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APPLICATI� FOR CONSTRUCT�N PERMIT � <br /> TO BE CuMPLETED IN BLA�CK INK—PLEASE PRINT <br /> BUILDING DEPARTMENT HEATING SYSTEM: D GAS ❑ELECTRIC ❑,_ <br /> 259•8810 <br /> DEMOLITION f_l COMBINATION i�l SUILDING ❑MECHANICAL �J PLUMBINu ❑ SIGN <br /> OINNER MAILADDRESP CIiY 21P PHONE <br /> ETN6L Noa.�.T 1ioA GR�,vO iwtR�Tr wA 9B2o� � 5� l94Z <br /> TENANT MAIL ADORE55 CITV ZIP PHONE <br /> APGHITEC�J/�ESIGNEA MAIL RDDRESS CITY 21P PHONF <br /> GENEFALCONTP��TOP MAILADDRE55 CITV ZIP PHONE �2/�)/JY STATELICENSEI <br /> (3av��w Co�vs7a��r�.w R�oB E Ssoo 5 /�,v�r�y u.w. 9'glsn BAYu�G �e7Sb <br /> MECMANICALCON7RAGTOR MFILADDPESS CIiV ZIP PMONE STATELICENSE• <br /> . PLUMBIN(i CONTR�CTOR MAIL ADDRESS CITV ZIP PHONE ST�tE LICENSE� <br /> CONTql1GT PRICE OF WORK �,� <br /> SSo <br /> ilESCRIBE WOPK AND;OUIIRE�OOUGE 1NVCxVED CONTRCT PERSON AND PNONE!.O .�{ <br /> J66 BNR�M�DT 3ZI-7�TV <br /> f��+a�c r �R.�F <br /> i <br /> �OD 54 i HEREBY CERTIFY 7HAT I HAVE READ AND EXAMINED THIS <br /> PROPOSED USE OF AUILDING APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT.ALL <br /> PROVISIOPIS UF LAWS AND ORDINANCES GOVERNINCi THIS TVPE OF <br /> LEG�LUESCNIPTqNOFPPOPERTYISMOWNBEIOWORATTACHiWOCOPIES� „ �, WORK WILL BE COMPLETED WITH WHETHER SPECIFIED MEREIN OR <br /> �or� BLOCK� oF ���►t� �- ` NOT. THE GPANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br /> AUT�OHITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br /> � OTHEH STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br /> � PERFORMANCE OF CONSTRUCTION.THAT I AM AUTNORIZED BY THE <br /> � OWNER OF THIS PROPERTV TO PEHFORM THC- WORK FOR WHICH <br /> APPLICATION IS M,>DE ANO I COMPLY WITM THE STATE <br /> � PARCEI T�N ID.NUMBEH ,4',�'y— � / —O 1��OI�O CONTRACTORS lAW 1b.27 RCW AND 296.200 WAC. <br /> I. / � p/p <br /> GONSTRUCTIONLOANIENDER.�UDRESS.TELEPHONENUMBER <br /> � � <br /> � PIIOJECT ADDRESS scru. e o�re � •� <br /> QiY MESSLILFNSENO <br /> p��� MEq/ANICAL <br /> N0, TYPE OF RIITURE OR ITEM FEE NO. T'PE OF EOUIPMENT FEE <br /> WATER CLOSET(TOILE7) � IVC—A/HNDLG UNITS—H.P. <br /> . � BATHTUB ; fORCED AIR SVSTEMS--B.LU. M E.A. ' <br /> , UVATORY(WASH BASIN) � UNIT MEATER�B.T.U. M � <br /> � SHOWER CIOTHESDRYERS � <br /> � K�TCHEN SINK 6 DISP ; VENTIUTION FAN � <br /> ' DISHWASHER RAN6E HOOD <br /> LAUNDRV TRAY ' WATER HEATER ' <br /> CLOTHES WASHER � WOOD STOVE � <br /> URINAL METAL FIREPLPCE(WOOD BURNING) ' <br /> DHINKING FOUNTAIN � FIREPLACE INSERT T_ <br /> �LOOR DRAIN —T— HEAT PUMP ' <br /> � BACKFLOW PREVENTERS ; GAS PIPING I <br /> � ROOF DRAINS—flAINLEAGERS � E%HAUST FAN � <br /> SINK(SERVICE—BAR,ETC.) � <br /> � <br /> � <br /> � � <br /> — � � <br /> � <br /> SI�B TOTAL E ' SUB TOTAL S ' <br /> PERMIT 5 PERMIT E � <br /> TOTAL FEE S ' TOTAL FEE S � <br /> FOR OFFlCE USE ONLY: <br /> PRONT SETBRCI; REAR SETBRCN SIDE SETBAGN PLAN CHEC NU ER FEE BEGEIPT N0. <br /> �? <br /> USE ZONE LOT RREA VAI;ANT SITE FECS VALUATON FEE <br /> �, Yts o No BUILDING ��,a �aa <br /> 7VPE Of CONST. NO.OF STOHIES Ota�tritv x0 IX UwFUM6 UwiS -� � <br /> c��oun pLUMBING � <br /> --r— <br /> 52E OF BLDG. FIRE SPRINKlERS REO'D BRSEMENT MECHANICAL � <br /> r_ ves �:: No - <br /> OGCUP�.vGv loAO FlPE ALARM RE00 HEIGHT LIMITRT1qJ ADOITiONAL PLAN CNECK � <br /> OTHCR i <br /> RERSON � J1 <br /> STATE BUILDING SURCHARGE � v <br /> INTAKE BY PLANS APPROVE�BY CITY OF EYERETT PUBLIG WORKS � <br /> LOCAL SALES Q � � <br /> DA7E TAX CODE IS 3105 TOTAL � � ; `,� <br />