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APPLICATIQ`�1 FOR CONSTRUC�N PERMIi � <br />TO BE COMPLETED IN BLACK INK—PLEASE PRINT <br />HEATING SYSTEM: O GAS ❑ ELECTRIC ❑ <br />BUILDING DEPARTMENT <br />259-8810 <br />❑ DEMOLITION ❑ COMBINATION ❑ BUILDING ❑ MECHANICAL ❑ PLUMBING fl SIGN <br />TENANT MRILADDRESS CITY 21P PHONE <br />�RCNITECTORDESIGNER MAI�RDDRESS CITV ZIP PMONE <br />GENERQCONTR�CTOR M�IL�DDRE55 CITV ZIP P�E <br />CiANICQCOMTRACTOii MAILADDRE55 CITV ZIP PHONE <br />� /o��, h�'.. <br />T.e..� o u�n �nnoocc CITV LIG PMONE <br />CONTRIICT PRh:E OF WORK <br />DESCR�BE WORK AND SOUARE FOOiAGE INVOlVEO <br />PROPOSED USE OF BUILO`Ny. <br />i <br />LE WL DESCRIPTION OF PROPf <br />LOT BLOCN <br />PARGELTA%LO.NUMBEil <br />CONSTRUCTIONLOAMLENDER,ADDRESS. <br />KITCHEN SINK 8 <br />DISHWASHER <br />LAUNDRYTRAY <br />DRINKING FOUNTAIN <br />fLOOR DRAIN <br />SINK <br />oF <br />[ONTRLT PERSON AND PHONE NO. <br />� • i <br />/� I . +/1/ <br />STATE uCENSE � <br />STRTE LICENSE � <br />STATE LICENSE t <br />i HEREBY CERTIFV THAT I HAVE READ AND EXAM'VED THIS <br />APPLICATION AND KNOW 1'HE SAME TO BE TRUE AND C7RREC�T. ALL <br />pROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br />TYOCOPIES� WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIW OR <br />NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME'.O Ct,VE <br />AUTNORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br />OTHER STATE OR l�1CAL 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 18.27 RCW AND 296.200 WAC. <br />. . n � .. �% �% n _ <br />Nl1MBER <br />TOTAL S <br />u11T $ <br />�L FEE S <br />FOR OFFlCE USE ONLY: <br />FRONTSETB�CK REAqSETBACK <br />USEZONE LOTARER <br />1YPEOFCONST. NOAFSTORIES <br />SIZE OF BIDG. FIRE SPRINKLERS REO'D <br />OCCUPANCV LORD FIFE ALAPM REO'D <br />ev <br />DATE <br />ev <br />FORCED AIR SYSTEMS--B.T.U. M E.A. <br />UNIT HEATERS--B.T.U. M <br />VENTILATION FAN <br />RANGEHOOD <br />WATER HEATER <br />WOOD STOVE <br />METAL FIREPLACI <br />FIREPLACE INSEF <br />HEAT PUMP <br />GAS PIPING <br />PLAN CHEGK <br />❑ YES ❑ NO BUIIDING <br />aavexcr xaarw[uixeuxrts <br />�A�P PLUMBING <br />BnSEMENT MECHFMICAL <br />❑ YES u NO — <br />HEIGHi LIMITATION ADDITIONAL FLAN GHECK <br />OTHER <br />STATE BUILDING SURCHARGE <br />C!TY OF EYERETT PUDLIC WORKS <br />LOCAL SALES <br />TAl( CODE IS 3105 ror�� <br />FEE <br />TOTAL S <br />MIT $ <br />�pu <br />no <br />Nn <br />Yp <br />N <br />� <br />E <br />