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APPLiCATIQ'�` FOI� CONSTRUCTrN PERMIT <br /> � TO BE COMPLET[D IN BLACK INK—PLEASE PRINT � <br /> C�'� '',� ��� <br /> BUILDING DEPARTMENT HEATING SYSTEM: Qp GAS ❑ELECTRIC O <br /> 259-8810 <br /> ❑ DEMOLITION �4 COMBINATIpN ❑ BUILDING ❑MECHANICAL ❑PLUMBING ❑ SIGN <br /> OWNER M�ILADDRESS LITY 21P PMONE ���Id�� W <br /> Dn�! W. M�K�n�n�on� 1��8 �,e,4wp x i,trz6rr 4JA 9s�e r �SFr-il�z �Q.) <br /> TENANT MPIL ADUpF.55 CITY ZIP PHONE <br /> ANCHITECT OR DESIGNER MAIL RDDRESS CITV ZIP PHONE <br /> GENER LCONTRACTOR Mr11LA0DRE5 ZIP PHO STATEUCENS I <br /> TG 'F�E DETpYJNiNtD � <br /> MECH�NICALCONTR�CTOF MAILADDPESS CITV Z�p PNONE STATELICENSEI <br /> ., ._ .. l�i���,��� 7 ��. - �3�7 CEIERm�z �i�n�1 <br /> PLUMBING CONTRACTOfl MAII ADDRE55 CITY ZIP��� � HQN� 1I S,T.AT1Ek�I�)ENSE s � <br /> 1• �. �. l �� V�I.J V� � <br /> CONTRACT PRICE OF WpqK <br /> „ <br /> " �� CA2o� OBBQG 3�/ - <br /> ' DESCRIBE WOIiK AND SOWRE FOOTAGE INVOLVED CONTACT PERSON R HONE NO. <br /> o e o e c u N ZS9—i 6 <br /> Scoe a <br /> � i HEREBV CERTIFY THAT I HAVE READ AND EXAMINED THIS <br /> � PROPOSED USE OF BUILDING APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT.ALL <br /> �ES IDPIJCE PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br /> LE6ALDE RIPTIONOFPqOPERTY�SHOWNB OWORATTAGHTWOCOPIES� WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br /> �� �25 (� /}� NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVe <br /> �ot eiocK F AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br /> SC G a7�Fd .L�� OTHEFi 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 /> ' PARCELTAI(I.D.NUMBER APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> CONTRACTORS LAW 18.27 RCW AND 296.200 WAC. <br /> � CONSTRUCTpNLOANLENDER.ADDRE55,TELEPHONENUMBER <br /> Q�,..Q... � � � <br /> � PHOJE/C�T ADDR/E�S�S x HAiURE �� Z <br /> � ^�Q <J((/�A/ CiiYB115tt1E%I�CEN5E1q. <br /> �� PLUMBING MECHANICAL <br /> � N0. TYPE OF FlI(TURE OR REM FEE NO. TYPE OP ECUIPMENT FEE <br /> � - WATER CLOSET(TOILET) / � AIC—A/HNDLG UNITS—H.P. � � <br /> � BATHTUB / ; FORCED AIR SYSTEMS—B.T.U. M E.A. <br /> � <br /> I <br /> LAVATORY(WASH BASIN) � UNIT HEATERS—B.T.U. M ; <br /> � SHOWER � ' CLOTHES DRYERS � <br /> � KITCHEN SINK 8 DISP � � � VENTILATION FAN ; <br /> � DISHWASHER i RANGE HOOD � <br /> �� LAUNDRY TRAY ; WATER HEATER ' <br /> � CLOTHES WASHER � WOOD STOVE I <br /> URINAL ' METAL FIREPLACE(WOOD BURNING) � <br /> � ORV�KING FOUNTAIN FIREPLACE INSERT ; <br /> FLOOR DRAIN � HEAT PUMP <br /> BACKFLOW PREVENTERS ; GAS PIPING ; <br /> ROOF DRAIN�RAINLEADERS � EXHAUST FAN � � <br /> � SINK(SEqVICE—BAR,ETC.) ; ' <br /> � <br /> i <br /> � � <br /> SUB TOTAL S � SUB TOTAL $ ' <br /> PERMIT $ � PERMIT $ � <br /> TOTALFEE $ TOTALFEE $ � <br /> FOR OFFlCE USE ONLY: <br /> FRONT rEAR5ET8AC� / SIDESETBRCK � PUNCHE�NUMBE, FEE � FECFJ�TNO�� <br /> S s— vz <br /> useiar+e LOTAREA �pCANT5ITE � FEES VALUATON FEE <br /> ^Z ❑ YES NO BUILDING � (�/ i <br /> TYPEOFCONST NO.OFSTORIES accuP�ecY NOamnitroGUNns <br /> X � <br /> � PLUMBING i <br /> SIZEOFBLDG. FIRESPHINKLERSREO'D BAS�E�T MECHANICAL �O � <br /> f�3 YES CI NO <br /> OCCUPANCY L �0 FIRE�L�RM REO'D MEIGNT LIMITATI� ADDITIONAL PLAN CHECK � <br /> O OTHER <br /> REASON <br /> STATEBUILDINGSURCHARGE (� i�0 <br /> INT�KE BV PUNS�OYED BY CITY OF EYERETT PUBLIC WORKS � <br /> �V LOCALSALES � <br /> DATE � (; TAX CODE IS 3105 �TAL �� <br />