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APPLICATIQ ^' FOR CONSTRUCTf1N PERMIT � <br />TO BE COMPLETED IN BLACK INK—PLEASE PRINT <br />HEATING SYSTEM• ❑ GAS ❑ ELECTRIC ❑ <br />BUILDING DEPARTMENT � <br />259-8810 <br />:_ I DEMOLITION I 1 COMBINATION C! BUILPING <br />��8 IAIL ADDRES CIiY <br />��jf�ZlCll4� �2C(SS(-)L� %(eLL �in`� 5T <br />ARCMITECT OR <br />1 IcDc <br />MECNANICAL <br />PLUMBING CONTRACiOq <br />MAIL pDDRE55 <br />MAIL AODRESS <br />MAIL ADORESS <br />MAIL AUOPESS <br />CIiY <br />CITV <br />! 7 MECHANICAL <br />ZIP PNONE <br />vc�t�T �:;I' <br />21P PNONE <br />21P PHONE <br />I I PLUMBING <br />,2> �-�i�i�3 <br />SIGN <br />� CITY ZIP PHONE STATE UCENSE t <br />Z f'D I9% C�`i� �r1i(�3a� �� OtTKX�y%,L 99��� G �r--Gi>7 /l�rL�L�SC/�o•' <br />CITY 21P PHONE STATE UCENSE k <br />CONTPAGT PRIGE OF WORK <br />��lQZ`7• OD <br />]ESCRIBF� WORK AND SOl1ARE FOOTAGE INVOLVEO <br />CITV ZIP PHONE STATELILENSE� <br />' �i.� : u��'9 � s;��,ry. 7-rr7,atio,� (Jooas <br />PROPOSED USE OF BUILDING <br />LEG�L DESCRIPTION OF PROPFRTY �SHOWN BELOW OR FTTACH TWO COPIESI <br />LOi BLOCN O <br />A t <br />PARC�LTA%ID.NUMBER <br />LONS RUCTION LOAN IENDER. AODRESS. TELEPHONE NUb <br />PROJECT ADDRESS <br />/� a.z ,2.4irvrc.� s <br />PLUMBING <br />NO. TYPE OF FD(TURE OR ITEM <br />WATER CLOSET�TOILET) <br />BATHTUB <br />LAVATORY�WASH BASM) <br />SHOWER <br />KITCHEN SINK 8 D�SP <br />DISHWASHER <br />LAUNDRYTRAY <br />CLOTHES WASHEF <br />URINAL <br />DRINKING FOUNTAIN <br />FLOOR ORAIN <br />BACKFLOW PREVENTERS <br />ROOF DRAINS—RAINLEADERS <br />SINK ISERVICE—BAR. ETC.1 <br />SUB TOTAL 5 <br />PERMIT 5 <br />TOTAL FEE 5 : <br />FOR OFFlCE USE ONLY: <br />FFONTSETEI�CN REMSETOACN <br />USEZONE LOTAREA <br />7VPE OF �ONSi. NO OF STORIES <br />52E OF BLDG. fIRE SPRINKLERS REO'D <br />FIRG ALARM REOD <br />REASON <br />INTANE DV PLANS �PPROVED BV <br />oarE <br />CONTACT PEFSON AND PHONE N0. <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 WIT4 WHETHER SPECIFI�D HEREIN OR <br />NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br />AUTHORITY TO VIOLATE OR CANCEL TFIE PROVISIONS OF ANV <br />OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br />PERFORA7ANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br />OWNER OF THIS PROPERTY TO PERFOFM THE WORK FOR WHICH <br />APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />�RACTQ�iS LA 18.27 RCW AND 296.200 WAC. <br />�� <br />it/�U �-/ %� <br />S�GN� G OeIE <br />CIiYpU9NC55LICENSf 4C <br />TYPE OF E�UIPMENT FEE <br />A/C—AIHNDLG UNITS—H.P. <br />FORCED A�R SYSTEMS—B.T.U. M E.A. <br />UNITHEATERS—B.TU. M <br />CLOTHES DRYERS <br />VENTILATION FAN <br />RANGEHOOD <br />WATER HEATER <br />WOOD STOVE <br />METAL FIREPLACE (WOOD BURNING) <br />FIREPLACE INSERT <br />HEAT PUMP <br />GAS PIPING <br />EXHAUSTFAN <br />PERMIT 5 <br />TOTAL FEE 5 <br />PLAN CHECK NUMB[R � FEE � RECEIPT NO. <br />VACANT SITE FEES <br />❑ VES .� NO BUILDING <br />OCCUVANCY NO 0'MIRUNGUNIi$ <br />caour pLUMBING <br />BASEMENr MECHANICAL <br />G YES i NO <br />HEIGMTLIMIT�TION ADDITIONALPLANCHECK <br />OTHER <br />STATE BUILDING SUFiCHARGE <br />CITY OF EUERETT PUBLIC WORKS <br />LOCAL SALES <br />TAX CODEIS 3105 rora� <br />N <br />� <br />�y <br />9 <br />