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APPLICATIPN FOR CONSTRUCT�ON PERMIT � <br />TO BE �uMPLETED IN BLACK INK—PLEASE PRINT <br />BUILDING DEPARTMENT <br />259-8810 <br />❑ DEMOLiTION ❑ <br />OWNER MAI <br />MA0. ADDRE55 <br />HEATING SYSTEM: Q� GAS ❑ ELECTRIC ❑ 1 <br />❑ BUILDING <br />cm <br />R�MECHANICAL <br />ZIP PHONE <br />��� ZSZ� <br />ZIP PMONE <br />ARCHITECTORDESIGNER MAILADDRESS CITY ZIP PHONE <br />❑ PLUMBING ❑ SIGN <br />OENEHALCONTiiACTOR MAIL�DDRE55 CITY 21P PHONE STATEIICENSE� <br />MECMI�NICAI.CONTRACTON AUILADDflE55 CITV ZIp PHONE STATELICENSE� <br />F�r_ra��. � il- S'/� �tl i FfAi�E�s =t�'n�sr �}ftzo/ s-z 3//4� c�'1'i� 6S 5/2/ K� <br />PLUMBINUCONTRACTOA MAILA�DPE55 CITV ZIP PHONE STATELILENSE� <br />CCNTHACT PflICE OF WORK <br />N <br />DESCRIBE WORK AND SIXI�RE FOOTAGE INVOLVED � <br />6FF�LL c..,P�u— /�rs � <br />PHOPOSED USE OF BUILDINQ <br />LEOAL DESCRIPTMJH OF PROPERTY (SHONR! BELOW OR ATTACH 1W0 COPIES) <br />LOT BLOdC OF <br />PARCELTA%I.D.NUMBER <br />CONSTflUCT10N LOI�N LENDER. ADDRE55. TELEPMONE NlIMBEy <br />3�F// f- G �.v_S <br />PR ATO,IE�DDRESS <br />(4.Ii��4kA�et�a�ts U1�-[.J �. <br />PLUMBINO <br />NO. TYPE OF Fl%TURE OR ITEM FEE <br />WATER CLOSET (TOILE� <br />BATHTUB <br />LAVATORY (WASH BASIN) <br />SHOWER <br />KITCHEN SINK R DISP � <br />� DISHWASHER <br />LAUNDRYTRAY <br />CLOTHFS WASHER <br />URINAL <br />DRINKING FOUNTAIN <br />FLOOR DRAIN <br />BACKFLOW PREVENTERS <br />ROOF DRAINS—RAINLEADERS <br />SINK (SERVICE—BAR, ETC.) <br />SUB TGTAL $ <br />PERMIT $ <br />TOTAL FEE $ <br />FOR OFFICE USE ONLY: <br />FRONTSETBACK F1EAR: <br />TYPE OF CONST. <br />52EOFBLOG. <br />(kCUPANCY LOAD <br />RE�SON <br />INT�KE BV <br />NO.OF STOqIES <br />FIPE SPRINKLERS REO'D <br />FIRE �URM REO'0 <br />PL�NS APPROVEO BY <br />DRTE <br />SIDE SETBRCK <br />❑ YES ❑ NO <br />occuwHcr rroaa+Fwxcuxns <br />GPWP <br />BASEMENT <br />❑ YES ❑ NO <br />HEIGXT IIMITATION <br />CITY OF EYERETT <br />LOCAL SALES <br />TAX CODE IS 3105 <br />CONTRCT PERSON AND PHONE NO. <br />� HEREBY CERTIFY THAT I HAVE 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 PROVISIONS OF ANY <br />OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br />PERFORMANCE OF CONSTflUCTION. THAT I AM AUTHORIZED BY THE <br />OWNER OF TNIS PFiOPERTY TO PERFORM THE WORK FOR WHICH <br />APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />CONTRACTORS LAW 7827 RCW AN� ^.96200 WAC. <br />x �G�7_ � �s-Z—`�l3 <br />sa,u RE wre <br />MECMANICAL <br />A/C—AIFINDLG UNITS—H.P. <br />FORCED AIR SYSTEMS—B.T.U. M E.A. <br />CLOTHES CRYERS <br />VENTILATION FAN <br />RANGEHOOD <br />WATER HEATER <br />WOOD STOVE <br />METAL FIREPLACE � <br />FIREPLACE INSERT <br />HEAT PUMP <br />GAS PIPING <br />EXHAUSTFAN <br />BUILOING <br />PLUMBING <br />MECHANICAL <br />ADDITIONAL PLAN CHECK <br />OTHER <br />STATE BUILDING SURCtIARGE <br />PUBLIC WORKS <br />TOTAL <br />0 <br />PERMIT $ � �S � <br />TOTAL FEE $ ! <br />RECEIPT NO. <br />Mp <br />N <br />tly <br />N <br />