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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 U ELECTRIC C] <br /> 259-BB10 <br /> ❑ DEMOLITION ❑ COMBINATION L BUILDING f�MECHANICAI ❑PLUMBING ❑ SIGN <br /> OYrtlER MaILADDRE55 CITY 21P FNONE <br /> �tN�L �ua..vT ��of3 Ga`wp EVbRrTT wa 982c� 253. -�4Y2 <br /> TENANi MAILADDRE55 CITV 21P PHONE <br /> N/q <br /> ARCMITECTOROESIGNER MpLADDRE55 GTV 21P PHONE <br /> GENERQ CONTR�GTOR� M11L ADDRESS t1TV 21P PMONE '.j,'t��)/Y�STATE LICENSE� ' <br /> BA 4 �sw GOn�YRucTr�, �oR 6 STOo 5 La.vo�ry w� 9f42�e BAYu c. �o� SG <br /> MELNMIIC/�L COHTPACTOF MAIL ADDRESS CITV ZIP PHONE STATE LICENSE� <br /> PLUMBMGCONTR�CTOR MAR�DDRE55 CITY ZIP PHONE STATELICENS:I <br /> CONTFACT PqICE OF WORK <br /> �0 , <br /> � DESCRIBE WORN�ND SOUARE fOOTRGE INVOLVED CONTACT PERSON AND PHONE NO. <br /> ou G � � W�r.t 706 <br /> - EBw � WA�L 1 R F I`7f <br /> lNSTAK R�F ew ��� G i HEREBY CERTIFY THh' I HAVE READ AND EXAMINED THIS <br /> � PRpPOSED USE OF BUILDING APpLICATION AND KNOW THE 3AME TO BE TRUE AND CORRECT.ALL <br /> , QpaK PROVISIONS OF IAWS AND OROINANCES GOVERNING THIS TYPE OF <br /> , LEGQDESCRIPTIONOFPROPEflTV�SHOWNBELOWORATTACMTWOCOPIE51 . � WORK Wlll BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br /> �n G✓6R�Tr 0�� 4 NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br /> , �ot ^�- e�xK�L— oF 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 /> 7 _Y�/ _ � APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> � P�RCEL TA%ID.NUMBER � �/ O 'O�S CONTRACTORS LAW 1827 RCW AND 296200 WAC. <br /> " DIO <br /> j CONSTHUCTqN LOAN LENDER.ADDRESS.TELEPNONE Nl1MBER <br /> � R Fi.�� ���/93 <br /> � P110JECT A saH�Tun o.rE <br /> ' Q� CrtVBU4 $$IICEN5EN0. <br /> � p��q MECHANICAL <br /> �. N0. TYPE OF FlI(TURE OR REM FEE NO. TYPE OF EOUIPMENT FEE <br /> � WATER CLOSET(TOIIET) � A/C--NHNDLG UNITS-H.P. � <br /> BATHTUB ; FORCED AIR SYSTEMS-B.LU. M E.A. ' <br /> � UVATORY(WASH BASIN) � UNIT HEATERS-B.T.U. M � <br /> � SHOWER ' CLOTHES DRYERS � <br /> ' KITCHEN SINK 6 DISP � VENTILATION FAN � <br /> ' DISHWASHEH � RANGEHOOD � <br /> �� LAUNDRYTRAY ; WATER HEATER ' <br /> ; CLOTHES WASHER � WOODSTOVE � <br /> � URINAL ' METAL FIREPLACE(WOOD BURNING) ' _ <br /> ' DRINKING FOUNTAIN � FIREPLACE INSERT � I <br /> j FLOOR DRAIN � HEAT PUMP � <br /> I BACKFLOW PREVENTERS ; GAS PIPING I . <br /> ' ROOF DRAINS-RAINLEADERS � EXHAUST FAN <br /> SINK(SERVICE-BAR,ETC.) ; � <br /> � <br /> �! � <br /> � � <br /> j , � <br /> SUB TOTAL S ' SUB TOTAL S <br /> ! PERMIT S � PERMIT S _� <br /> i� TOTAL FEE S ' TOTAL FEE $ <br /> FOR OFFICE USE ONLY: <br /> � FRONTSE N RE�RSET SIDESETBACIy, PLANGNECK UMBER / FEE ^� RECEIPTNO. <br /> �� � �� <br /> � use LOi RREA VAC�NT SITE FEES VALUATION FEE <br /> � ❑ YES ❑ NO BUILDING 3 �f �j iOD <br /> PEO fANST NO.OFSTORIES OctursMcr NoaowElliMtuMrts � <br /> � �a�P / PLUMBING i <br /> -(�[ � 'i <br /> SIZE OP BLDG. FIRE SPFINNLEPS REO'D BASEMENT _�/ MECHANICAL � <br /> �b`/ SF ��o ❑ YES L�✓NO � <br /> OCCUPANLY LO�D FIRE ALARM REO'D HEIGHT LIMITATION ADDITIONAL PLAN CHECN � <br /> I � <br /> /.1 NJ �+� OTFIER i <br /> RE�SON � <br /> STATE BUILDING SURCH�RGE �J� <br /> INTANE BY PLANS APPPOVEO BV CITY OF EYERETT PUBLIC WORKS � <br /> JT= LOCAL SALES <br /> DATE S ` 9y TAX CODE IS 3105 �TAL �� �s9 <br />