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APPLICATION FOR CONSTRUCTION PERNAIT � <br /> TO BE COMPLETED IN BLACK INK—PLEASE PRINT <br /> HEATING SYSTEM: �,J GAS �GLECTRIC ❑ —I <br /> BUILDING DEPARTM�NT <br /> 259-8810 <br /> ; '. DEMOLITION L] COMBINATION )( BUILDING i-1 MECHANICAL �PLUMBING �I SIGN <br /> 01YNER MFILA��RESS CITV 21P PHONG <br /> 1as�.��JFNNr^rr� o;To 3z8 r�auPlst��c £�txF�- YYav3 �si—yS� <br /> TEN-4� MAILADDRE95 CITV ZIP PHpNE fl <br /> �b <br /> � � <br /> ARCNIiECi OR DESIGNER MAIL ADDRESS GITY ZIP PHONE� <br /> 1�F5/6.t,� L-I�c'S /9/5 M�D isa�v JT £tst72EYT `JY�J 3 � aS.�l <br /> , GEN�FR`A,LLCON��LTOFja�'MAILADDRE55 -- CITY 21P PH STATELICENSEs <br /> � <br /> 61ECMANICAL CONTRACTOR MAIL 6�DRE55 CITY P (�� PH NE STATE LICENSE a <br /> U <br /> PLIItABINGCONTRACiOR MAILADDRE55 ��TY PMONE STATELICEYSEY <br /> CONTRFCT PRICE OF WORK � <br /> DESCRIBE WOP R�Jp 50 TAGE INVOIVED TAGT P RSON AND NE NO. <br /> � � ',L�t7'TL� C� I i7J <br /> ADDlTloN 2F OFF/CE CkTN LIV/NG QCo�� T'O $C(�� J.Sry' �/SO 'J <br /> £KrST+"'G /1rZr4F,vice, SI.3 • �E� HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br /> PROPOSEUUSEOFOWLUING APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT.ALL <br /> L IV(,v 4 i?4C — PROVISIONS OF LAWS AND ORD�NANCES GOVERNING THIS TYPE OF <br /> LEGr1LDE5CRIPTIONOFPPOPERiY�S��OWNOELOWORATTACNTWOCOPIES� WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br /> NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br /> �oT � e�ocK oF AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br /> �/� t ar /11 OGE i4-' �l D i V a OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTIOPI OR THE <br /> — PERFORD.fANCE OF CONSTRUCTION.THAT I AM AUTHORIZED BY THE <br /> OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br /> APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> PAFCEL TAX I.D.NUM6ER CONTRACTORS LAW 18.27 RCW AND 296200 WAC. <br /> (pp (oe(— O �O — DO 'J— 000$ <br /> � CONSTRUCTIONLOANLENDER,AD�RESS,TELEPHONENUMBER / <br /> y�� (��°�r/�f' <br /> PROJECT ADDRESS sim++une o�e <br /> j21f PA�t�e VC/�CE fVr71t-� / W✓� crtreuswessucrr+scNo <br /> PLUMBING MECHANICAL <br /> NO. TYPE OP FIXTURE OR ITEM FEE NO. TYPE OF EOUIPMENT FEE <br /> � WATER CLOSET(TOILFT) � A/C—NHNDIG UNITS—H.P. I <br /> BATHTUB ; FORCED AIR SYSTEMS—B.T.U. M E.A. � � <br /> LAVATORV(WASH BASIN) � UNIT HEATERS—B.T.U. M ; <br /> T <br /> SHOWER CLOTHES DRYERS � <br /> KITCHEN SINK&DISP VENTILATION FAN ; <br /> DISHWASHER � RANGE HOUD � <br /> LAUNDRY TRAY WATER HEATER <br /> CLOTHES WASHER � WOOD STOVE <br /> URINAL ; METAL FIREPLACE(WOOD BURNING) � <br /> DRINKING FOUNTAIN � FIAEPLACE INSEFT <br /> FLOOR DRAIN � HEAT PUMP <br /> BACKFLOW PREVENTERS � GAS PIPING ; <br /> ROOF DRAINS--RAINLEADEFS � EXHAUST FAN � <br /> SINK(SERVICE—BAR,ETC.) � ' <br /> / � <br /> � � <br /> � � <br /> SUBTOTAL $ ; SUBTOTAL $ / ' ' <br /> PERMIT $ PERMIT $ <br /> TOTAL FEE 5 ' TOTAL FEE 5 � <br /> FOR OFFICE USE ONLV: <br /> FRONiSET�RCN REAR65T9ACK , S�DESEiBACK PLANCNEC NUMBF.q F"rE REGEIPTNO. <br /> Zv / Zp � � 3i�lo �S��9S ��75 <br /> USEZONE LOTAREA VACANTSITE FEES VALUATION FEE <br /> �,� d .7 YES ❑ NO BUILDING `3 � 2 i��� <br /> 7VFE Oi CONSi NO.OF STORIES ao�raN[r im o�mv[u'Nc uNrtS d- <br /> �°p1° PLUMBING ' <br /> SIZEOFBIDG FIRESPRINKLERSREO'D BASEMENT MECHANICAL <br /> � 0 p ❑ YES ❑ NO — <br /> OCCUPANCV OAD FIRE ALARM REO'D NEIGNT LIMITAT`G.`I AODITIONAL PLAN CHECK i <br /> �� Z � ' <br /> OTHER ' <br /> REASON 0 <br /> STATE BUILDING SURCHA�GE � <br /> INTPKE PY PIANS AP R VEDUY CITY OF EYERETT PUOLIC WORKS i <br /> LOCALSALES <br /> on.e � � n� TAX CODE IS 3705 Tora� � ; �� <br />