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APPLICATI�'�'7 FOIf� CONSTRUCT`�N PERMIT � <br />/�'�/ TO BE COMPLETED IN BLACK INK—PLEASE PRINT <br />1 <br />BUILDING DEPARTMENT HEATING SYSTEM: �GAS ❑ ELECTRIC O <br />259-8810 <br />f J DEMOLITION C I COMBINATION I 1 BUILDING ECHANICAL 1_i PLUMBING � i SIGN <br />ONRiER � �MAIL�DC��E55 + qI1V 21P PIIONE <br />��p�ry cviL���HnS ►�zS2R�N�f� A�� ZgU�R£T1--P ZSL olof� <br />ARCMITECTORDESIGNEN MRILADDRE55 CITV ZIP PHONE <br />OENERALCONTRACTOR MAIL�DDRESS CITV ZIP PHONE STATE�IOEry$E� <br />MECH�NIC/�I.CONTRACTOR �� �IMIL DORESS <br />PLUMBIN���-+ca� IAIA���R� <br />CUSS OF WqiK <br />I 1 NEW [ I ADDITION I�LTERF <br />CONTRACTPRICEOFNVIM( �/V(� <br />DESCRIBE WqIK AND SOUARE FOOTAGE INVOLVED <br />G�s CuQ.�I. �� <br />PROPOSEO USE OF BUILDING <br />LEGAL DESCRIPTION OF PROPERTV �SHOVIN BELON <br />LOT BLOCK OG <br />� <br />WATER CLOSET <br />F SHOWER <br />� NITCHEN SINK 6 DISP <br />w DISHWASHER <br />� LAUNDRYTRAY <br />DRINKINa FOUNTAIN <br />FLOOR DRAIN <br />+ BACKFLOW PREVENTERS <br />ROOF ORAINS--RAINLEADERS <br />FOR OFFICE USE ONLY: <br />F110NT SETBACK RE�R SETEACK <br />USE ZONE <br />� 1VPEOFCONTS.uIOWI�BLE <br />� SIZE OF BlD(3. <br />OCCUPANCVLOAD <br />REASON FOR SPflINKLERS <br />INTAI(E BY <br />LOTAREA <br />cin <br />ZIP PHONE <br />�lyp'!�,/yi 1/�ctf � 4�o7Z <br />ZIP PNONE . <br />� <br />LICENSE • <br />LICENSE • <br />I i REPAIR I I DEMOLIT�ON I i WOODSTOVBFRPL INSERT I 1 BUILDING RELOCATION <br />CONTACT PERSjIy AND PHONE NO. <br />SUB TOTAL 3 <br />PERMIT S <br />TOTALFEE S <br />SIDE SETBACN <br />VACANT SITE <br />NO.OF STORIES <br />FIRE SPRNICLERS REO'D <br />PIANS APPROVED BV <br />t 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 TVPE OF <br />WORK �VILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br />NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br />AUTHORITY TO VIOLATE OR CANCEI THE PROVISIONS OF ANY <br />OTHER STATE QR LOCAL LAW REGULATING CONSTRUCTION OR THE <br />PERFORMANCE OF CONSTRUCTION. THAT 1 AM AUTHORIZED BY THE <br />OWNER OF TH�S PROPERTY TO PERFORM THE WORK FOR WHICH <br />APPLICATION I� MADE AND I COMPLY WITH THE STATE <br />CONTRACTORS LAW 7827 RCW AND 296.200 WAC. <br />X �,GL��,F %�5��' 3 <br />SIGH TUflE _ _ �iE <br />A/C—A/HNDLG UNITS—H.P. <br />r'ORCED AIR SYSTEMS—B.T.U. E.A. <br />UNIT HEATERS—B.T.U. M <br />CLOTHES DFYERS <br />VENTILATION FAN <br />RANGEHOOD <br />WATER HEATER <br />WOOD STOVE <br />METAL FIREPLACE 8 CHIMNEY <br />FIREPLACE INSERT <br />HEAT PUMP <br />GAS PIPING <br />EXHAUST FAN <br />PWI CHECN NUMBER <br />BUILDING <br />OLLUMHtv NO Of UVE0.iNG IIM�iS <br />cnouv ' pLUMBING <br />BASEMENT MECHANICAL <br />HEIGMT LIMITATION ADDITIONAL PUN CHECK <br />SPRINKLER <br />STATE BUILDING SURCHARGE <br />CITY OF EYERETT PUBLIC WORKS <br />LOCAL SALES <br />TAX CODE IS 9105 TOTAL <br />u <br />�u <br />tl <br />