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APPLICATI�"1 FOR CONSTRUCT"1N PERMIT � <br />C� � TO BE COMPLETED IN BLACK INK—PLEASE PRINT <br />BUILDING DEPARTMENT HEATING SYSTEM: ❑ GAS ❑ ELECTRIC ❑._ <br />259-8810 <br />f 7 DEMOLITION �! COMBINATION I I BUILDING L] MECHANICAL I PLUMBING ❑ SIGN <br />OWNER MFILAOORESS qTY 'ZIP / PNONE <br />'Y) /�-E R o 1� / n/ 7 C la L/ e 1!� R� ��%(� �,gA rt/i� n ve z 5'2 -T 5�Z <br />TENANT MAILAODRESi CITY ZiP PHONE <br />:�:.'.HITECTORDESIGNER MAILADDRCSS CITV ZIP PNONE ��/_//�� <br />��l1/n/��.�.i� .QoAA..7�iiw�� /nl�/ :UaALar�.../ 1./.�li /�f�% <br />GENERAL <br />ADL <br />MECHANILPLCONTRACTOR MRILADDFE55 <br />PLUMBING CONTPACTOR MAIL ADDPESS <br />CONTRRCT PRICE OF WORK G^� '/(-7 <br />// Y <br />L O <br />DESGRIBE WORK AND SOUARE FCAT�GE INVOLVED <br />t LEGAL DESCRIPTION O� PROPERTY �SHONM BELOW OR ATTACH iW0 COPIESI <br />LOT BLOCK Of - <br />PARCELT�XID.NUMBER <br />CONSTRUCTION LO�N LENDER. <br />PROJECTADDRESS <br />PLUMBING <br />NO. TYPE 0 <br />WATER CLOSE' <br />BATHTUB <br />flXTURE OR ITEM <br />SHOWER <br />KITCHEN SINK 8 DISP <br />LAUNDRYTRAV <br />CLOTHES WASHER <br />DRINKING FOUNTAIN <br />FIOOR DRAIN <br />BACKFLOW PREVENTERS <br />ROOF DRAINS—RAINLEAC <br />SINK (SERVICE—BAR, ETC <br />FOR OFFICE USE ONLY: <br />FRONTSETBACN REARSET�ACN <br />USE ZONE <br />TYPE Of CON51. <br />SIZE OF BLDf. <br />OCCUPANCVLOAO <br />REASON <br />INTANE BY <br />TOTAL FEE $ <br />LOT AREA <br />NO. OF STORIES <br />FIRE SPRINKLERS REO'D <br />FIPE NAFM REO'D <br />PLANS /�PPROVED BY <br />DATE <br />GTY ZIP <br />GTV ZIP <br />CI7Y 21P <br />FEE <br />PNONE <br />CONTACT PEFSON AND PHONE NO. <br />�n �T�` "o �3 �8 <br />STATE LICENS � <br />3f i l5� <br />STRTE IICENSE R <br />I HEREBY CERTIFV "fHAT I HAVE READ AND EXAMINED THIS <br />APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />PROVISIONS OF LAWS APlD ORDINANCES GOVERNING iHIS TYPE OF <br />WOflK WILL BE COMPLETED WITH WHETHEF 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 />OTHEF STATE OR LOCAL LAW REGULATING CONST�UCTION OR TI�E <br />PERFORMANCE OF CONSTRUCTION. 7HAT I AM AUTHOR2ED BY THE <br />OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br />APPLICATION IS MADE AND 1 COMPLY WITH THE STATE <br />CONTRACTORS LAW 18.27 RCW AND 296.200 WAC. <br />x �i(fr.b'�i i���tEt�'N/ � � � �" 7 '� <br />SK'i URE � OAIE <br />urreusm[ss�kcnsEr�o <br />A/C—A/HNDLG UNITS—H.P. <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 />� METAL FIREPLACE <br />� FIREPUICE INSER' <br />� HEAT PUMP <br />; GAS PIPING <br />� EXHAUSTFAN <br />SIDE SEiBACK � PLAN CNELK NUMBER <br />VACANT SITE FEES <br />❑ YES ,�.' y0 BUILOING <br />acuvaxcr r�aorowm�xcuuns <br />�nouo pLUMBING <br />BASEMENT MECHFNICAL <br />❑ YES ❑ NO <br />HEIGMTLIMIiAT10N ADDITIONALPLANCHECK <br />OTHER <br />STATE BUILDING SURCHARGE <br />CITY OF EYERETT PUBLIC WORKS <br />LOCAL SALES <br />TAX CODE IS 3105 rorn� <br />SUB TOTAL $ <br />PERN�.T $ <br />TOTALi�� S <br />FEE <br />i <br />1 <br />� <br />