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APPLICATIO�� FOR CONSTRUCTI �N PERMIT � <br />TO BE COMPLETED IN BLACK INK—PLEASE PRINT <br />HEATING SYSTEM: ❑ GAS ❑ ELECTRIC ❑ � <br />BUILDING DEPARTMENT <br />259-8810 <br />❑ DEMOLITION ❑ COMBINATION Cl BUILDING <br />/O�4NER MAILADOflE55 CITY <br />.-.H�...►,o „�i.�liau�.�i 330� �.�-n� c�f� <br />ADORESS <br />❑ MECHANICAL ❑ PLUMBING C� SIGN <br />CITV 21P pHONE <br />� 7— 908 <br />A CTOflDESIGNER MAILPLDFESS CIN 21P PHONE <br />���4 ,(j�wo��w+� 3i/� u_7eT"�to��e 6UP,�_ 2�Sz-�--�$ fGb' <br />GENE�^ LCONTRRGTOR MAILADDflESS CITV 21P �� PHON STATELICENSE� <br />�,b2�f�Sou,�.cQ !'c.os �}'�Fo}� �01� �r�3�� Alr�rc�� zs��- �rt•�rn.rs��6 �1'f- <br />MECMANICALCONTRACTOR MAILADORESS CIN 21P PMONE STATELICENSEs <br />PLUMBMGCONTRRCTOR MAILAD�RESS CIN ZIP PHONE STATELILENSEs <br />�� D� � _ <br />�D�SO{IARE FOOTAGE INVOLVED <br />L <br />rTe.c� — 3 � <br />) L <br />k DR <br />n <br />)N ROPERTV SHOW/N�BELOWOR <br />— BIOCN ��`� OF — <br />� <br />PARCELiAXI.D.NUMB � <br />Y3?.S �?8� -oo/ -O6oe <br />CONSiRUCTION LOAN LENDER, PDDRE55, TELEPHONE NUMBER <br />PROJECTADDRESS <br />WATER CLOSET <br />BATHTUB <br />SHOWER —J�..�' �r <br />KITCHEN SINK 8 DISP <br />LAUNDRYTRAY <br />CLOTHES WASHER <br />URINAL <br />FLOOR DRAIN <br />BACKFLOW PREVENTERS <br />ROOF ORAINS—RAINLEADERS <br />SINK (SERVICE—BAR, ETC.) <br />SUB TOTAL $ <br />PERMIT $ <br />TOTAL FEE 3 <br />FOR OFFICE USE ONLY: <br />FRONi SETBACI� R°AR SETBACK <br />_� �� <br />OF:ONST. <br />i � <br />OF9LDG. <br />l�1(el <br />OF <br />FIRE SPRINKLERS REO'D <br />SI�E SETBACK <br />OCCUPANCYLOAU FIREALAFMREOD 1 <br />/2 � 5 <br />REASON <br />oRo��J�Nc` 7902 _ h z <br />INiAKE BV PLANS �h`/E� BV <br />I DATE � _ I �� — � 1 <br />ri — <br />— zS�'Z <br />I HEREBY CERTIFY THAT I HAV� READ AND EXAMINED THIS <br />APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />PROVISIONS OF LAWS AND ORUINANCES 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 GIVC- <br />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 />APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />CONTRACTORS LAW 18.27 CW AND 296200 WAC. <br />i <br />. ����f2 Y/rs%7 <br />FEE N0. TYPE OF EOUIPMENT <br />� NC—NHNDLG UNITS—H.P. <br />; FORCED AIR SYSTEMS—B.T.U. M E.A. <br />� UNIT HEATERS—B.T.U. M <br />' CLOTHESDRYERS <br />� VENTILATION FAN <br />RANGEHOOD <br />WATER HEATER <br />WOOD STOVE <br />FIREPLACEINSERT <br />HEAT PUMP <br />GAS PIPING <br />� � �, � <br />❑ YES ❑ NO BUILDING <br />CU�ANCY NO 01NYF1lItlGUN115 <br />:eauv PLUMBING <br />�S EN7 MECHANICAL <br />_i YES ❑ NO <br />7GHT LIMITATION AOOITIONAL PLAN CHECK <br />3 OTHER <br />STA7E BUILDING SURCHARGE <br />CITY OF EYERETT PUBLIC WORKS <br />LOCAL SALES <br />TAX CODE IS 3105 Torn� <br />SUB TOTAL S <br />PERMIT S <br />TOTALFEE $ <br />FE�E) / RELEIPTNO. <br />,� . ' ' ; 1 <br />�, De� <br />.' ,� <br />,I �I <br />T <br />� l �� I l�� <br />