Laserfiche WebLink
APPLICATIQ'' FOR CONSTRUCT,'1N PERMIT � <br />TO BE COMPLETED IN BLACK INK—PLEASE PRINT <br />BUILDING DEPARTMENT �-- <br />259-8810 <br />❑ DEMOLITION ❑ COMBINATION <br />HEATING SYSTEM: <br />❑ BUILDING <br />] ELECTRIC ❑ <br />❑ PLUM9ING f_1 SIGN <br />pyMEp MAtL AODRES$ GITY ZIPp PHONE G O <br />llv��. � inri �U1�7 (^P141�iO 1��)P Fl� 1820 ( ZJ�l�'�O�%7 <br />TENANT MAIL ADDRE55 CITY ZIP PHONE <br />ARCHITECTORDESIGNER MAILA�DRE55 CIN ZIP PHONE <br />GENEML CONTRACTOR MAIL ADDRESS CIN ZIP PMONE STATE LICENSE e <br />MECH�NICALCONiR4CTOR MAILADORESS CITY ZIP PHONE STATELICENSE• <br />PlUA31NGCONTR�CiOH MAILADDRE55 CITY ZIP PNONE SiATELICENSEM <br />CpNTRAC�yJ_?RICE OF WORK <br />T/ <br />DESCRIBE WORK AND SOUARE FOOTAGE INVOWED , ` • CONTACT PERSON �N� PHONE NO. <br />r�� l"'TC 1 Y1 n t t� . -- <br />LEG/� OESCRIPTqN OF VROPERT' (SHOWN BELOW Ofl ATfACH TWO <br />LOT BLOCK OF <br />PARLELTA%I.D.Nl1MBER <br />CONSiRUC710N LOAN LEI <br />KITCHEN SINK 6 DISP <br />DISHWASHER <br />LAUNDFYTRAY <br />CLOTHES WASHER <br />URINAL <br />DRINKING FOUNTAIN <br />FLOOR DRAIN <br />BACKFLOW PREVENI <br />ROOF DRAIN�RAIN' <br />SINK (SERVICE—BAR <br />TEL[PHONE <br />SUB TOTAL $ <br />PERMIT S <br />TOTAL FEE S <br />FOR OFFlCE USE ONLY: <br />FRONTSETB�CK REARSETBACN <br />USEZOqE LOTPREA <br />TYPEOFCONST. NOAFSTORIES <br />SQEOFBLW. FIRESPFINNLEFSREO'D <br />OCCUPANGY IOAD FIRE ALARM FEO-D <br />INT�NE BY <br />DATE <br />APPROVED OY <br />I HEREB`! CERTIFY THAT I HAVE READ AND EXAMINED THIS <br />APPLICATION AND KNOW THE SAME TO 8E TRUE AND CORRECT. ALL <br />PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br />WORK WILL 8E COMPLETED WITH WHeTHER SPECIFIED HEREIN OR <br />NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br />AUTHORITY 'i0 VIOLATE OR CAPICEL THE PROVISIONS OF ANY <br />OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br />PERFORMANCE OF CONSTRUC710N. THAT I TM AUTHORIZED BY THE <br />OWNER OF THIS PROPERTY TO PERFOFM THE WORK FOR WHICH <br />APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />CONTRACTORS LAW 1827 FCW AND 296200 WAC. <br />, o\ <br />Y T(i�n C �, � A'�73���— <br />SIGNA 11E D� f <br />NO. TYPE OF EGUIPMENT FEE <br />FORCED AIR SVSTEMS—B.T.U. M E.A. <br />UNIT HEATERS—B.T.U. M <br />CLOTHES DRYERS • <br />VENTILATION FAN � <br />RANGEHOOD <br />WATER HEATER <br />WOOD STOVE ' <br />METAI FIREPLACE (WOOD BURNING) <br />FIREPLACE INSERT � <br />HEAT PUMP _ <br />� <br />GAS PIPING <br />EXHAUST FAN _ <br />0 <br />SIDESETBACK rLANC�53SR� I FEE <br />� <br />VACANT SITE �CW <br />❑ YES �� NO BUiLDiNG <br />MLUP�4CY NO O�PMELLiNG11N�i5 <br />c"W" pLUMBING <br />BnSEMENi MECHANICAL <br />C1 YES G NO <br />HEIGMT LIMIIAiION ADDITIONAL PLAN CHECN <br />OTHER <br />STATE BUILDING SURCHARGE <br />CITY OF EYERETT PUBLIC WORKS <br />LOCALSALES <br />TA)( CODE IS 3105 TOTAL <br />SU8 TOTAL $ U � � <br />PERMIT S � � � <br />TOTAL FEE $ �- ' � <br />RECEIPT NO. <br />