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APPLICATIQ�I FOR CONSTRUCT'-1N PERMIT � <br /> TO BE COMPLETED IN BLACK INK—PLEASE PRINT <br /> BUILDING DEPARTMENT �� � I HEATING SYSTEM: ❑GAS ❑ELECTRIC ❑ <br /> 259-8810 <br /> f 7 DEMOLITION I_i COMBINATION }�' BUILDING I ] MECHANICAL Cl PLUMBING ❑ SIGN <br /> �OW ER MAILADDRESS CITV ZIP PHONE <br /> �✓ ����f 2�27 �'�iS %�ir 1//F�s� �c�l�(ll .9-S 9-�//J-�� <br /> 7ENANT MAIL A�DRE55 dTV ZIP PHONE <br /> ARGHITECTORDESIGNEP hIAILADORESS CITY ZIP PNONE <br /> GENERFLCONTRACTOR MAILADDFESS CITV ZIP PHONE STATELICENSEs <br /> .Le�sr-r :�:/.��i�� ��� '//%-l5 ���1 Si: �i�rr�� yl'fi/-� 33`l-Gi/'? /al�tF��2y�./. � <br /> MECHANICALCONTRACi��MAILADDRE55 CITY ZIP PHONE STATELICENSE� <br /> PLUMBING CONTRACTOR MAIL AODRESS CITY 21P PMONE STATE UGENSE 1 <br /> CONTRAGT PRICE OF ORK <br /> �'� _ �, , <br /> DESCRI EWOFiKAND OUAR FOOTAGEI�} OLVED � CONTACTPERSONANOPNONENO. <br /> -J^V)U��/�Vr`SiC1C/rf.2 �MOi�LQ�� C! <br /> �i P �� ) / .�.1 <br /> I HEREBY CERTIFY THAT I HAVE READ AND E%AMINED THIS <br /> PFOPOSED USE OF BUILDING � APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT.ALL <br /> / <br /> � /in i I ✓ ��/ PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF <br /> LEGALDESCRIPTIOD�OFPROPERTY� HOWNBELOWORATTACHTWOCOPIES) WORK WILL BE COMPLETED WITH WHETHER SPEGFIED HEREIN OR <br /> ' NOT. THE GRAIJTING OF A PERMIT DOES NOT PRESUM�: TO GIVE <br /> �1 r y�s �� �(22c/ <br /> �or� e�ocK oF AUTHORITY TO VIOLATE OR CANCEL THE PROV�SION:' OF ANY <br /> OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTIO�'OR THE <br /> PERFORMANCE OF CONSTRUCTION.THAT I AM AUTHORIZEf)BY THE <br /> OWNER OF THIS PROPERTY TO PERFORM iHE WORK FCFi WHICH <br /> APPLICATION IS MAUE AND I COMPLY WITH T1iE STATE <br /> PARCE�TA%I D.NUMBER CONTRACTORS LAW 18.27 RCW��296200 WAC. <br /> LONSTRUCTIONLOANLEN�EF.A�URESS,TELEPHONENUMBER � � ��� <br /> , ,r� y <br /> PROJECT ADDRESS sww rune • o re <br /> crtr eusmEss uc[r�sc rw — <br /> PLUMBING MECMANICAL <br /> N0. TVPE OF FIXTURE OR ITEM ' FEE N0. TYPE OF EOUIPMENT FEE <br /> WATER CLOSET(TOILET) � NC—A/HNDLG 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 /> DIS�iWASHER � RANGE HOOD <br /> LAUNDRY TRAY WATER HEATER ' <br /> CLOTHES WASHER � W000 STOVE � <br /> URINAL ; METAL FIREPLACE(WOOD BURNING) ' <br /> DRINKING FOUNTAIN � FIFEPLACE INSERT � � <br /> FLOOR DRAIN HEAT PUMP <br /> BACKFLOW PRE'JENTERS ; GAS PIPING � <br /> ROOF DRAINS—RAINLEAOERS � EXHAUST FAN � <br /> SINK(SERVICE—BAR,ETC.) ; <br /> � � <br /> � <br /> I <br /> � � <br /> SUB TOTAL S ; SUB TOTAL $ ' <br /> PERMIT 5 PERMIT $ � <br /> TOTAL FEE $ TOTAL FEE $ ' <br /> FOR OFFICE USE ONLY: <br /> FRONi SETBACK REAR SETBACK SIDE SETBACN PLAN CNECK NUMBEF FEE RF.CEIPT N0. <br /> UfE ZONE LOT AFEA VACANT SITE FEES VALUATION FEE <br /> ❑ YES 'u NO BUILDING D ' � <br /> 7YFEOFLONSi. NOAFSTORIES Oc[uvqN[r HOOfV.vFluNcuHnS i <br /> taouo pLUMBING i <br /> SIZEOFBLDG. FIR'eSPRINK�ERSRE7D BRSEMENT MECHANICAL � <br /> �.7 YES C��. NO � <br /> OCCUPANCY LO�D FIRE ALARM REOD HEIGMT LIMITATION ADDITIONAL PLAN CHECK � <br /> i <br /> OTHER ' <br /> REASON -7 <br /> • STATE BUILOING SURCHARGE `� <br /> INTAKE BY PLANS APPROVED BY CITY OF EYERETT PUBLIC WORKS i <br /> LOCAL SALES � 7 � <br /> onre TAX CODE IS 3105 TOTAL ; `jG� <br />