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APPLICATIOr: FOR CONSTRUCTC� N PERMIT � <br /> TO BE COMPLETED IN BLACK INK—PLEASE PRINT <br /> BUILDING DEPARTMENT HEATING SYSTEM: [�GAS ❑ELECTRIC ❑ <br /> 259-8810 <br /> C! DEMOLITION ❑ COMBINATION ❑ BUILDING i 7 MECHANICAL ❑ PLUMBING ❑ SIGN <br /> I OWNER MAILADDRE55 CITV ZIP PHONE <br /> �G ��iti!S �3Z3 oAKcs Afc c%�--� `��zol 252- �4�� <br /> TENANT MAILADORE55 CITY 21P PNONE <br /> `^�IriG �c "J �E��IC <br /> ARCMITECJORDESIGNER MAILAD�RESS CITY 21P PHONE <br /> hJ�� <br /> GENER LCONTRACTOR MAILADDRE55 CITY 21P PNONE STATELICENSEII �����s <br /> ���1Sc ce..lT�,lc7�vr2 �� B S 4j. 7& A�lr STE Zvl Ir14�N/[.�� 9�27� o7�z <br /> MEC�ICALCONTRAGTOR MAILAD�RESS GTY ZIP PHONE STATEUCENSE• <br /> �.� //' <br /> PLUM'BII CONTRACTOR MRIL ADDRESS CITV 21P PMONE STRTE LICENSE� <br /> N � - <br /> CUJ ACT P�RyIC�E OF WORK <br /> Vv� <br /> DESCRIBE WORN RN�SOUARE FOOTRGE INVOIVED CONiACT ��AND PN 1N�0. � , _ � � <br /> �� <br /> T��� df'-� �x+S7�ti''G �P � <br /> G �� • CJ I HEREBY CERTIFY THAT 1 HAVE READ AND EXAMINED THIS <br /> PROi'OSED USE OF BUILDING APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT.ALL <br /> —Q� {`S)/�SGC PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br /> LEGALDESCRIPTIONOFPPOPEPTV�SHOWNBELOWORATTACHTWOCOPIES� WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HEREIN OR <br /> NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE <br /> �oT e�°�K oF AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY <br /> OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE <br /> PERFORMANCE 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 COMPLV WITH THE STATE <br /> PARCEL TAX D.NUMBER _ �Q h/ CONTRACTORS LAW 18.27 RCW AND 96.200 WAC. <br /> S - ' - D � �- <br /> CONSTRUCTION LOPN LENDER.ADDRESS,TELEPMONE Nl1MBER � ` <br /> y� r-I� �. <br /> PROJECT�A`DDRESS ✓ sro""' e �rE <br /> ' `L3 C� ls C c `G l. CIiY SNESSL�CENSENO <br /> PLUMBING MECHANICAL <br /> NO. YYPE OF flXTURE OR ITEM FEE NO. TYPE OF E�UIPMENT FEE <br /> WATER CLOSET(TOILFT) � A/C—A/HNOLG UNITS—H.P. � <br /> BATHTUB ; FORCED AIR SYSTEMS—B.T.U. M E.A. ' <br /> LAVATORY(WASH BASIN) � UNIT HEATERS—B.T.U. M � <br /> SHOWER ' CLOTHES DRYERS ' <br /> KITCHEN SINK&DISP � VENTILATION FAN � <br /> DISHWASHER � RANGE HOOD ' <br /> LAUNDRY TRAY ; WATER HEATER ' <br /> CLOTHES WASHER � WOOD STOVE � <br /> URINAL ; METAL FIREPLACE(WOOD BURNING) ' <br /> DRINKING FOUNTAIN � FIREPLACE INSERT � � <br /> FLOOR DRAIN HEAT PUR1P ' <br /> BACKFLOW PREVENTEFiS ; GAS PIPING = _ <br /> ROOF DRAINS—RAINLEADERS � EXHAUST FAN ' <br /> SINK(SERVICE—BAR,ETC.) � � — <br /> � � <br /> � ; <br /> � ' <br /> SUB TOTAL $ ; SUB TOTAL $ ' <br /> PERMIT $ � PERMIT $ � <br /> TOTALFEE $ ' TOTALFEE $ <br /> FOR OFFICE USE ONLY: <br /> FRONTSETBACK REARSETBACK SIDESE78ACN PLANCHE Nl1MBE FEE RECEIPTNO. <br /> 7 7 <br /> USEZONE L�iAREA VACANTSITE FEES VALUATION FEE <br /> ❑ YES ❑ NO eui�oiNc �(� �'7 'Ov <br /> IVPEOFCONS7. Na-0FSTORIES acuv�xn xoovowFllMcuxi�s � <br /> cqIX1P pLUMBING <br /> --r— <br /> i <br /> SREOFBLDG. FIPESPRINNLERSREO'D BASEMENT MECHANICAL � <br /> ❑ YES ❑ NG � <br /> OCCUPANCY LOAO FIRE ALARM REO'D HEIGH?LIMITAI I01r ADDITIONAL PLAN CHECK � <br /> OTHER <br /> flEA50N ' <br /> . <br /> STATE BUILDING SURCHARGE � <br /> INTAKE BY PLANSAPPROVEDBY CITY OF EYEflETT PUOLIC WORKS � �� <br /> LOCAL SALES ?/ � � <br /> cATE 7AX CODE IS 3105 TOTAL <br />