�.�- <br />COt� TPUCTION LOAN LENOER. ADDRE55. TELEPHONE NUAIBER <br />N0. TVPE OF FIXTI <br />WATER CLOSET (TOILI <br />BATHTUB <br />LAVATORY (WASH BA: <br />,^,HOWER <br />KITCHEN SINK & DISP <br />DISHWASHER <br />IAUNORYTRAY <br />CLOTHES WASHER <br />URINAI <br />ORINKING FOUNTAIN <br />FLOOR DRAIN <br />BACKFIAW P9EVENl <br />ROOF DRAINS—RAIN' <br />FOR OFFICE USE ONLY: <br />FRONT SETBACN REAR SETBACK <br />USEZONE <br />iYPE OF LONSi. <br />SIZE OF BLDG <br />OCCUPANCYI <br />REASON <br />CONTRCT <br />�//!//.-�ii L-_-. <br />I / <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 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 PRESUME TO GIVE <br />AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANV <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 I COMPLY WITH THE STATE <br />CONTRACTORS LAW 1827 RCW AND 296.200 WAC. <br />ITEM FEE NO. TYPE OF EOUIPMENI <br />� A/�A/HNDLG UNITS—H.P. <br />� FORCED AIR SYSTEMS—B.T.U. <br />, UNIT HEATERS—B.T.U. M <br />� CLOTHES DRYERS <br />; VENTILATION FAN <br />� RANGEHOOD <br />� WATER HEATEP <br />� WQOD STOVE <br />� METAI FIREPLACE (WOOD BUI <br />SUB TOTAL <br />LOT AREA <br />NO.OF STORIES <br />FIRE SPPINKlERS REO'D <br />FIRE AIARM REO'D <br />PLANS�PPR��EDBV <br />DATE <br />HEAT PUMP <br />GAS PIPING <br />EXHAUSTFAN <br />E� <br />SIDE SETBpCK I PLAN CHECK NIIMBER <br />V�CANI Sllt <br />❑ YES n NO BUILDING <br />oauo.�xr xoauwnurwm:vc <br />�^a'v PLUMBING <br />B�SEMEN7 . MECHANICAL <br />❑ ves ❑ No <br />NEIGNr uMltAnor+ � ADDITIONAL PLAN CHECK <br />OTHER <br />STATE BUILOING SURCHARGE <br />CITY OF EYERETT PUBLIC WORKS <br />LOCAL SALES <br />TAX CODE IS 3105 TOTAL <br />SUB TOTAL S <br />PERMIT $ <br />TOTAL FEE 5 <br />FEE R� <br />i� t, /�'9'1�' <br />„p <br />H <br />0 <br />—J— <br />