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APPLICAT14;d FOR CONSTRUCT :�: DN PERMIT eV11��� <br />TO BE COMPLETED IN INK—PLEASE PRINT � <br />ihr Fveryrcen <br />ciTv or <br />everett I HEATING SYSTEM:�GAS _ LECTRIC ❑ <br />BUILDING DEPARTMENT <br />259•8810 , <br />I DEMOLITION I I COMBINATION I I BUILDING I I MECHANICAL L I PLUMBING LI SIGN <br />pWNGfi � M�ILAD�RE55 CIIY 21P PHONE <br />- - . ,,. . . � _ ., ,,. ., _i. i_ . _ i-_ . _ ,. _.N• �n n�--, �7G_ nt/l <br />IENAM <br />CITY <br />PIIONE <br />�IiC111IECT OR DESIGNEB MAIL �ODOESS CITV 21P PIIONE <br />GENER�LCON�R�CTOfI MAILA[lORE55 CITY ZIP PIIUNE LICENSE/ <br />� 61ECII�NICALCONTR�C70R MAILAD�RE55 CITY ZIP PIIONE LICENSEI <br />s �r� ��� <br />a PWMBINGCONTR4CT011 M�ILADDOESS CITY IIP P��ONE IICENSE■ <br />' CLASSOFWORN <br />� � I NEW I I ADDITION ! I AL7ERATION I I REPAIR I I DEMOLITION �WOODSTOVE/FRPL INSERT I_l BUILDINCa RELOCATION <br />. CONTACT PEA50; ANO P/qNE NO. n � 1^ <br />ioT <br />PRICE OF WURK <br />VORN �NO SIXI�RE <br />rr,oreerv �si rowtr oeiow on ni rncu rom� cor�e:.� <br />ni,xK or --__ <br />1 <br />i <br />� PR0.IECTADD E55 , <br />� � /� ��{.- : <br />PLUMBING <br />�[ NO. TYPE OF flXTURE OR ITEM FEE <br />i WATER CLOSET (TOILET) _ <br />k BATHTUB __ <br />� LAVATORY (WASH BASIN) <br />+ SHOWER <br />� KITCHEN SINK 8 DISP <br />- DISHWASHER <br />LAUNDRYTRAY <br />' CLOTNES WASHER <br />URINAL <br />. DRINKING FOUNTAIN <br />FLOOH OR�IN <br />� BACKFLOW PREVENTERS <br />, ROOF DRAINS—RAINLEADERS <br />SINK ISERVICE—BAR, ETC.) <br />FOR OFFICE USE ONLY: <br />Ff10Ni5ETBACK REARSETAAGK <br />USE ZONE <br />IYPf 0/LOIIIS PlLO� <br />54E O� BLDG. <br />OCCUPANCYLO�O <br />Il[�SON FOR SPRI <br />INt�RC OV <br />SUB TOTAL <br />PERMIT <br />TOTALFEE <br />7YPE Of CONSI. �CIUAI <br />PLANS APPROVED OY <br />SE70�CK <br />VACANT SILE <br />33 �- .�i �/j �, <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br />APPIICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />PflOVISIONS OF IAWS AND ORDINANCES COVERNING THIS TYPE OF <br />WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br />NOT. THE GRANTING OF A PERMIT DOES NOT PRESU1.tE TO GIVE <br />AUTHOflITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br />OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br />PEFlFORMANCE OF CONSTRUCTION. THAT I AM AUTHOHIZED BY THE <br />OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH <br />APPLICATION IS MADE AND I COMPL� WITH THE STATE <br />CONTRACTORS LAW 18.27 RCW AND 296.?^.J WAC. <br />S�GNATUREOFCONiRACTOROR�UiHORIZED�OEP.f DATE <br />i����//�� �� / /r � /L� / <br />ff� f-� <br />APPIICANTS CIIY PUS�NESS UCENSE NO. �ND BUSINESS NAME <br />TYPE OF EOUIPMENT <br />FORCED AIR SYSTEMS—B.T.U. M E.A. <br />UNIT HEATERS—D.T.U. M <br />CLOTHES DRYERS <br />RANGEHOGD <br />WATER NEATEF <br />WOOD STOVE <br />METAL FIREPLnCE & <br />FIREPLACE INSER! <br />HEAT PUMP <br />GAS PIPWG <br />EXHAUSTFAN <br />Pl1WCNFLHNUlAOEB � FEE <br />BUILDING <br />aNr�xtt xnOrnMIUMGIMtS <br />cnwr p�UMBING <br />o�SEraer�t MECHANICAL <br />I�EIG4rtUr.11tAUON ADDITIONALPLANCNECK <br />_ OTHER <br />STATE BUILDING SURCHq(iGE <br />CITY OF EYERETT PUBLIC WOAKS <br />LOCALSALES <br />TAX CODE IS 3105 TOTAL <br />SUB TOTAL $ <br />PERMIT S <br />TOTALFEE $ <br />