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APPLICATIC � l FOR CONSTRUCT' lN PERMIT � <br />TO BE COMPLETED IN BLACK INK—PLEASE PRINT <br />BUILDING DEPAATMENT CHEATING SYSTEM: AS J ELECTRIC U <br />259•6810 <br />❑ DEMOLITION I_� COMBINATION i� BUILDING �IIIECHANICAL ❑ PLUMBING ❑ SIGN <br />O R MAIL ADORESS CITV ZIP PMONE <br />V Gt -� v S�c� S�. -�c� ��,:50n f�(1-r �cJ � C c�c�'t� l �n� 1- 7S� C� <br />TENANT �'ADDPESS dTV ZIP PMONE <br />ARCNITECT <br />GEN[R4L WNTRACTOR <br />MAIL ADDRES$ <br />MRIL ADDRE55 <br />� .. �_ <br />CONiP�CT PRIGE OF WORK <br />'-t"7S:� <br />DESCRIBE WORN AND SOURRE F(bTpGE INVq.VEO <br />� �` . � �i� i <br />(�Jt� l L ��� � <br />PROPOSED USE OF BUILDING c <br />C�J� � <br />LEGRL DLSCRIPTION OF PROFERTY (SMOWN BEL01Y OR ARAGM TWO COPIES) <br />LOT BLOCK OF — <br />PARCELTAXID.NUMBER � <br />CONSTRUGTION LORN LENOER. <br />PLUMBING — <br />O. TYPE Of <br />WATER CLOSET <br />BATHTUB <br />- -r �uz <br />TEIEPMONE NUMBER <br />KITCHEN SINK 8 DISP <br />DISHWASHER <br />LAUNDRYTRAY <br />CI.OTHES WASHER <br />URINAL <br />DRINKING FOUNTAIN <br />FLOOR DRAIN <br />BACKFLOW PREVENTERS <br />ROOF ORAINS—PAINLEAC <br />SINK (SERVICE—BAR, ETC <br />CITY 2iP <br />CITV 21P <br />GTV ZIP <br />� G-�nn qCt�Ce -' <br />cm ziP <br />CONTqpT PERSON AND PNONE NO. <br />� r— <br />FEE <br />0 <br />TOTAL FEE $ I . <br />FOR OFFICE USE ONLY: <br />FRONTSETBACK FEARSETBACK <br />USEZONE LOT AR[A <br />TVPE Of CONST NO. OF STOFIES <br />52@ OF B�OG. FIRE SPRINKLLRS REO'D <br />DCCUPANCY LOAD � FIRE ALARM REOU <br />REASON <br />MTAKEBY � PLANSAPPPOVEDOY <br />onTe <br />PNONE <br />PNONE STATE UCENSE t <br />PHONE STATE LICENSE � <br />7����1� SNann <br />PHONE STATE LICENSE � <br />V.,.�- �%"7C'_ "7 <br />I HEREBV CERTIFY THAT I{IAVE READ AND EXAMINED THIS <br />APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />PROVISIONS OF LAWS AND ORDINANCES 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 GIVE <br />AUTHORITY TO VIOLATE OR CANCEL THE PROVISION� uF ANY <br />OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTIOI, OR THE <br />PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br />OWNF.R OF THIS PROPERTV TO PERFORM THE WORK FOR WHICH <br />APPLICATION IS MADE AND I COMPI.Y WITH THE STATE <br />CONTRACTpRS LAW 18.27 RCW AND 296200 WAC. <br />� �E�-�l. c �, ���.3 <br />S�GNnLpRC � ?C� D9E <br />N0. � TYPE OF EOUIPMENT I FEE <br />A/G—A/HNDLG UNITS—H.P. <br />FORCED AIR SYSTEMS—B.T.U. M <br />UNIT HEATERS—B.T.U. M <br />CLOTHES DRYERS <br />VENTILATION FAN <br />RANGEHOOD <br />WATERIIEATER <br />WOOD STOVE <br />METAL FIREPLACE (WOOD BURNWC <br />FIFEPLACE INSERT <br />HEAT PUMP <br />GAS PIPING <br />EXHAUSTFAN <br />SIOE SETBACK p�AN CN[GN NUMpER FEE <br />�-i/ S/ / <br />VACANT SITE FEES <br />❑ YES f � NO BUILOING <br />acuP��ucr uooernvuur;cum�s <br />Gp�Or pLUMBING <br />BASEMENT MFCHANICAL <br />❑ YES ❑ NO <br />NEiGHT LIMiTqnoN ADDITIONAL PLAN CHECK <br />_ OTHER <br />STATE BUILDING SUf?CHARGE <br />CITY OF EYERETT ruouc wo�Ks <br />LOCAL SALES <br />TAX CODE IS 3105 TOTAL <br />SUB TOTAL <br />PERMIT <br />$ <br />