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APPLICATIC�y FOR CONSTRUCT'flN PERMIT � <br />TO BE COMPLETED IN BLACK INK—PLEASE PRINT <br />HEATING SYSTEM• GAS I] ELECTRIC ❑ <br />BUILDING DEPARTMENT ' <br />259-8810 <br />❑ DEMOLITION 1j�COMBINATION ❑ BUILDING I_] MECHANICAL ❑ PLUMBING ❑ SIGN <br />ONRJER _� _ AILADDRE55 38/�.q Cltt , 21P � pqpq� <br />MAILADDflE� CITY ZIP PHONE <br />a�ra�v. �e.e.c��e� <br />AIIA DRE55 CILV 21P PHONE <br />�'+-�t I�IIJ I`�flisov �w►,r�-ti GI'�dE�3 <br />lec�SS in.D.3oK �4� NIuL�I� [�Ue. 4Y�7C <br />MEGHANIC/�LCIXJTq�CTOR NAILADDRESS CIN ZIP PHONE ST�TELICENSEI <br />uup�...-- <br />PLUMBINOCONTRRCTOR MAILADDRESS CITY ZIP PHONE STATELICENSEI <br />CONTRACT PRICE OF WORK <br />S�� oco'! <br />DESCRIBE WORK �ND SOU�RE FOOTAOE IINOLVED <br />PROPOSED USE OF BUILDIN(3 <br />5n�.�-,L� �.�..- . L, T2 <br />LEGAL DESCRIPTION OF PROPERTV (SHOWN BELOW R ATfACH <br />l0T BLOGK OF <br />F�RCELTAXID.NUMBER <br />�TAU�TION LOAN LENDER. ADDRE55. TELEPHONE NUMBER <br />Heiu2M �•C �:b6.�r � $I,w <br />PROJE T ADDRESS �a,� �,� � a <br />PLUMBINO <br />BATHTUB <br />LAVATORY(WASH BASIN) <br />SHOWER <br />KITCHEN SINK 8 DISP <br />DISHWASHER <br />LAUNDRYTRAY <br />CLOTHES WASHER <br />URINAL <br />DRINKING FOUNTAIN <br />FLOOR DRAIN <br />BACKFLOW PREVENTERS <br />ROOF DRAIN�-RAINLEADERS <br />SINK ISERVICE—BAR. ETC.I <br />FOR OFFICE USE ONLY: <br />FRONTSETBACK REARSETBACK <br />_. , <br />USE ZONE <br />� <br />� <br />siZE �6�8 <br />� <br />OCCUPMlCY <br />REASON <br />INTAKE BY <br />SUB TOTAL $ <br />PERMIT S <br />LOT AREA <br />/Oi�+/� <br />Z <br />FIflE SPRINK�ERS RE�'D <br />PUNS A� V[D BY <br />f� <br />onre � /.e L <br />�. <br />CONTACT PERSON RND PHONE NO. <br />�63 , i EREBY CERTIFY THAT I HAVE READ AND EXAM'NED THIS <br />APPUCATION AND KNOW THE SAME TO BE TRUE AND CONRECT. ALL <br />� PROVISIONS OF LAWS AND ORDINANCES GOVERNING THiS TYPE OF <br />LOPIES� WORK WILL BE COMPLETED WITH WHETHER SPECIFIED hEREIN OR <br />NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br />AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br />OTHER STATE OR LOCAI LAW REGULATING CONSTRUCTION OR THE <br />PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BV THE <br />OWNER OF TH�S PROPERTY TO PERFORM THE WORK FOR WHICH <br />APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />CONTRACTO�R }" W 1827 RCW AND 296200 WAC. <br />1�568- s x���4-�-- ���/�i[�- 7- t 7-? 3 <br />SNi URE DATE <br />CItV BUSINESS LICENSE Iq. <br />MECHAINCAL <br />FEE NO. TYPE OF EOUIPMENT FEE <br />� A/�/VHNDLG UNITS—H.P. � <br />; FORCED AIR SYSTEMS--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 />; GAS PIPING ' <br />� '/ EXHAUST FAN �— <br />PERMIT $ <br />TOTAL FEE $ <br />SIDE SETBA �N PLAN CHECK NUMBER FEE <br />s �.� a�s <br />VACANTSITE ,�/ FEES VAL <br />❑ YES ! NO BUIIDING SZ <br />acur�xcr xoaownin�cuHrts <br />a0tl3 I PLUMBING <br />BASEMENT MECHANICAL <br />❑ YES NO <br />NEIGH7 uMI7nTiON ADDITIONAL PLAN CHECK <br />�/ <br />OTHER <br />STATE BUILDING SURCHARGE _ <br />CITY OF EYERETT PUBLIC WORKS <br />LOCAL SALES <br />TAX CODE IS 3105 TOTAL <br />